MSCE: Where are you working now? Is this your first book?

MM: I did self-publish a book 15 years ago about Vitamin D, but that was just a little pamphlet, so this would be my first book. I work for the state; I work for the Buffalo Psychiatric Center. I’m an internist there. I also do some consulting work for some health tech startups, mostly based in Seattle and San Francisco.

I started off as a journalist and went into healthcare administration for a little bit here in Buffalo, then went to medical school (for) internal medicine and preventive medicine. I worked after that for the Buffalo Psych Center from ’01-’05; hospitalist, chief medical officer for a small hospital; a little primary care; then I worked for an insurance company for a couple of years, a not-for-profit insurance company. After that I worked for one of these health tech startups part time.

MSCE: Tell me about how you and Joe got together. You told him “You should write a book,” he said, “No,” and you said, “I’ll write it; tell me what you got.”

MM: That’s the sum of it. The way it happened was, I was working for this not-for-profit insurance company, and they sent me to a leadership program. It’s one of these things where you go for a week, a couple of times a year, with a cohort, and do a little work between the times that you go.

The first week, we were in San Diego, and there was going to be a talk about leadership. I’m a child of the ’80s so for me leadership was a dark art. It was all about manipulating people to work more for less money. So I was expecting nothing special.

Then this guy stands up there -- he used to be a Lutheran minister years ago – and he starts saying things like, “The same qualities that make a good leader are what makes a good person.” I thought, “Oh, my gosh, I gotta write that down.” And he said these other things, like “Beware of your shadow side.” And I found myself every five minutes writing something down for the first 45 minutes.

So lunchtime comes, and I go up to my room and chill out for a bit. I get on Amazon; I want to find his book. There’s no book! And so I end up talking to him on the phone a week or two later. I said, “Why don’t you write a book?” He said, “I can’t write a book!” I said, “Yes, you can write a book; it’s not that hard.” He said, “Really, I can’t write a book.”

Couple more conversations, I finally said, “Look, you can talk, right?” He said, “Yeah, I can talk.” I said, “You talk, I’ll write it down, and we’ll make it into a book.” And so every Saturday for two years, we spent an hour in the morning; I would give him questions, and I would type it down.

He doesn’t talk like an Oxford professor; he talks like a minister, and so I had to edit the material intensely. I combed it out into a straight line, such as it is. He wanted me to put a lot of my stuff in there, too, so we ended up doing that, and it’s really the both of us. That’s the way it came to be.

MSCE: As you know, there are a lot of books out there about leadership. How does this one stand out from the pack?

MM: Maybe it doesn’t! This is really packed full of a lot of different perspectives, different angles upon which one pontificates. This is a really rapid-fire, dense set of material. I’m going to tell you a story to indicate my perspective on this whole thing.

The most elaborate vacation my family and I ever went on was to Botswana, which is just north of South Africa. You fly a plane out into the middle of the bush, and these really intelligent, very, very sophisticated guides meet you. We wanted to go for a walk in the bush, so (a guide) gets us out of the Jeep and says, “OK, this is the only time you’ll ever see me hold a gun. I’m going to have a gun here while we’re doing this. You walk behind me in single file, and if any animals come, do what I tell you to do.”

So we’re walking along. No animals came. I’m talking to the guy at some point, and I say, “Hey, listen: If I was out here by myself I’d be in trouble, right?” He says, “Oh, yes, you would be taken!” I said, “Oh, OK. But if 50 people were out here, walking on this road, all the animals would run away.”

“Oh, yes, all the animals would have nothing to do with you.”

I said, “How many people does it take, walking together, to make all the animals run away?”

He thought for a minute, and he said, “I think four.”

So four human beings are more badass, and are able to scare away any animal in Africa. Why is that? It’s not because we’re strong. Yes, we’re smart, but it’s because we cooperate. We work together as a group. One elephant is no match for 50 people with weapons. No lion is going to stand up to 50 people with weapons.

So it’s very fundamental for human beings to work in groups. And any time you work in a group, there has to be a process for that. There’s probably going to be somebody who takes care, who manages the process -- who does what – making sure nobody is left out, making sure nobody is left behind. That person’s the leader.

Now thinking about it this way, leadership is an ancient, ancient part of being a human being that is probably not easily understandable. It’s like trying to write a book about family. You can’t summarize and encapsulate all the aspects of family in one book, and leadership is the same way.

This is a long way of saying this book is an attempt to sort of stare into, or look into, the nature of what leadership is. This is informed by a lot of other people’s work, absolutely; every piece of work is. But it’s an attempt to sort of carve bricks out of that chaos and make something out of it. And that’s why there are so many of these maxims, because they come at it from different ways.

MSCE: You met Joe at this leadership event when you were in the insurance field and not practicing medicine, correct? But you are now?

MM: I started up again during COVID because I wanted to be useful. I did some shifts during COVID, and then kept it up. So it was about two years when I wasn’t really practicing.

MSCE: Your position as a leader as a practicing physician is different from your position as a leader in an insurance organization. What do you see as the biggest leadership challenges specifically facing doctors, knowing that’s who’s going to read this article?

MM: The big problem doctors have is the huge cultural difference between medicine, and how it’s practiced on the ground, and what I’ll call the administrative apparatus – health insurance administrators, hospital administrators, practice administrators, regulators, the government, everybody else. There’s a huge, almost impenetrable barrier there. Because we do things differently.

Doctors obviously have famous specific characteristics everybody knows about. But on the administrators’ side, it’s a problem because they want to be useful, they want to support the system, they want to make the system better, but they don’t want to actually even observe what is happening on the front lines sometimes.

It’s frightening. The first-year medical students, walking onto the hospital floor, they’re scared. It’s not a magical process; you’ve just got to become exposed to it. And people who are not used to it instinctively shy away from it. And yet, they are charged with managing that process, which is a little bit absurd if you think about it.

If I’m working at a Ford plant, and I’m an engineer, and I have an idea about how to improve safety on the assembly line, I’d do a better job if I went down and looked at the assembly line. It’s like having somebody in charge of a Ford plant who’s not a car person.

It’s not to say that they can’t do it; it’s just that they have to have a greater attention to the operations of what’s going on on the ground. And there’s a barrier to that; the mystique of medicine keeps them from going through there and actually being sensitive to what’s happening on the ground.

On the doctors’ side, what doctors need to know is that it’s very easy to frighten non-clinicians. I’m going to walk up to an emergency room nurse, and I know exactly how to talk to the emergency room nurse, and I can say disturbing stuff, funny stuff, whatever, and we’re going to get along just fine, because we operate in similar “war zones.” If I get p***ed off about something in the emergency room, nobody’s going to care. But if I go into an executive boardroom and I get p***ed off, even for five seconds, that’s going to destroy my relationship with them.

So the first thing doctors need to know is not to scare non-clinicians. That’s the first thing you have to do. And you’ll see that pediatricians do really well in leadership positions inside organizations, because the nature of the job of pediatrics is largely to keep the parents calm.

MSCE: And the kids.

MM: And the kids, right. But the parents are a bigger problem. So they know how to manage adults. In terms of stuff that doctors need – I was thinking about this, and I think (Maxim) No. 11 (“Your Rat Brain Will Try to Sabotage You”) --  I think you’re just so focused on trying to control something outside yourself that it’s difficult to control – the processes of life and death – that when your inner angry animal comes out, you’re not even aware of it sometimes, and you do stuff that annoys and scares and hurts people around you.

I think (Maxim) No. 22, “Uncertainty Is Not Necessarily a Bad Thing”: I think that a lot of doctors have various levels of uncertainty tolerance. And that leads to conflict between doctors. The difference between your average family medicine doctor and your average academic endocrinologist is going to be very, very different in terms of how they solve problems. You’ve got to be able to tolerate other people’s different levels of tolerance of uncertainty, and that’s a hard thing to do.

The one I come back to is (Maxim No. 9), “Your Shadow Side Is Deathly Dangerous.” Most people walk around not even understanding that. They have an unconscious that’s driving most of the stuff they do every day, and that creates a lot of biases. It can create biases in the way we deal with patients, biases in diagnosis. It can cause you to do things you didn’t think you would do otherwise; it can cause you to do things without even knowing it.

MSCE: Why 52 maxims? Did you intentionally plan on one for each week of the year, or is that just what came out because there was so much good stuff to cover?

MM: It turned out to be just about 52, so we said, “Why don’t we make it 52, because that’s how many weeks in a year?” Basically we took the process of finding these chunks of things that we wanted to talk about, and the way they came together was as a series of maxims, and then ultimately – I think it might have been 54 at one point, or 57 – and we said, “Why don’t we make it 52? So that’s just sort of the way things rolled. The idea is, you can do one a week and think about it.

MSCE: My favorite maxim is No. 18 – “Listening Well Requires Self-Awareness” – because I had a recent experience with a doctor who was not a good listener. He thought he was, but he was reacting, not listening. What are your thoughts on that?

MM: I couldn’t agree more. It’s hard to listen well. I think my time as a journalist primed me to be able to do that better. I spent years just trying to figure out how to ask people questions so they would feel comfortable and tell me what I needed to know.

To listen to people well, especially in a situation where there’s conflict, does require self-awareness, because you need to be aware of and compensate for your own strong reactions to whatever is going on.

MSCE: I think this doctor was not self-aware so much as self-conscious. “I want her to know I’m listening to her, so I’ll say ‘Yeah, yeah’ and chuckle a lot.”

MM: He probably got some training on how to do it, some techniques to use. The other part of it is, the way the system is constructed, especially in primary care, you have 45 minutes of work to do every 15 minutes. And it doesn’t stop. If I had an hour to sit down with you and listen to you, you’d have a much better experience.

We’re crushed by the system, and that’s why I won’t do primary care. I can’t handle it; I won’t do it, and I admire people who would. That’s why there’s a shortage of primary care physicians, because the working conditions are really bad.

But I agree with you entirely that listening is a very, very difficult thing to do. Not everybody is a natural at it, it’s hard to teach and requires, ideally, self-awareness. Think about the way the Dalai Lama would listen to you versus the person at Starbucks. It’s pretty different, and largely that’s because someone who has some spiritual depth to them, or emotional intelligence, is just more able to focus themselves on what you’re saying and manage their own reactions to what you’re saying. It’s about managing yourself.

MSCE: Is there one maxim that stands out to you as a lesson you learned the hard way?

MM: Probably the hardest one for me to learn was “If You Don’t Agree With Your Boss, Hide It,” No. 35. It sounds like kind of an authoritarian demand, that you are a good soldier and walk over the cliff and die. But that’s not what it is. It’s about acknowledging that your boss generally know more than you do, knows things they’re not telling you it’s also about allowing the group to function. It’s about the group.

If I’m second in command, and I’m bad-mouthing my boss’ decisions, who’s going to work hard? Who’s going to move toward any goal? And how do I know I’m right? Once in a while I’m wrong! Undercutting the boss is destructive toward the organizational goals – and the organization pays me. Why am I going to undermine the organization?

Now if the boss is truly incompetent, that’s another question, and it’s a really hard thing to get through. But as a rule, nobody should be able to tell if you disagree with your boss. Behind closed doors, you can tell the boss, “Listen, I don’t agree with this. Can you explain to me your reasoning?” And either they will or they won’t, and if they explain it, you may agree or not. But when you walk out the door, nobody should be able to tell.

That’s not a natural thing, and that’s why leadership is overcoming the natural. The natural thing to do is to gossip, to backstab – hell, violence is natural. Emotional violence is natural. Coercion is natural. Those are all leadership techniques that work to some extent. But they’re not the best for the long-term survival of an organization. They don’t make people happy; they don’t make people thrive.

MSCE: I wouldn’t call emotional violence “leadership.”

MM: It isn’t leadership, but it does help you, if you’re a bad person, to get people to do what you want. It pushes them in a certain direction. It’s counterproductive in the long run, but it’s a very natural thing to do.

“Leadership Is Overcoming the Natural” is available at overcomingthenatural.com, on Amazon and wherever books are sold.