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It's such a pleasure to meet you all. Uh My name is Anita DEA. I'm a vascular surgeon at the Mass General Hospital in Boston, and an associate professor of Surgery at Harvard Medical School. Um It's really a pleasure. Uh I um have known Joseph for a little while and I was thrilled when he asked um if I could give this talk about leadership because, you know, all of us have suffered through many talks about leadership and it's kind of a, you know, soft topic, sort of wishy washy, you can really say anything and it, it, it doesn't really have any applicability. And so, um it's great to be able to actually give a talk, which I think is gonna be very practical and hopefully something that you can take uh something away from. So, um I am the um associate director of the wound care center here, Clinical Director of Research, um director of our uh limb evaluation and amputation prevention program, which is all about like advanced um vascular intervention so that you can try to save the patient's leg. Um And uh and I do a lot of teaching also, as I mentioned, with Harvard Medical School. So hopefully, you know, at once I get talking, I'll, I'll show you like having been in leadership positions and experienced what works, what doesn't work. A lot of this is also just what I feel um has been successful. I will give you this caveat though out the gate, this was successful in the United States. And I, that does matter because culture matters. And um even though we're talking about the UK versus the U and you know, you can draw a lot of parallels between the West and you know how we do things and how we talk and what we think culturally, there is a deep difference between the United States and the UK. And I'll bring that up and uh I don't bring that up to say that you should do things differently. I bring it up as a base point that wherever you are, the culture of the place is really important as to how you lead that place. Um So just a moment, I'm gonna share my screen. Tell me if you can see, can you guys see that? Yeah, we can see that. Perfect, lovely. All right. So this talk is all about how to be a strong kind and fair leader. And I put these three things up there because ultimately, if you wanna take away one statement, like what, what do you need to be to lead? You need to be strong kind and fair. If you can do these three things. You will be a good leader. Um, and some of them actually kind of go in opposition to each other, like you could say, well, how can you be strong? How can you be kind at the same time? Surely you have to be sometimes. Yes, but almost in a parental fashion where you would be unkind if you just looked at that, you know, kind of spot in time. But, um, overall you're doing the right thing for the, the, the group and we'll get into a little bit of that. Um, moving forward. So, first of all, I wanna kind of tell you, you know, what gives me the right to give you this talk in the first place. Who the hell am I? That I can even tell you what leadership is about. So I wanna give you a little bit about my story how I'm connected to the UK specifically. So, um, my parents, both of them are doctors and they both actually trained, um, um, in Aberdeen and I went to medical school at the University of Aberdeen as well up in Scotland. Um, loved it, you know, feel like the education was phenomenal. And, um, and then I actually did one year as an fy one. It was painful, painful, painful, I'm sure it's the same now and, and then, um, matched to general surgery in the United States. So the way it works here, of course, you do your five years of general surgery training and then whatever you're going into, I went into vascular. You do a fellowship in that usually for somewhere between 2 to 3 years, vascular was two years. So I did my, my mm medical education at the University of Aberdeen and then went to the Medical College of Wisconsin for general surgery training, got board certified in general surgery. Um, during that time, I did do a postdoctoral research fellowship in um Thrombosis and coagulation, which is the lab. I run here at Mass General and then went to Stanford for my vascular surgery training. And after that, in 2019, moved over to um uh Harvard and the Mass General to become a vascular surgeon here and I've been here ever since. So, um I do have deep roots in the UK. In fact, I mean, now I'm so old. I have spent more time in the US than the UK. But there was a time when I definitely had spent more time in the UK because I was actually born in the UK. So I'm a United Kingdom citizen and um you know, come back all the time, give a lot of talks there, have all my friends are there from school. So I really get to um understand what their journey has been compared to mine. And that's why the cultural difference does matter and I'll bring that up um uh in the future. So again, you know, I just wanna give you that background about me, but the original question was what makes me qualified to talk to you about leadership at all? Well, um, as I, you know, rattled off all those titles, director of this associate of that run on NIH Lab. That was not just, you know, to toot my own horn though. That is absolutely. Also what I'm doing again, a cultural difference. Um, in the States, it's all about that in the UK, you're perceived as arrogant and you can get shot down doing stuff like that. So, um I'll keep highlighting this throughout because it's something that I want in your mind in your consciousness when you're leading. The first question needs to be, what's the culture of this place? What am I walking into because you can't lead it if you don't understand it. So I've done a lot of things that are leadership type roles where I've had different people from different backgrounds, different levels. You know, sometimes it's a nurse practitioner, sometimes it's a resident, sometimes it's an attending that might be older than me that I've needed to lead. And, um what lessons are learned from that? Um There are really three big things currently that, you know, have kind of been culminations of my leadership or practices that are very different that I've learned from and um I put them up here. Um As far as mass General is concerned, as I said, I'm the leader of the limb evaluation and preservation program. Um, our program here and um, this program really focuses on um, taking patients that otherwise would be amputated and preventing them from being amputated. So, what does that entail? Well, I've got myself, you know, the vascular division, infectious disease, um, a number of nurses, a number of trainees, wound care. Um, the, in the emergency department, I mean, I don't have to sit here and list it off. My point is these are all different people with different needs and different motivations. Whether that be financial, whether that be taking care of the patient, whether that be literally conflict in terms of what they think is best for the patient and bringing all these people together to get them to save these patients legs. It's a task and, um, requires very different, um, kind of leadership styles depending on who I'm dealing with within the program. Then. Um, uh Healthcare for Action is actually, uh something I started a couple of years ago. Um, you guys don't have this problem in the UK, but we have a lot of shootings here. School shootings in the United States. You guys know that. And so one of the most horrific ones that happened in recent times was what we call the Uvalde school shooting where there was a guy who went into a, a school, an elementary school and was actually there for an hour and a half in the classroom with first graders and at the end, they were unable to negotiate with the guy and he ended up unleashing with an assault rifle in this classroom. All the kids died. I bring that up to say that that really launched me into wanting to take the lead politically to change some of the things that are going on in the States. And so I launched this group called Healthcare for Action that specifically works to get health care workers elected to office in the United States. Not because we're so much better than everyone else, but really because we work together, collaborate together to try to get the best for a patient, you replace patient with America. And in theory, you should be able to do the same thing on the floor. So that's what that organization does again, bringing together a variety of people with different political beliefs just because you're a Democrat or just because you're a Republican doesn't mean you think exactly the same. Um There are Democrats on my board who own guns. There are Democrats on the board who wouldn't, you know, go near a gun and, and it matters because you have to all work together to focus on getting congressional candidates forward. And uh a lot of the learnings that um I had about leadership ultimately ended with me being a presidential leadership scholar, which is a group that President Bush and President Clinton run. They actually personally um uh work together one's a Republican, one's a democrat over the last eight years, they've selected about 50 people per year from all different walks of life. So, certainly not just medicine and they actually cover all costs and bring you to their presidential libraries and they personally kind of walk you through how to um be a good leader. And I say them personally, I mean, they, they, of course, are present but a lot of people from their cabinet and um different leadership groups talking about how you get things done. And that's what leadership really is all about. How do you take the people around you who may be different, who may be thinking different, who have different skills, different motivations and align them with a particular vision that you have. But then actually get them to work. Why would anyone do anything for you? That's what leadership is kind of all about. And that's the journey I'm gonna take you on today, not telling you so much. You need to do this and you need to do that. It's all about really the mindset and that's what this talk is really gonna focus on. Another piece that you can't get away from, which is pretty obvious, hearing my voice and seeing my man reasons is that I'm a woman. And so I know that there are women on this call, obviously, there are men on this call and I want to bring out because again, this is about my journey what happened with me, this element of the female leadership style because they are different and anyone who tells you anything else is wrong. And it's not because women are different than men. That's not the, I mean, they are, but that's not the inherent purpose of, of saying that actually what it is is the reactions that you get being a female versus being a male by the general population, whether they are male or female is different and to bury your head in the sand and say that that's not true, hurts you and hurts the institution. So it's not that there's a different leadership style. It's that you need to understand the nuances um as a female specifically um about how you might be perceived and how that's gonna impact in terms of people listening to you. So I always put this quote up, you know, it's hard to be a female, it's hard to be a woman. I didn't come up with this. Um This is a quote um that you have to think like a man act like a lady look like a young girl and work like a horse. Obviously, it's a joke. I know I have to say that these days it is a joke, but you guys can kind of get the point. So that brings me to my first piece, the mindset when you are leading an institution. The first thing that you need to think is how am I going to approach this, what's my attitude gonna be? And how's that attitude gonna translate to people's behavior and that behavior then leading to action and ultimately success. And how do I understand the people around me, the institution around me and then be able to implement so that people wanna align with my vision? Well, the first thing I'll tell you and especially as a female, but definitely as a guy as well, you cannot confuse leadership with dominance. We have all been subjected and that's the word I'm gonna use, subjected to somebody who's been put in a leadership position who thinks that if they come and squash you, yell at you, push you. That is leadership. It is not leadership. That is something that invokes fear. And the 1st 2nd, ok, that the people that are being squashed, put down assaulted have to oust the leader. They will do it. They will only do things for you if you are being dominant because you're scaring them and there's, you're not gonna win their hearts and minds and you're gonna go right back to medieval times. The second that that leader, whoever that person is, is ousted a great example of this would be what happened in Afghanistan with the American invasion. You know, we, we got there. Um We couldn't win over hearts and minds over 20 years. Actually, you guys were with us, the Brits. We, we, we couldn't, we couldn't do it. And so at the end of the day, what happened literally within 24 hours when we walked out, everything went back to what it was not because people didn't want to change. Not because, but because we just couldn't make the base route change. And that means going in and dominating didn't work 20 years, 100s of lives, thousands of dollars. What happened? Nothing. So always remember that example. And this thing is gonna be peppered by the way with those types of examples so that they come into your mind when the day comes, when you are leading. So now I'm gonna give you a few rules. OK? I think it's five in total about how you can be a good leader. So number one, number one is truly, you have to be you, you literally cannot be anyone else. What do I mean by that? People say, oh come be your authentic self. That's a weird cliche thing. You can't do that. I mean my authentic self is basically sitting, you know, in my, my pajamas eating ice cream that's falling on me while my dog licks it off. That's my authentic self. Obviously, I cannot come to work like that. That's not what I mean. What I mean is there are certain personality characteristics that make you and there are gonna be people telling you I, I'll tell you this out the gate for me. You're too loud, you're too abrasive. You just, you know, you, you got a, you need talk less, listen, things that maybe you just can't do, talk my hands, put your hands down and you know, I can do that for the first day, for the first meeting, for the first week, maybe even the first month. But after that, I'm gonna break character because this is actually who I am. So if I don't embrace this element of me, display it to the people that I'm leading out, what's gonna happen is they're gonna think I'm not authentic. I am a liar. And in a month they're gonna say who is this person? That's shape shifting. So leadership is really important because out the gate, you need to be transparent about who you are as a person. What is your leadership style? And there are different leadership styles. Some are quiet from the back, some are kind of in the middle and some are from the front and you can actually evolve these styles and change them depending on what you're at. For example, if you are running a startup, ok. So you've got a new medical device, you wanna get onto the market. So you got this new start up and you're trying to get it out the gate. Actually, it's well established that when you have a startup culture where you have just a few people that you're trying to like really get things done and be kind of like scrappy and get out the gate. You want people who all kind of think alike and you want people that are all aligned behind the vision and are willing to just say yes, sir, yes, ma'am and do it. But when you get into bigger organizations where you're trying to just like keep the hum of the machine going, then you need to bring people in that will shake it up a little bit and tell you how to do things better so that you can stay with the times. And so you need different leaders in these two different things and the same person can do it. They just need to have a different style. So my point is at the end of the day, you need to embrace the things that make you you and you need to allow them to really become the fabric of your leadership style so that you can have a sustained coordinated action throughout your time as a leader that is perceived as authentic and perceived as transparent because people like genuine people, they like people, they can trust you never like imagine if you couldn't trust your dad or trust your mom, how weird family life would be. Well, really a leader is kind of in that role no matter how much part of the group, so to speak, you are at the end of the day, everything falls on you because you are the leader. So people need to be able to follow you. And we sometimes we need to just say, hey, you know, Samantha, I need you to go do this. Well, Samantha will do it if she believes that, hey, I trust this person, they know what they're talking about. They've showed me a sustained coordinated action that has been to my, you know, benefit over the past. I am willing to go execute this thing. I may not completely understand because I trust this human being. And so leadership comes from that and in order to gain the trust from people around you, you have to be transparent, genuine and authentic. OK? Now that leads into number two respect, earning the respect of those around you, but not as a dominant force. I can walk into my health care for action board meeting. Tell everyone, you know what, none of you guys are raising money. They're all terrible people. This is unacceptable. If you don't do this, I'm gonna do this. I can do that. But guess what? They're all gonna quit my board, right? I don't own them. And that's a mistake a lot of leaders will make. And it's understandable because at the end of the day, we are human beings. And so what happens is a leader is kind of the ele looking down at everything else, knows what all the pressures are, where all the concerns are. And so what can happen is when somebody comes in asking for something because they don't know the whole picture, the leader could snap demand, do these things that again, the, the dominant side comes out because it's easy because you have that power. You are the leader so you can say shut up, get out and the person will do it, but they'll do it because they're afraid of you. Not because they respect you. Right. Number one thing, I'll tell you, number one being rude will sign your death warrant. Now, don't misunderstand that being rude doesn't mean that, you know, if somebody walks in, like I said, if you say shut up and you say get out, that's obviously rude. But if you say something like listen, Samantha, I really can't speak right now because I'm, I'm just inundated with this stuff. How about we set a time for two weeks from today and I'll make sure that I can give you my undivided attention. I'm basically telling them the same thing, but one is rude and one is kind of firm right now. You may think, oh, that's obviously different. But actually you'd be amazed how, how frequently leaders sometimes will snap into just the like, oh Samantha will get it. Just tell her I'll see her later. But all she heard was you blew me off, you dismissed me. But if you do this secondary part that I said, hey, why don't we make a time for you? Two weeks from now? I'm giving you pause and I'm telling you this is when I will make space for you so we can talk and that immediately like even though I've gotten the same outcome, she's left and I'll deal with her later. She walks away, happy. She walks away, respecting me that I gave her that little bit of extra time being rude, like I said, will sign your death warrant because the minute that your your subordinates so to speak can rise up against you. They will, I've put on here men can, you can't, nobody should because that is in reference again, for my girls out there, my women out there sometimes and we all experience this. So if you're one of those people that's like that never happens. And that's not. Well, then you're just talking fake news. It absolutely does happen. I'm, I'm a surgeon in the operating room. I have seen, we've all witnessed a man raising his voice to the nurse, throwing something doing and some rarely, of course, women have done it as well. And the dis discrepancy in the blowback again, nobody should be flinging instruments and screaming. That's ridiculous. But what happens? Oh, he just had a bad day but she's not allowed to have any bad days. We all know this is a fact. So that's not right or wrong. That's just the way it is. The only way we can change that for your girls that are getting, you know, stimulated out there is we stay in academics, we get to the top, we become leaders and then we change the culture as I talked about earlier. But the point I'm making here is that sometimes as women or as junior men, we see our bosses, our, our, you know, 60 year old doctor, professor, whatever being an asshole, ok? And we're like, clearly this is the way we get things done. So tomorrow I'm gonna do that and then we go into the operating room and we're rude and guess what? It's 2024 nobody tolerates that shit anymore. So what ends up happening? You end up getting completely written off, not being able to get promoted and essentially being told you'll never lead anything because everyone hates you. So again, no matter how angry you are, everything, every move, no matter how tired, how angry, how stressed, how many reasons you have, you can never be rude. Every interaction with your subordinates must be respectful from both sides. Of course. And if you have someone who truly is not respecting you, then you need to fire them, not attack them because they are just not gonna work as part of your group and firing people is part of leadership. Getting rid of people who can't do what they're supposed to do to move the machine forward is a part of what you have to do. So that takes me to number three, the ideas of being the foresees. So the first thing you have to be as a leader, first thing is you must be competent if you get put into a leadership position where you don't know what the hell you're doing because you have not taken time to understand what the job is. You are going to be demolished. You may sit in those meetings and you may get pats on your head by, you know, whoever is above you, everyone's got a boss as we all know, but your own subordinates, your own team will know that you're not competent and will not respect you. A good example of this is actually in surgery where sometimes you do have people who are in leadership positions who can't operate or who and, and not because they weren't trained or they just because, you know, that's not what they do anymore. You know, they've, they've not seen the inside of an operating room forever, but they do the admin and they try to make the, the, the decisions, but without really understanding the atmosphere. Another example is when people can make it up the, the chains for reasons that are not because of their competence. Um Sometimes in the military, you know, somebody may go all the way up to like heavy hitter number, but they've never seen combat or they never, and I'm not saying that you have to be at the front lines all the time. Of course, you don't, you can't if you were at the front lines all the time or if I was, you know, constantly in the operating room and never able to do my administrative duties. I would be an incompetent leader but you do have to understand and have your finger on the pulse when it comes to what the job actually entails. So if you're the leader of operational um uh logistics in the, or you need to know why there's an operative delay, you need to understand what the patient journey is when they enter the, er, all the way to when they get to the operating room so that you can make the system better. And if you don't understand that everybody will know. It's like being, it's like standing naked, everybody will know and they will not respect you. So number one out the gate competence beyond that, you must be collaborative, you must be calculating and in my opinion, you must be a comic what I mean, collaborative, you absolutely have to work with other people. There is no leader on the planet that doesn't work with other people. Even Kim Jong Un and Putin have to work with other people to do whatever horrible things they're doing. Ok. You must, and what does that mean? It means that you should surround yourself with people who are better than you in certain elements. If I am the operations again, director of the operating room, I wanna bring turn over time down. So the time between cases I wanna bring that down because we're wasting time between cases. Guess what? I need a nurse lead who really understands why because the nurses are part of turning over the, the system. I'm not a nurse, I'm not gonna be part of that tribe, but I need somebody who understands and who I can work with, who respects me and I respect them at the end of the day. It's my call, right? Collaboration does not mean equal. It doesn't mean when, you know, the nurse decides that he wants to do things this way. And I need to say, oh yes, yes, we're equals. No, we're not because when that patient has a, a bad outcome and we're going to court guess who's going, I'm going alone. So it's not a hierarchy in the sense that like, you know, I tell you what to do, but it absolutely is a hierarchy and the decision ultimately falls with me. I show you that picture of President Bush and President Clinton. They said repeatedly, we had really smart people around us foreign affairs. You know, all these different things that you need to know and they sat there every morning and they listen and they listen and they listen. But at the end of the day, they have to decide and that comes down to the calculating part of it. Calculating, especially when it's, it's put on a woman is um got a negative connotation like you're manipulating, like you're actually reclaim the word calculating is amazing. All calculating means is you're taking in the information and you're making a intelligent decision about what to do. Um, based on the data you have and you must do that. Why do I, why, why is that so important? Because if you're not calculating, then what you're doing is being reactionary, you are getting information and you're acting, getting information and you're acting, you do that. That's what dogs do, right. That's what animals do. You can never do that. I'll give you an example. Let's say I'm the leader of my division. Somebody walks through my door and says, you know what that doctor do up. I hate her. You know what she did today? She came into the operating room and she screamed at the nurse. It was unacceptable. How dare she if I'm the boss and I called the doctor in and I say, you know what? You are not allowed to scream and yell. This is unacceptable. Well, two seconds later, I'm again gonna have my pants down because the person sitting in front of me is gonna give me a whole different story about what actually happened. And I'm gonna have to wait and be like, oh God, now I've created more of a mess because now I've pissed off the person that the complaint was made about and I've not given them their space to give, tell me their story. The number one thing about being calculating is that you have to be able to get information before you make a decision. So it's brain based, not heart based and being very intelligent and calculating and brain based ties into being fair. And remember what is the title of this talk? Being fair and kind and strong. And if you are not calculating and you are reactionary, you will never be fair because it will always be whoever gets to you first and that will make you a shitty leader. And the final thing is you gotta be a little chill, you gotta be a comic. I make jokes all the time because you, you have to lighten the mood, especially in medicine. My God, our jobs are hard, right? And if we're so serious and we harass people and we, you know, it's OK to make a joke once in a while. And it also makes you human to the people that you're leading that of course, wins their respect. And in line with that number four, as I've said earlier, you have to throw yourself into the community. Now you have to be somebody and that goes back to that competence idea that you have to be somebody who knows what they're talking about. You've lived it, you get it, you know what things can make, uh what can make things better. But at the same time, you're not one of them, you're not one of them. Women will often get tied into this tangled into this silly thing where people try to treat you as an equal. Oh We're all collaborative. Everybody's voice matters. That's all true. But at the end of the day, you're the one who again needs to make the decision. You have to be seen as different from a lot because if you're not different, then why the hell are you the leader? There has to be something about you that makes you different. Maybe you have the vision, you have the mission, you have the, the, the understanding of how different people's needs and motivations work. You know, maybe there's somebody who's very difficult in your department and you're the whisperer to that person. It can be anything but you need to portray yourself and be genuinely a part of the community. But always know that there is a hierarchy. If everyone is sitting, you know, in the, in the break room, laughing and joking and you know, saying something negative, you can walk through, you can smile, but you cannot become a part of that. Because again, you always have to be seen as that person that they come to. Your mom is not your friend, your mom is your mom. She can act as a friend, she can be your greatest ally. She can do all these wonderful things for you. But at the end of the day, you know, when you're sitting around smoking weed with your friends, your mom's not gonna join you. That's a bad mom. OK? So that's the way to think about it. I'm not saying it in a paternalistic or maternalistic sense, like you need to tell them what to do as if I'm just saying that there is that difference. And I like to use that example because that puts it clear in people's minds. Now this slide again is sort of fixated a little bit on what happens with our women versus men. Um I want our and this and this is for our women specifically to see the point of this, But I want our men to pay attention to this because I want you to know that this happens, it happens and it's not cool and it sucks. But maybe, you know, you can be allies in this with us as you move forward into leadership positions. There is a reality that has to be accepted specifically between men and women like I have spoken about earlier in this talk. Look at this quote up here even in this day and age, a guy barks in order and he's treated like someone who's in charge and a leader. But when a woman communicates in the exact same way, she's immediately labeled aggressive, assertive, dominating and overbearing. Um By the way, guys, I just wanna confirm, you can still hear me right. I'm not just talking to myself. Yeah. Don't worry, we can hear you. You never, it's happened to me before. It happened to me before because I can't see you. Um Anyway, so, so you see this quote, OK, all of us have said this. All us women have said this at some point in our lives. Oh, you know God, that guy in the operating room, you know, he did this and this is what happened and I did this and this is what happened. And you know, the, the fact of the matter is and that's why I set up here. It's only 2024. You know, the first woman uh Elizabeth Blackwell here who went into medical school. I mean, she, this is very recent, same with you guys, very recent. You know, we just got into medical school and the, the, the history, you know, the, the one of the stories that, that, that she used to say is that um she was in, she was accepted into med school and the way that it worked, you know, there were those amphitheater and she would come in and sit at the basically closest to where the body was because, you know, that's where the lecturers were and the, the gentlemen around her up top would spit on her from the top. You know, that's where we started. OK. Now we're talking about leading the world running divisions doing the and we've chipped away and we'll continue to chip away. Things aren't better. They are, things aren't getting better. There's no question. You can't force hearts and minds. Remember that it has to be won over slowly slowly and it's happening. But this phenomenon where women and men are thought of a little bit differently. Absolutely still exists. Um, one of the, the, the best kind of, kind of quote unquote explanations for this that I read was in Sheryl Sandberg's book Lean In. I don't know if you guys have read it. Um, she used to work at Facebook and, uh, uh, wrote this book about, like, leaning in, as in, you know, women should lean in and she talked about this phenomenon where, like people, regardless of whether they're males or females, humans, people see women in this like kind of maternal sense. And so they like, get more of a personal hit when, when a woman shouts at them versus a man shouts at them. She said that in the book and it, it's an interesting take. I mean, I don't know, I don't, I don't do this type of research. I don't know. But like, at least that's the way that I have made some sense of it because it's so unfair and annoying. But what it does is it kind of cuts women both ways because when you have to be strong about something you can be immediately labeled in these sorts of ways and that can really drag you down. So I only put it up here to show you if you look on the right side here, look at these, these two emails and, and I know that's not too clear, but this is considered, you know, from a woman a threatening send me the presentation when it's ready versus nonthreatening. Hey, smiley face. Can I take a peek at your presentation when it's ready? Smiley face? Exclamation point? I mean, all us girls, we all do this. OK? And I just wanna point out that this happens other than you chugging along in academics, my female friends and getting to the very top, there's nothing else that can be done about this. Calling it out to some extent works. There are absolutely people that are like, wow, you're right. I'm so sorry. But most people's reaction again will be kind of passive aggressive and sort of, oh, you're being hysterical or you're so the best thing to do is to, again, like I said, add comedy into the way that you deliver stuff. Like, for example, I would send this, this and again, it's my personality type. So people don't take it very badly. Obviously, if you just did it when you did, you, you, you met somebody and you've never like, spent any time with them, they might take it badly. But if I was sending this email to Jake, I would say something like send me the presentation when it's ready, Jake, because otherwise I'm gonna die of old age, ha ha ha. You know, and it gets the point across like, I'm like, Jake, what the hell? But at the same time, I it's, it's like, I don't know if you guys have ever had sour patch kids that have like, they're like sour on the outside but sweet on the inside. So they confuse people basically. That's the way that I handle this particular issue. So I will, it'll be something biting, but they'll be confused about it. And II again, that's just my personal way of doing it. You guys can do things differently. It has to do with who you are as a person. But I just wanna point out that this happens and you know, the next time that, you know, as a man, you're hearing somebody talk about a woman that way or a woman, you know, even we get, get pulled into this sort of thing. We should kind of call it out. But in a quote unquote, nonthreatening way. So it actually makes a difference. And to that end, whether you're a man or a woman, you don't wanna take things personally. If you are called right, aggressive, dominating, assertive, overbearing, you wanna lash out like how dare you, you know, you're the one who's being unfair and this and that never do that as a leader. You have to be completely calm, cool and collected. Any display of emotion where you appear to lose control of yourself immediately will lose respect. Now, when I say emotion, I don't mean like if someone walks into your um into your office and their dog died and they're asking, you know, they're, they're crying, hey, guess what? I will stand up and give him a big hug and say that I'm so sorry, you know, take what you need, do what you need to. No, I'm so sorry. I'm sorry. You mute please. So yeah, can you just uh oh yeah, perfect. Thank you. It's all, it's all good, it's all. No worries, no worries. Um But but but uh if I, you know, have something happen like you know, so so I mean that and that, that, that form of emotion is ok. But if I have something happen, like let's say I'm unfairly told something like, hey, a member of your team did this blah, blah, blah, blah, blah, me kind of attacking and saying that's, you know, this is unacceptable and like this is so unfair and, you know, that sort of like almost tantrumy type behavior. Never, never, even if you're right and it feels good in that second will pay you any dividends. You always wanna be absolutely common collected. You know, when people say never write an email angry, never. That's what they mean. And yes, yes. Yes. For women, we get no leeway, no leeway. They're waiting for you to quote, be hysterical or act in a way that is unbecoming of a le for women. We absolutely are not allowed. You have to just sit back. You know what I used to do. Actually, I, if I had something that's really unfair, I would actually tell my girlfriends about it. I have a bunch of friends obviously in the hospital and I would be like, you know, just bitch about it, talk about it be like that this is what I wanna say but then I'd go back and write an email that was very crisp and clean samurai sword cut, not in any way, you know, emotional um like I said, it is a trap there when people try to instigate you, they are trying to trap you. So think of yourself as I'm just gonna walk away from this when something happens, that's unfair. And I'm gonna write an email always document and I'm gonna put it in very clear crisp terms with nothing emotional in there. And I'm not gonna take it personal because they're just trying to elicit a reaction and they would do it to anybody who is in my position. That's the way I think of it. So with these sort of, you know, things that I told you about, that's really your strategy, that's your strategy, your mindset where you should be at as you approach leading a team. Now you actually have to execute and get success. So in order to do that, you have to have a vision as a leader, you have to think to yourself. OK? I understand the culture, I understand the people here and why do you need to understand the people? Because that means that you understand your Armamentarium. If I have someone who's really, really, really good at, at, at kind of delineating and organizing but not so great in the operating room. Well, I can have a conversation with that person and I can sort of steer them towards something that I think that they can blossom in. Because guess what, I'm happy, division is happy, they're happy. And if I have someone who's a killer in the operating room, you know, does case after case, after case, but just cannot write their notes, just cannot be. And in America that really matters because your notes are connected to insurance and that's connected to reimbursement. So you can literally have your s your privileges in the hospital, spend it if you have not done your notes in time. Somebody like that could never be at a position where they're leading a division because they can't do paperwork. Well, somebody like that is my work course and I can sort of team them up with the other person I talked about and like collectively they can really win and both of them can get promoted. So you need to know who the people are in your group. You need to know what your vision is. Now. It's really important with your vision that you come to the conclusion yourself. You can take input from everybody. Sure. Absolutely. But you don't have to have everybody's buying. This is a mistake of 2024 that people feed you this garbage. It's not true. You don't need to get buy in from everybody in your division, you do not need agreement, you do not need everyone to support it. You do not need validation. That's what I'm saying. You were picked for this leadership position because you're the best and you need to be play that. But the way that you do it is you need to be very strategic in the information that you give your group. If people are not buying in, I'll give you an example right now. Mass General Hospital is actually merging with Brigham and Women's. Ok. Brigham and women's is a very amazing hospital. Mass General is a very amazing hospital. They have extreme histories, not like you Brits have histories, but like, you know, a couple of 100 years and it's a big deal to merge these two things, two different cultures, two different worlds. People have been here for 4050 years of their career. They love the Mass General Mass General badge. Now suddenly you're taking their emails away saying no, no, it's Mass General partners. It's a big deal. So not everyone is gonna be behind that vision, but there's a reason for it and it has to do with patient care and finances. And so you need to show these people why they should have buy in. Even if they don't agree today, they may agree in a month, in six months, in nine months, when you show them that your vision is working. So all you need to do right now. Is to get these people to believe in you as a human being and believe in your vision, not necessarily agree with it. So in order to do that, you need to be very transparent. Explain to them why you want them to do what they're doing and say to them, this is where I think we'll be in this much time. This is where I think we'll be in that much time. And this is how you play into this story. Now, in order to do that, you have to take some risks because what are you doing? You're basically an oracle, right? You're telling them this is what's gonna happen in the future. You need to do things that other people don't have the guts to do. And that means on the inside, you're gonna be screaming in terror. But on the outside, you need to be a complete ice queen. Nobody can know that this is how you feel. Go home and tell your husband go home and tell your kids, go on, tell your friends, but you don't need to tell your team. You don't need to sit there now and again, I'm gonna come back, come back to my women on this one. Ok? We are told, we are told, hey, you know what, show your emotions, express yourself to your team. Tell them, I don't know. I'm not sure we're in this together. No, you're the leader, ok? If I'm going into battle with you, I don't wanna hear that. You're not sure, ok? You can, you don't have to lie to me but you can tell me with the data that you have. This is what you think is gonna happen and cool cool like this ice queen you're gonna take us for and you're gonna be there every step of the way even on the inside. If you're scared, you know, courage, right? Courage is not, not having any fear. Courage is about being terrified but doing it anyway. That's what courage is and that's what being a leader really takes. So in order to do that, you really need to be explaining what your logic is to people. Why do you wanna do something? Why is your vision the way that it is? Why not this way? And if somebody comes to you and says, you know what, I really don't understand why we're merging, I think we should be an independent hospital. You can ask them, why do you think that? But then you need to counter with this is why I think this and you know, again, don't need to come to an agreement. You just need to have a space that both of you have been able to voice what you think and why and that way people will respond because you've given them a reason, you know, who else does this Children? When my daughter, I have a seven year old daughter and a four-year-old son. When my daughter wants to know something. Why do people die? Why, why is this, you know, why did our puppy get taken? Why this, why? That I don't tell her, you know, nonsense. I tell her why this is the and, and I literally will say, well, cells, you know, have a time of death. And actually, if everybody in the world never died, then you would just have an overpopulation and it's not kind of fair, you know, other people should have a chance to live. And I mean, it may be nonsense, but that's what I think. That's what the reason why people die. And she can understand it, even though it is not, she doesn't agree, she still thinks dying is bad, but she understands why. And that allows her to, to, to absorb it better. So that only can come from being kind of knee deep and crap with your team, understanding what their trepidation is about why your vision may not work and then coming to them and having a conversation with them clearly about what um it takes to win. So in conclusion, I'm just gonna show you two more slides essentially overall. How do you win? If you take nothing from this, this slide is the way to go. You gotta understand individual needs and motivations of your team. And that means you got to take the time to understand your team. If you've become a leader, you don't just come in and start making changes right away even though you may externally from the outside of thought. Oh, this really needs to change or that no, you come in, you become a part of the culture. It's always easier to change from inside. You don't take bullshit and you don't have a tolerance for bullshit. What do I mean by that? If you're getting the wall pulled over your eyes, if there's somebody who's not working, if there's no, you need to be a strong and fair leader, kindness doesn't mean that you're a pushover and that you let everyone do whatever they want because actually that is very unkind because what that means is for the people that are working for you, you're screwing them to try to pacify whoever is not doing great in your group. So no tolerance. And you should be known as somebody who has no tolerance, you should have zero favorites because again, being perceived as fair is absolutely mandatory. Every single team member needs to have individual goals and expectations that they need to achieve. And different people have different scales. As I said, the guy who can't do his notes has a different need than the guy who can't operate too well. But you need to understand what the needs and motivations are and that will allow you to set the goals for your team when people achieve those goals, one must reward. This is a place that women actually do very well calling people out for what they have done, right? Giving them the credit, never taking it yourself. Because if your team is succeeding, I assure you the people above you recognize that you did it. They're not even gonna know the faces of your team. They're only gonna know you. So you know, walking into a meeting and saying, hey, you know John did this, everyone's gonna clap for John but everyone knows that you said John did it and that's actually benefit show to you. You can have an open door policy and you should, people should feel very comfortable. Samantha should be able to walk into your office and have a conversation with you, but I'm not your mom, I'm your boss. So what does that mean? I'm not here to pander to you. I'm certainly not gonna drop everything I'm doing to talk to you. It needs to be a very boss and you know, uh um in this case, resident relationship, but that doesn't mean you need to be mean but you do need to set those boundaries otherwise you will get bold over and that's why that that perception of fairness is really important and the tolerance for no bullshit is really important. Um oops for women. Um You wanna be a little careful of this women on women crime I've put in there very specifically because those days are gone where there's only one of us, all of us are in that psychological. Oh my God, there can only be one. And even if you don't know it consciously, you think it subconsciously and, you know, we're all, we're sort of engineered to fight over the one thing. And so what invariably ends up happening is there's this women on women crime and the men sit back and let it happen. Never let it happen. That's a huge mistake. Now, on the other hand, if there's a woman in your division who sucks, I'm not telling you that you need to be like, oh she's so amazing and proper up if she sucks. Merit and competence are number one, remember that number one? But if you know it's just like, and, and we know we know when it's real, when it's fake, you should make an effort always to collaborate and work together so you can bring each other up. That's the way to do it. Never pull that ladder up from behind you because that makes you an asshole, ok? And of course you need to remember you're a leader but you have a boss and you're gonna wanna be, you know, somebody who's endeared to your boss, but never throw your family, which is your group of people that you're leading under the bus to make your boss like you, what do I mean by that? You know, you show up and uh your boss tells you, hey, your division is doing shitty. Your numbers are bad and you say, yeah, you know I've got these two people in my division. They don't do anything because that will get back to them and they will lose all trust in you. You need to always take the blame, you need to be loyal. If a nurse comes to me and complains about one of my people, I let me bring my person behind closed doors and just say, hey, what the hell were you doing? Blah, blah, blah, blah, blah. But to the nurse's face, I'm gonna say, I'm protecting my team, tell me what you need to know and then I'll go out there and I'll try to handle it as fairly as possible, but never by throwing my team under the bus. So just remember that family first, you create your own society as a leader, your secret society of people. Like I said, your friends, your family who you can talk to about leadership issues, never go and dump on your team. They don't wanna hear, they'll listen. Oh, they love the gossip. Oh, the boss is talking to me. Oh, the boss is feeling uncomfortable and they'll try to give you advice but you are just weakening your own um uh group. What you wanna do is take that stuff outside and no matter what if you say you're gonna do something you deliver under any circumstances. I was the director of our vascular lab for a while. I told them that I was gonna get them chairs because ergonomically they were having issues doing vascular lab, ultrasound and I made sure it happened at the end of the day, what happened is we didn't have the money in the budget and I had promised it. So guess what I did, I opened up my own wallet. Luckily I, that got back to my own boss who was like, whoa. And he actually ended up the division covered the cost. But the point was like, you know, I made that promise that was on me. I shouldn't have made it without having. And that was my fault because I didn't know division funds before I made a silly promise. I thought it wasn't a big deal, a few $100 but it was a big deal. But once I made that promise I had to deliver because that's how you erode your trust when you don't deliver. And when you do a good job, there is nothing wrong in. This is the cultural difference. Again, between the British and the Americans. Nothing wrong with tooting your own horn. You need to, especially you women out there. You need to because you need to highlight to people what you've done well and there's a way to do it. There's a style of doing it and the way to do it is to say our division is doing wonderfully. And I wanna thank all the people in our division for how amazing they're doing. Everybody knows you're talking about yourself because you're the one who was the leader. So in conclusion to be an effective leader, you need to be a visionary, but you need to be boots on the ground. Strategizing intelligently, you need to care what people say, but you also need to not care what people say because you need to know when it should go in and when it should go out, you are qualified. If you've been given the leadership position, you are qualified. And if you don't believe you are and you keep going to people asking for things and asking for permission, then no one else is gonna believe in you either. You need to know that you were picked for a reason, even if you don't feel it, you're scared on the inside. I clean on the outside and you need to make sure that whatever your vision is, is a calculated intelligent, brings the culture and your, your people into the group and actually something that you can achieve and deliver on. And if you need someone to talk to, if you're reading something, no matter how big or small, I will be a part of your secret society. That is my email and my phone number, you're free to call me anytime and I'm happy to help um in any way, always. Thank you. Thank you so much doctor for that. Um Really engaging talk. Um I'm obviously aware of your amazing CV, but it's so unlikely to hear you talk through your journey and obviously some of those, er, great insights with regards to strong, fair and kind leadership, you know, those, those three qualities and some of your, er, advice for embodying those qualities and, and how to win obviously will uh will definitely stick with me and I'm sure they'll stick with the audience. Um Just before we get to the Q and A, just to mention that the Yorkshire fdss will be recruiting a new committee soon. So definitely follow our Instagram page to see when we open applications if you'd like to be a part of the society. A not so secret society. Um So if, er, so with regards to your questions, um feel free to unmute and ask or pop in the chat, I can see that there's one or uh or 223 already in there. So, um I'll kick us off with a, oh, sorry, sorry. Yeah. Well, so I'll kick off with a in person one just in, just to in inspire people if they want to um want to do it face to face. Um But if not, yeah, we'll go through the ones in the chat. So, er, in terms of your, your like expertise, obviously span surgery, politics, research. Um and you've given me some, you know, really amazing tips for being a su a successful leader sort of in, in any domain. Um uh So I was just wondering, do you have an example all the time? That you kind of achieve something in your clinical capacity. Um and like, apply that knowledge or those learning points to your academic work and like healthcare for all, like healthcare for action, you know, like a kind of different field but like, you know, you kind of developed the skills and then it was, you know, you managed to successfully translate it across. Oh, absolutely. Actually, you know, that, that is really the name of the game, isn't it? Otherwise we're just machines and all and everybody dies as we talked about and, and you really not done much. So I'll give you a perfect example. II told you I do peripheral artery disease and I do a lot of limb salvage, right? So one of the things that um one of the unfortunate situations, at least in the United States is um minority uh patients specifically African Americans, Hispanics and South Asians um have a much, much higher rate of amputation than uh patients that um are white. And you know, II was sick of going to these talks going to, we go, go to these doctor talks, you know, where they, they put these statistics up. They're horrible. Like a black woman has 7.6 times more of a likelihood of getting amputated than a white man. It was crazy, you know, in the same healthcare system. And um uh II was sick of going to these talks where they put these jarring statistics up and at the end, their conclusion slide is all doctors are racist, you should stop doing that. And like, I mean, of course, there is inherent racism built into the system that, that, that affects the way in which you. But the fact of the matter is the this P AD issue, for example, peripheral artery disease affects a lot of people typically who are socioeconomically, not as you know, high. And um in this country, at least in the United States, 73% of the amputations done. 73% of amputations done are done without an angiogram, which means that you're not even checking to see whether or not the light could potentially be right now. And why is that happening? Well, at least in our country again. So it's not the UK but in our country, um there's a, there, there is money associated insurance reimbursement associated with procedures. So Medicare, which is the kind of the the the government way of getting uh payment for, for things you do. Medicare could make a change to their guidelines that said, listen in a patient that doesn't have sepsis and this is not a trauma as in it, a diabetic patient, for example, that's coming in with a black toe, we will not reimburse you for an amputation unless you've done an angiogram or given us some reason why you had overnight, you would decrease the number of patients that are not getting angiograms, you know, for their now there's some unintended consequences that may or may not happen. But at the end of the day, you'd be able to hit really hard and a major problem with such a, such a basic p political change. So what what happened clinically is I was amputating these legs. I was seeing these patients at two o'clock in the morning, coming in festering with gangrene and I was like, this is ridiculous that translated to me deciding that, you know, the blood thinners that these patients got were not perfect. And so my NIH lab actually runs um personalized coagulation testing. So we can target the way in which we give blood thinners to these patients. But even that's not good enough. And that translated then to doing the political work. And actually, um if you guys want, if you're interested, um you can Google, I wrote a New York Times uh op ed about it that was published a few months ago about it's called my patient did not have to die this way. I'm looking up because I have it framed in my office. Um And so that's something worth looking at that will show you how the government ties back into this very clinical thing that I'm dealing with on a day to day basis. And the way that, that, that I would suggest you approach that in life is not to think of the problem, it's to change your mindset. You know, we all go to you know, everyone wakes up in the morning, goes to the bathroom, brushes their teeth, puts on their pants and kind of bumbles about their day. And we have like a little list, we all of the things we wanna do in the day and we strike them off and we achieve it and then we go to bed and, you know, you've done a lot but it's almost hamster in a wheel, sort of in your own world. You've done a lot of things and really what you wanna do, especially at you guys' age, right? Is you wanna touch those stars, you wanna be those people that make the difference, change the political landscape. So 100s of patients are benefited instead of just the, you know, I think I've done the math myself. Actually, it's something in the like 35,000 people that I will actually treat in my life. But if I do one research thing, right? When I'm dead and gone, 100s of patients will still be treated by whatever I want. That's the same thing from, from policy. So you wanna think big, you want your mindset to be able to say I see this problem locally. How am I gonna change it systemically? And then you chip away at the problem slowly over time, but you always come back to your root as to why you know what, what inspired you to do what not. So, you know, when I was in the presidential leadership scholars thing. They had asked us, we had these little books, they had asked us to write in the beginning of the book. Um What, what inspired you to do this? My project was all about amputation, product, uh amputation decreasing in the United States. And II won't name the patient obviously for Hipaa. But there was a patient in my first year as an attending. I mean, it's terrible. She was a black lady who had, had a stroke, had a heart attack, had basically bits of her leg chopped off. Very young forties, fifties chopped off all the way to an above knee amputation. And on the other side, we started up, I mean, she was just like being whittled away that she had multiple Children and I got to know her really well over the course of a couple of years and then she died of like a massive vascular issue and I'll just never forget her because she was totally preventable, totally preventable. And that's some, that's some bullshit in a first world country that has all the resources so that I always go back to her no matter how big we're talking. Because if I'm tired and I don't wanna do that email or I'm sick of talking to another donor, you know, begging for money for my health care people or whatever, I'll think of her and be like, I can make this extra call. I can do this extra thing in spite of whatever. I've got the two kids, I've got the, you know, I've got the husband, I've got a mother in law who lives with me, I've got, and I got all the, the stuff that can tell you I'm already doing a lot, but you gotta keep that mindset and that inspiration. So you can always do more because if it's, it's not gonna be the people that you're seeing on the wards these days, the 6070 year olds, they're done, their lives are over, professor, whatever they did it, it's all you, you guys, if you don't do it, nobody's doing shit. So I hope that you, you know, and you can change your mindset from right to second onward. Yeah. Absolutely. Well, no pressure there guys, but we can do it. Yeah. Um, so, yeah, I'll just have a look so there's, uh, I'll just go through the, er, go through the questions in order. So the first one. hi, thank you for your advice. Just wondering, er, if you have any pearls of wisdom about, er, managing time as someone with so many different moving, er, so many different roles slash moving parts. Yes, absolutely. You know, uh, my, my whole thing is about efficiency. I definitely, um, you know, I've got my iphone, I've got my email on my iphone, a lot of the stuff that I do at the leadership level. Um, again, a, a lot of it has to do with like being reaction, like you never wanna be someone that, you know, two weeks have gone and not answered an email, like stuff like that. That's really what keeps things going. Um I have a couple of inventions and things like that. I do too on the side and a lot of these things kind of cross a line and so I'm able to take care of a lot of that work. Um when I'm walking from patient to patient or in between, you know, downtime during the operative time, II usually will use what would be considered downtime like when you would go have lunch or whatever to do these sorts of things. Um My, my if if you want to call it a pearl of wisdom is done is better than perfect. You do not need to iterate, iterate, iterate, get it done and get it out the door, let somebody else get their eyes on it. Remember I told you with the collaboration. So I'll give you an example. I'm writing an ro one NIH grant. I'm writing actually three NIH R grants, but they're due coming up. I've got one with this guy, I've got one, you know, doing the graphs on this one. I've got and I've got people, my post docs, my colleagues, Joseph, why not? Hey, can you look at this? Can you change this graph for me? And I know because I know who's got what strengths where I can delegate to these people as long as I am in the middle of it, keeping it all straight. And that's, that's the way that I, so I would rather like put a sketch together and email it to Joseph and say, hey, can, can you turn this into a bar graph for me? That looks good. And I want red and green on the graph. He'll do it right. And, and, and I'll get it back and it may suck. But he's giving me something to then work with and I can, you know, start from and that's how I tend to do things so that I have a lot of, and, but then, but then you can bet your ass that Joseph's name will be on that paper never would. I, you know, take, that's, and that's what I mean by giving credit and honoring people for doing because then guess what, tomorrow, when I say Joseph, write this paper, he's gonna do it. And that's how you build up, you know, um uh collateral with people and they, with you, you'll feel equally comfortable to say, hey, listen, I wanna come to the States and I'm looking to do this. This, this, would you mind writing me a letter? Yeah, guess what? We've done these two things for me. I'm ready to do it for you and that's the way in which the moving parts have sort of all worked. Um I have a delegates and everything that I do that. I, you know, my right hand people, so to speak, that I have earned trust from and I take care of and they help me. Yeah. Um I think that's really, really great advice. Um, the, just to say, guys, I know that we're um, ticking over, uh a little bit so I'll just put the, er, feedback form in the chat. So the one I've just put in is the uh one for this event. And then, um, the one that I've put in now is the one for those of you that have attended all the sessions to get your, uh, to get the, uh CPD points. Um, but yes, we have more questions. So I need to get my bar charts better. I think that's in my head now. Oh, no, II totally get that. I got other things for you. Um Thank you for the great talk. How would you advise going about being a Cole? There is actually someone, well, at least one who is an equal, great question. Actually. Remember I told you, I'm the director of the P AD center. I'm actually the co-director. And the reason for that is I'm a vascular surgeon. The, the other person is a cardiologist. Um, we're good friends. We're very much equals. Um, what you will find usually with co leading though is that one person has strength in one area and one has and other, the most dangerous thing that can happen though. Is you end up being the worker. This is something that happens to women a lot actually that women can get things done. Their ability to execute is very good. And so what ends up happening is they end up being the like, oh you know, Samantha will do it. She always does, she does a great job but Greg will go and present it. That's some bullshit. No. Right. So in the co leading space, what's really important is out the gate? What are the roles and responsibilities to achieve? Like if you were just a single leader, what do you need to do? And then you split it as to who's gonna do what? And if you, you're gonna get three scenarios in scenario number one leader, number, there's gonna be one leader that's trying to crush another leader that doesn't work and you, the, the way to fix that is the leader that's be being crushed, needs to kind of step up and say, hey, listen, this is not gonna work, you know, this is what I think and it's some, it sometimes it doesn't work. That's why countries don't have multiple heads. I mean, the the concept sometimes cannot work. We do it because we're pandering to this idea of collaboration. But really what ends up happening is, you know, you can think of a CFO and a CMO and a CEO, they're all leaders but they're all different and they do, they have different roles but if you're actually given the same role, you can see how that could be, but you could have a situation like I said, situation number one where one is crushing the other. And what you would do is this person needs to kind of step up and say, hey, this is not working, this is how it would work better. Never come with problems, always come with solutions. This is how I would fix it, right? Because then you've already start, you, you put the train on that track versus letting the other person who's crushing you already, you know, have the authority situation. Number two, you really are two colleagues. You really do work collaboratively together. Typically what happens there is that you really are splitting the work. So you got two people and one's like, you know what, I'll send out the email if you'll put this on social media, that sort of thing. And, but, but the vision is the same, we're trying to get the message out for whatever we're doing and that tends to work a little bit better. It doesn't work in like huge organizations, but it will work. Like, let's say you're the head of the surgical society, you know, you and someone else that usually can work and sometimes one person's like, I don't wanna be the one giving the presentations. I'm not good. I don't like that, but I can make the flyer wonderful. That really works out if people's like, you know, where their strengths are kind of work together. And then the third thing that can happen is you have a situation where you have complete, like both people are type a and you're, you're clashing with each other. And frankly, in those situations, you need to have a come to Jesus talk and say this is not working and that's ok. That's what I mean, like, you don't need to be the dead horse. If it's dead, it's dead, it's not coming back, you know, and that it's OK to say that this would never happen. And actually that can almost reset the thing for you because you could be so deep in it. And then you say this is never gonna be. And you know, a good example of that is in relationships frankly when like, one person's like, we're fighting too much, like, are we breaking up or not? And that kind of everyone's kind of comes to the same page and like, and makes a decision and that can be the same way that you can lead. But it is a challenging situation. I don't love it. Um But it can work if you've got the right people. Yeah, I think that that makes a lot of sense. Um Next, next question. Um I totally agree with you about the different reactions between male and female demonstrations of anger or rudeness from seniors. Do you have any tips on trying to change that culture? In organizations as a junior doctor, things I can do before I make it to the top of the tree can be difficult to raise it directly with individuals who are guilty of it. It, so I'll give you a couple answers here. Right. This is a great question. Um as a, as a woman, right? And uh it's funny, I literally had this conversation with one of my girlfriends yesterday who was dealing with this in her division. She is a senior person. I just, you know, it's kind of like death by 1000 cuts, you know, every day. There's something and it, and you're just like, I can't live like this. And what I told and, and she also, you know, her, her, her decision was like, you know, do I go to the boss or not? And I said to her, what I'll tell you, it depends, it depends on what the situation is, right? OK. I'll give you a scenario. In fact, I'll give you my own example when I was a fy one, there was this uh psychopath, ok, who was one of our uh seniors and he was super in like, like he was really like, well loved by the senior, the professor. And um he really had took a shining to this girl actually who was a fy one with me. Um It wasn't like a weird sexual thing. It was just like, he just, you know, liked her more. She's had the same accent and like, there are, there are many reasons and he would torture. There were a couple, two other girls that and, and it, you know, and, and the first thing I'll say at the gate is go back to that competence thing. There are absolutely situations where a senior will berate a junior, but because the junior sucks and is doing something wrong. Like, you know, if you're not coming in on time or if you're not doing your job or if you're screwing things up, then you, you know, should be yelled at for your own benefit and for the patients. So you, first of all, I'm trusting Jessica that what you're saying is already um hey, there's an unfairness to this. Ok. So let's assume that situation that indeed what I'm describing, what happened to me was happening where there's an unfairness and you're just kind of getting the short end of the stick here and it's, it's not fair in the operating room. You know, the nurses are nicer to the guy than they are to you. I mean, we all love that too, right? And um and, and you're suffering through it. Well, in my particular situation, I could have gone to that professor or to that professor's kind of boss, but they would have given me the lip service. But at the end of the day, it would have never worked because what would have happened is that guy would have told the professor who would have told this guy who then made my life even more. Hell. Now I knew I had six months before I'm off this rotation and I was trying to get to the States at the time I was trying to match the general surgery residency. I needed a letter from that professor and I needed him to shut his mouth. So he wouldn't tell a bunch of other people that, you know, she's not good and you know, they'll find something, Jessica, they always do. Oh, she's bad with the nurses. Oh, she forgot this blood, whatever bullshit they wanna put on you at the time. So what I decided I made a conscious decision that I'm gonna tough this out for six months and then I'm gonna go work at Stanford and Harvard and I'm gonna come back someday and I'm gonna screw this guy and guess what? Ok? Did that happen? You know. So, so I made a decision now, if you're really getting the short end of the stick and it's untenable, ok? Or if it's gonna be sustained, then the answer is what you just said right down here. It can be difficult to raise it directly with individuals who are guilty of it. Well, Jessica, you just need to bust those ovaries out and you need to do it because, because if you go to the top and you circumvent the person who's doing this to you. Now again, there are exceptions to this rule. Obviously, this person is a crazy person and like, they're never gonna, or they're gonna make your life, then you need to, of course, go above them. But most of the time you'd be amazed how people will take feedback, especially in this day and age, ok, this day and age, we're not living in the 18 100s anymore. So if you go to this person and you say, listen, I need to have a conversation with you and it's your, you know, whatever, he's some boss and you sit down, you're like, look, bro, these are the problems I'm having. Remember what I told you earlier about no emotion. You're not crying at this meeting, Jessica. You're not talking about how it made you feel. You're writing down how it was not right? How it was unfair. OK? How he is doing and, and the, and you say, let me just speak and you say it and the best thing to do is it's written down. So you say these are the things and then you stop and there will be an awkward pause. There is always an awkward pause and you let the guy respond, ok? People are gonna be taken off guard or her, whoever it is taken off guard and then you might, you might be surprised at the breakthrough and they will be so thankful that you didn't go to the top of the tree, right? And that you, it might have a, it might cause a breakthrough in your relationship. I've had that happen to me. I have done it. Um, now, now it's easy for me to tell you that at the stage I'm at right now. It might have the opposite thing. The guy may be a total jerk. And if it, if you did guess what, you have it all written down, now you say when you go to the professor, hey, I had it, I tried, I had a conversation. It shows a lot of maturity on your part and it keeps the whole like, oh she just circumvented me, you know, so out of the game because that's what they're gonna come at you with. She didn't have the guts to come and tell me she went to the top and like, you know, and then it's always gonna be the top because remember the top of the tree, these, these branches are together, right? So it's always gonna be them against you. But if you start down here, you can really build and you, someday Jessica will be a senior yourself and there will be another Jessica that wants to tell you that you did something unfair and you need to also sit down and take it like a woman and you know, be like, yeah, I hear you. And this is how I'm gonna rectify what I'm doing. Assuming that, you know, again, what I'm saying is right? And, and that this is something that's not a competence issue or whatever. And if it is a competent, I mean, you might, you might sit down Jessica and say this with whoever this person is and they might tell you, you know, actually Jessica, the reason I keep doing this to you is I think you've got a lot of potential. But, you know, God, why can't you come to work on time? Right. And you might have a real breakthrough because I know in Britain, at least when I was there, everything was like nonsense. Never, ever. And nobody said what they meant ever. Like it would always be like, you know, it's been really challenging with you coming to work these days because it's really not nice for the patients. You're like, what are you talking about? And then actually it's that they want you to use deodorant, like, you know, I have no idea better to just like, say it. And I know I'm, I'm sort of making a joke about it, but I'm trying to make it really clear what I mean. And so that's the way I would say and I know it's tough, Jessica. But believe me, once you do it one time, you will never. And this is a skill because for the rest of your life, you're gonna be needing to have these tough conversations with patients, with your own spouse, with your family members, with people above you, with your boss. You will never not have a boss, even if you're the president, you answer to somebody. So I think this is a good time, you know, and if you want Jessica offline, you can call me, we can talk about the actual situation and I can tell you, you know what I think if you wish. Oh, it's really generous offer. Oh, if uh yeah, thank you. Um, so, uh oh, so that's very true. Thank you. Um, oh, just will there be recording presentation and previous se er er, yes, there will, there will be a recording of this. I can put previous sessions up if people would find that helpful. Um, I, some of them, the first one is already up. Um, I trying to see if there are, I think that's all the, all the ones I can see in the charts. Um, well, to be fair, we're already 20 minutes over. So, yeah, II really have to go. They'll let you go, but thank you so much for giving up your time. Um, and um, yeah, keep in contact. Thank you. Nice to see you. Bye bye bye.