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Dr. Lazarus: Experience of an International Medical Graduate
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发表时间:2009-01-11
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发信人: docrockville (docrockville), 信区: MedicalCareer
标 题: Experience of an International Medical Graduate
发信站: BBS 未名空间站 (Sun Jan 11 02:33:26 2009)

Leadership in the U.S. Armed Forces: Experience of an International Medical
Graduate

Capt. Angeline A. Lazarus, MD, FACP
Rockville, Maryland
Former ACP Governor
ACP Regent, 2003-2009

Leadership in the Armed Forces provides an unique opportunity to excel as it
requires the leader to keep the organization/unit functioning at its best
at all times and to carry out the mission at peace and war-time. The unit
has to be cohesive, well-prepared, organized, competent, skillful and above
all, understand the mission clearly and work together as team. At times, the
unit has to carry out the mission regardless of circumstances and dangers,
willing to accept the Commander's decisions and follow the directions
diligently.

The basis of successful leadership lies in the leader. It has been said that
good leaders inspire us to put our confidence in them; great leaders
inspire us to put our confidence in ourselves. The foundation of Department
of Defense is discipline. The structure, functionality and effectiveness of
the organization depend on the leader. The accomplishment of the mission
depends on the team.

To give you some background, I was born in Lalgudi, Tamil Nadu State in
India and graduated from Madurai Medical College, University of Madras in
1969. After completion of internship, I worked in a Railway Hospital until I
came to the United States of America in 1972. I did a rotating internship
at St. John's Hospital in Cleveland, Ohio and residency and chief residency
at the Veterans Administration Medical Center, Dayton, Ohio. After
graduation, I joined the Veterans Hospital in Martinsburg, WV and had two
rewarding years of practice as a staff internist. My experience in the Armed
Forces began on 7 July 1978 when I joined the Navy to begin my fellowship
in Pulmonary Medicine at the National Naval Medical Center, Bethesda,
Maryland. This is a prestigious medical center where many presidents of the
United States of America have received their medical care. Academically it
is a sound institution. I was pleased with the program it had to offer. I
had to sign a contract of serving two years after graduation and the
assignment could be anywhere in the USA or overseas. I carefully considered
the offer and accepted it. My husband, parents and siblings were supportive
of my decision.

Training in the Navy was a new experience. I had to wear the uniform every
day, learn all the rank structure of the Navy and other services, the types
of ships, and observe proper military courtesy. In addition, I had to learn
the Navy lingo, how to salute and how to polish my shoes. I must meet weight
standards and complete physical readiness testing twice a year. Soon after
I joined, I noticed that the training program met the Residency Review
Committee's curriculum requirements and also prepared me as a military
medical officer. I recognized the need for leadership skills during my
fellowship.

In the twenty years of my naval career, I have held several leadership
positions including Head of the Pulmonary Division, Program Director of
Pulmonary, pulmonary and critical care fellowships at two naval hospitals,
and Director of Medical Services. Currently I serve as the Chair, Department
of Internal Medicine and Program Director of Internal Medicine Residency. I
have gained valuable experience during these years. I would like to share
just a few of my thoughts and experiences that have been helpful to me in my
career. "Fear of God is the beginning of wisdom" says Proverbs in the Bible
. With this in mind, I knew I can be a leader if I exercised good leadership
skills. There are many leadership skills and styles. There are many books
written on this subject. For me, I considered four skills that are critical
for leadership. These are knowledge, attitude, fairness with caring, and
communication. We need clear goals, well-defined strategies, adequate
resources, and we need to work closely with the team to accomplish the
mission. Remember there are no easy answers or cookbook solutions. The
leader has to understand the cultural resistance of the department when
change is called for.

Knowledge: Knowledge is power, and it is your vital asset. In service, you
will find yourself in situations of discomfort and danger. You may not be
able to predict or prevent these unwanted circumstances that cause fear,
anxiety, and discouragement. Knowledge for a leader includes not only
subject matter but also knowledge of personnel, their strengths, weaknesses,
resources, choosing the right person for the right task. The leader should
understand the mission of the Navy and the role of his team/unit to
accomplish the mission. I realized during my first leadership role that the
key is to study the unit's goals, assignments, resources and to evaluate the
need for changes. If your goal is to accomplish the Navy's mission, you
will receive the attention of your unit. When you demonstrate detailed and
thorough knowledge of the unit's mission and the unit structure, you receive
the respect of the unit. Knowledge and sound decisions are crucial for
effective leadership that inspires loyalty. You have to be flexible and be
able to utilize the available resources to accomplish the mission. During
the Gulf War, I was assigned to the Fleet Hospital 5 in Al Jubail, Saudi
Arabia about 80 miles south of Kuwait. I was the Director of ICU that had 80
beds. This was a tent hospital and the equipment was not comparable to what
you have in the ICU in the USA. There were many limitations to traditional
practice but we were able to provide the care that was necessary to help
these wounded and ill military men and women to stay alive and to arrange
transportation for them when stable. Knowledge and experience can overcome
the obstacles.

Attitude: We have the freedom to choose the attitude. Embrace a positive and
rewarding attitude. Having a healthy, positive attitude consumes less
mental energy with high productivity. It is also contagious. Your hopeful
outlook through difficulties, trials and discouraging situations can
energize your team and keep the mission on focus. It will create innovative
ideas, paradigm changes and opportunities to excel. Good attitude toward
life begins with gratitude towards God. A positive attitude in times of
crisis, chaos and calamity will determine your strength. My attitude at home
and work is very important to me. I learnt the secret that talking of
positive things that happened in your life and in others' life instill
positive feelings and create a positive attitude within you and in those
surrounding you. Well, we all get into the trap of sharing negative things
at times - some days more often than others. I realized, often it is an
expression of self pity and other times, it is a forewarning to your
colleagues to prevent them from facing unwanted end-results. Remember, when
you engage in negative talk, do not share it with your junior colleagues or
with your superiors. Choose your friends wisely and they can be your
sounding boards. Recognize and reward your staff. I actively seek out
opportunities to recognize and reward my trainees and staff for their
accomplishments and contributions to the department. All champions have seen
failures. Failure is not an end. There are plenty of good footprints that
need accolades.

Caring with Fairness: I strongly feel you cannot care unless you are fair.
You have to be a good listener to be fair and to care. Listening is an art
and it has a broader dimension than you think. In the last twenty years, I
have met a few colleagues who have the art of listening. With increasing
demands on productivity and time constraints, this valuable tool for strong
leadership is often ignored or underutilized. Listening with sincerity
followed by guidance and mentoring will make you a strong leader. Your
caring and fairness will earn the loyalty and respect of your unit. Your
unit will seek your advice and appreciate your feedback if you demonstrate
fairness in your actions.

Communication: This is a crucial skill you need to lead your team. In the
military, we diligently follow the chain of command in communication, a
discipline that is critical for smooth operation of our mission.
Communication is considered to be effective when the mission is accomplished
successfully. It travels through many tiers of leadership and therefore has
the potential to break down. An efficient leader considers proactively all
the possible avenues of miscommunication and prepares in advance to prevent
them. An effective communication requires the ingredients of articulating
precisely, listening carefully and understanding clearly. Now we know why
communication can fail. I learnt early on that you must do a careful follow-
up on your communication to reap a successful outcome of your mission.

Over the years, I have tried to capitalize on my strengths. I have become
very aware of my skills that need extra attention. Successful leadership at
higher levels calls for personal introspection, education and commitment. I
have learnt to prioritize, receive training, teach others, be prepared and
try not to be defensive. I have the following quotes in my office. "Wisdom
is knowing when to speak your mind and when to mind your speech", "Wisdom is
knowing what to do, skill is knowing how to do, and virtue is doing it".
Leadership is an ongoing challenge. In the military, approximately one
fourth to one-fifth of the staff in a team change every year and
consequently, the training and cumulative knowledge of your team changes.
You may be deployed or transferred. You may be called for a humanitarian or
combat mission at a moment's notice. Discipline, details and dedication are
cornerstone to sound decisions. Sound decisions and strategies earn respect
and loyalty that are pivotal for successful mission. A cohesive unit can
face the challenges and obstacles with courage and commitment.

The core values of the Navy are commitment, honor, integrity and loyalty.
These are the essentials of a role-model leader. I do not expect every one
and every action to be perfect. After a few years in the Navy, I began to
understand the different leadership styles and personality traits. I got my
skills analyzed so I know how to maximize my style in working with others of
different leadership skills. I also read books to get better grip on
leadership styles of men and women. Not having too many women in leadership
in Navy medicine in my early career, I am keenly aware of the value of
mentoring.

In summary, I have sailed through calm and stormy seas. There are only a
handful of international medical graduates in the military. Most of the
international medical graduates in the military have demonstrated exemplary
leadership and have received awards of recognition. The basic skills of
knowledge, attitude, caring with fairness and communication have helped me
to lead my team to accomplish the mission. I have enjoyed the collegiality
of my comrades, shared mutual trust and respect and have received loyal
support. Personally for me, the team includes patients and health care
providers, military and civilian, officers and enlisted staff. I am glad
that I did not leave the Navy after my two years of obligated time but chose
to pursue my naval medical career. I was chosen as the Governor for the
Navy Chapter of ACP in 1999. My husband and family have always been my
encouragers and sounding boards. With God's protection and guidance, I enjoy
serving the country both during peace and war times.

This article was prepared for the ACP IMG Web site in 2000.
--

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