To me the most daunting of speaking assignments is the after-dinner presentation. By the time the speech begins, the audience has been well fed, and many have emptied their wine glasses and refilled them several times. Bedtime is approaching, and the often somnolent listeners are nowhere near the peak of their powers of comprehension.
I have heard many such presentations, usually at surgical meetings and several from notable, even famous, personalities who had considerable wisdom to convey. Unfortunately, although I do remember the names of many of the speakers, their messages, if they were captured by the memory circuits of my brain, have since escaped me. There is one notable exception: a talk entitled "Tickets" given by Dr. Jerry Shuck, who was then professor and chairman of surgery at Case Western Reserve University. The occasion was the annual dinner of Surgical Biology Club III that is held during the American College of Surgeons fall Congress. This meeting occurred in the mid-1980s soon after I had assumed a major administrative responsibility as chair of a department of surgery. At the time I was the definition of a young, unseasoned, and inexperienced leader. The wisdom so unexpectedly imparted that evening goes to the core of exemplary leadership and has served me well over many years. In fact, I consider the message I received so important that it became a central tenet of a publication I wrote on surgical leadership several years later (Rikkers LF: Surgical leadership: lessons learned. Surgery 2004;140:717-24).
Virtually all surgeons are expected to be leaders. This responsibility may be limited to leading their operating room team or as extensive as guiding a large multidisciplinary health care team or a major academic department of surgery. Unfortunately leadership skills are not a component of the curriculum of most surgical residencies. Many surgeons have leadership responsibilities suddenly thrust upon them, and they are often ill-prepared. Courses in leadership offered nationally are usually expensive both in the cost of participating as well as time away from work. An exception is the ACS’s Surgeons As Leaders course that is conducted over a 3-day span. Thus, whenever a pearl regarding this challenging responsibility that we all face unexpectedly appears, it is essential to tuck it away into the recesses of one’s brain so that it can be quickly mobilized when needed. That evening at the Surgical Biology Club III dinner so many years ago was one such opportunity for me.
Shuck’s thesis was that a leader is presented with a gift of tickets when taking on a new position. In a sense, the tickets represent the goodwill freely given from the institution and the unit led at the beginning of one’s term. This is often defined as the "honeymoon period." Subsequent success or failure of the leader is greatly dependent on how these tickets are spent. Unfortunately, there are hard and fast rules of this ticket game that must be adhered to. Most importantly, once tickets are spent, they cannot be replenished. Second, one is never told exactly how many tickets he or she has been given. The bottom line is that one must be extremely careful in how the tickets are used. In other words, throughout the course of one’s leadership, issues and battles that require expenditure of tickets must be carefully chosen. Ticket spendthrifts tend to squander their tickets on relatively insignificant concerns early in their tenure with none left when a truly game-changing matter arises. A key concept that must be understood early on by inexperienced leaders is that most apparent crises are not crises at all. The tincture of time resolves or modulates most of them. Careful study followed by benign neglect is a wise course in many cases. Immediate and decisive action not preceded by detailed analysis, although occasionally merited, usually results in an unwise and unnecessary disbursement of tickets. The supposed crisis of today is often forgotten by tomorrow, even by those who were embroiled in it.
Another important notion for the unseasoned leader to grasp is the fact that we live in a gray world and that black or white issues are quite uncommon. The art of compromise, so poorly understood by our present national leaders, can be a crucial ticket saver. Rapid, definitive, and possibly risky decision-making is warranted only when one’s most cherished values are threatened. However, such instances should be infrequently encountered even during a long career in leadership. One absolute in ticket spending is to never waste tickets on those things that cannot be changed. The Alcoholics Anonymous serenity prayer provides sage advice for successful leadership: "God, grant me the serenity to accept the things I cannot change, the courage to change the things I can, and wisdom to know the difference."