Know Thyself


"Thank you all for agreeing to what I think is an excellent plan." Thus concluded the meeting led by one of the division heads in our department of surgery. The key agenda item was developing consensus on a highly controversial academic incentive plan that would transfer revenue from the busy clinicians who produced it to the faculty who were more engaged in the academic and educational missions of the division.

Several faculty members later related to me that the division head had dominated the conversation, belittled suggestions from his younger and less powerful colleagues, and "convinced" them to accept his plan with minimal alterations. They were irritated and frustrated. The division head reported to me that the meeting had gone extremely well and that he was able to gain consensus on a controversial and difficult issue. He was very pleased with himself.

I think we have all experienced this scenario – a person who is highly competent and possibly even pleasant in a social setting enters a meeting and, within minutes, irritates and comes into conflict with nearly everyone present, but sadly does not realize he has done so. What is lacking here?

The ancient Greeks called it "nothi auton" or "know thyself," and the modern parlance for it is self-awareness: the essential core of emotional intelligence and one of the most valuable attributes you can possess as a human being. In essence, it represents opening a door to your mind and discovering your own reality.

If self-awareness is so valuable, what exactly is it, why do you need it, and how do you get it if you don’t have it? Self-awareness consists of a number of components. First, it is an objective recognition of your strengths and weaknesses, values and beliefs, motives, and emotions. It also consists of an ability to continuously compare your current behavior to your core values and objectively assess whether that behavior reflects those values. Self-awareness also helps you to understand other people and how they perceive you. It helps you to recognize when you are stressed, and is a prerequisite for effective communication and interpersonal relations.

Why do you need self-awareness? Having self-awareness is required for you to be able to accept who you really are, to change those aspects of your personality that need to change, and to build on your strengths and clearly define your weaknesses. It is an important ingredient for effectively communicating with the world around you. In fact, it is difficult to imagine a happy human existence without a reasonable dose of this essential elixir.

Also, knowing oneself is the component of emotional intelligence that effective leaders possess in abundance. When I have encountered a failure of leadership in my surgical world, 90% of the time it has been due to a relative lack of self-awareness. (By the way, the division head described at the beginning of this editorial is now working elsewhere and the incentive plan for which he thought he had gained consensus is on the trash heap of unrealized objectives.)

How do you get self-awareness? In my experience, it is extremely difficult to instill self-awareness in people who are starting on empty. For individuals in leadership positions, the complete lack of this attribute may be a fatal flaw. For most of us, it is a natural part of maturation and can be improved by spending time in self-reflection, a practice few surgeons utilize because of their busy lives. Self-reflection should include spending quiet time, asking yourself difficult questions, and giving honest answers. Did I live to my core values during the meeting I just led? What could I have done better to lower the temperature in the room and avoid the conflicts that ensued? This requires commitment and courage. Also helpful is to have a sounding board of friends, colleagues, and/or mentors who are willing to critique you and provide honest feedback regarding your conduct during meetings, in the operating room, and even when having informal conversations.

So if you haven’t had the opportunity or acquired the tools to introduce yourself to yourself, it is never too late. It is not an easy process, but I believe you will be pleased with the result – a happier and more productive life.

Dr. Rikkers is Editor in Chief of Surgery News.

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