On Leadership

Louisiana medicine is fertile breeding ground for the American Medical Association, a 161-year-old organization dedicated to the art and science of medicine. In the last 12 years, both Dr. Daniel “Stormy” Johnson and Dr. Donald J. Palmisano skyrocketed from leadership positions in the Louisiana State Medical Society to become AMA presidents.
Palmisano tells what makes him tick in the newly published book On Leadership – Essential Principles for Success. At Southern high schools “leadership” is too often a code word describing football players who weren’t all that sharp with the books. But don’t let the Dale Carnegie-sounding title turn you off. It is a spellbinding read to be enjoyed by the general public as well as members of the medical profession.
The jacket blurbs by, among others, a former U.S. Senate Majority Leader and the 2007 King of Carnival (both physicians themselves), are an instant tease for the reader. Former Senator and physician Bill Frist quips that “the book is an invaluable tool to improve a management style or inspire others” while Dr. Ronald French dubs the book a “magnificent outpouring of the truths learned by the careful observations of a questioning mind.”
Palmisano was born in the old Mercy Hospital on Annunciation Street and lived his early years above his grandparents’ Caronna’s Restaurant and Bar at 2032 Magazine St. His mother was born on the same block. Beginning as a motorcycle patrolman, his father rose through NOPD ranks.
Palmisano’s anecdotes cover his youth, medical school training, military service, surgical practice, medical politics on the national level and everything that happened along the way. The book is punctuated with what he terms “pithy quotes” from prolific reading that has fueled his life.
Earlier in his career Palmisano shook dust out of his brain by flying out of Lakefront Airport in a T-34 military trainer. He flew acrobatics including snap rolls and chandelles over Eastern New Orleans, patterned after the antics of pet flying squirrels he had caught in his youth. As a gadgeteer par excellence, he was the first physician I know who adapted computers into his daily life. An award-winning photographer, he always has his camera. I have never seen him without one.
The book is worth its cover price if only for its bevy of quotations, including Dante and former New Orleans Mayor Victor Schiro. As with other physicians with military background, Palmisano is quick to quote great generals such as George Patton on how essential it is for a leader to be decisive, a trait he deemed to be in short supply after Hurricane Katrina on the local, state and national levels.
“In any moment of decision, the best thing you can do is the right thing, the next best thing is the wrong thing and the worst thing you can do is nothing,” is a quote in the book from former President Theodore Roosevelt. Palmisano identifies “fear of being blamed for a bad outcome” as the root cause of an inability to make a decision. As we saw after Katrina, indecisiveness cost lives and promoted disorder. The lesson is that indecision and delays beget failure.
The art of communication rates an entire chapter, and Palmisano emerges as a proponent of the active voice in the written word, rare among physicians. The Times-Picayune reporter John Pope has remarked to me many times that the medical profession seems addicted to the passive voice in writing. Palmisano tells how to deal with the press, an activity that sends chills down the spines of many physicians. My favorite of his hints is the well known “rule of three” – have three things that you want to get across and always work one of these three points into the response to any question.  
He recounts Tulane surgeon Dr. Oscar Creech saying that after two nights in the library, a student knows more than 90 percent of the people in the world on a topic but that knowledge doesn’t equate with experience. The lesson: Do your homework.
When he was an Air Force surgeon, Palmisano wanted some advice on a  deteriorating patient so he called Dr. Alton Ochsner Sr., only to be told he wasn’t available. Palmisano called back and had the operator page Ochsner. He answered, listened to the scenario and told Palmisano to hang up and operate immediately. The patient lived. The lesson: Persistence pays, but don’t be afraid to change course and continue on.
His chapter on interpersonal relations describes a three-pronged approach to improve communications on any level – parent and child, spouse and spouse, and friend and business relationships of any sort. First, listen with full attention. Second, express understanding of the problem as expressed by the other party. Third, ask this question: “What can I do to help?” The lesson: Being an active listener is important.
A former professor of medicine at Tulane said, “Surgeons use statistics like a drunk uses a lamppost – more for support than illumination.” This isn’t true for Palmisano, who gives an excellent insight into how even peer-reviewed medical publications can be more opinion than fact. He teases the reader with such phrases as “inappropriate comparisons,” “improper sampling,” “lack of randomness of sample” and “the difference between relative and absolute risk reduction.” His enthusiasm for statistics took me online to order an updated text on the topic.  
Palmisano shares how he became very discouraged during his first year of medical school. His father encouraged him to continue. “Do your homework, have courage – and don’t give up.” We talked about this at length a couple of years ago because I had the same feelings and for the same reason. We had both always studied independently and by ourselves. Yet an important part of that first year of medical school is learning from your classmates and working with them. We both discovered this during medical school in different ways.  
The easy route for physicians on a medical school faculty is to let the “basic science guys” run everything from the admissions committee to the anatomy course. Shame on the lazy medical school faculty who bestow three hats on a single non-physician colleague to avoid the scut work involved with medical school admissions, anatomy course teaching and directing student affairs.
While not written as a textbook, Palmisano’s book should be incorporated into the curriculum for medical schools. From the basic science professor’s standpoint, it’s easier to force students to memorize a chock-a-block of trivial facts, measured by computer-graded multiple choice questions. Doing so damages two factors important to the art of medicine – individual thinking and creativity.
For more information on Palmisano’s book, check the Web site at www.onleadership.us. Excerpts from On Leadership
Essential Principles for Success by Donald Palmisano

“In 1967 and 1968 I was chief resident of surgery at Tulane and on a rotation to a charity hospital outside of New Orleans. I noticed the hospital’s lack of an external defibrillator. I asked the hospital administrator to buy one. He refused…and said he planned to use the money to buy a photocopier. A couple of months later the administrator clutched his chest and fell to the floor [while Palmisano along with a visiting professor, other residents, and medical students were making rounds]. He was unresponsive. We immediately began cardiopulmonary resuscitation. He opened his eyes and looked at us. Because we had no external defibrillator, we had to carry him to the operating room, continuing resuscitation en route, open his chest, and attempt defibrillation with internal paddles directly to the heart. Unfortunately, he died.”

On Leadership – Essential Principles for Success by Donald J. Palmisano. September 2008, $16.95 Hardcover. Skyhorse Publishing New York (distributed by W.W. Norton), www.onleadership.us.

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