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This is What Toxic Leadership Looks Like

A cold, long, Thursday afternoon in PA school, I gingerly walked into the operating room (OR) before a vascular procedure. I was welcomed by the attending physician and I was very excited to get the experience and find out if I liked surgery. (it turns

As the team came in I and because I had an innate understanding that there is no lower life-form in an OR than a PA student, I politely introduced myself to someone I did not recognize. Their response:

"Are you f---ing kidding me!"


"I'm the chief resident."

Oh...Talk about a great first impression.

For the next six hours, I had to stand by this person. My only thought was, the sooner I could get away from this person the better my life would become.

Toxic leadership comes in abundance in medicine. In fact, when it comes to toxic culture & toxic leadership, healthcare may be one of the chief offenders.

I was fortunate to learn what exemplary leadership looks like early in life. As an eagle scout, I was part of a troop with a strong tradition of youth leadership.

The Scout Masters who were the adults who led the troop, gave us (high school and junior high boys) a lot of opportunities to take the reins and run the program.

I learned a lot about leadership in this experience. I learned effective leadership skills, but also how not to lead.

In our troop, most lessons in leadership meant the oldest, meanest, biggest, loudest, most dominant guy became the leader and everyone else fell into place. It was a conglomeration of "Animal House" and "Mean Girls".

From age 11-16 I was completely dominated by 230 lbs line-backers and rugby players who could crush me into a pulp. They were faster, louder, know, a "leader".

Under their command, something sad began to happen to me. In trying to live up to their expectations, I also became mean.

Eventually, when I developed into a 210 lb wrestler, by those standards, I fit the role of leader perfectly.

If I’m honest, It did not feel right.

So What does Great Leadership Even Look Like?

So I began looking for a different type of Scout Master for a different approach.

Then I found Mac.

Mac was a Korean War veteran, attorney, grandfather, and icon in our community who was tougher at 75 than I could ever imagine. He was everything any of us could hope to be.

But, Mac did hold his experience or credentials over us. Mac was a servant.

The man carried the respect of everyone around him, including the other Scout Masters.

I noticed small, but meaningful differences in their leadership styles.

When the 18-year-old, 220 lbs linebacker, the leader of the troop always ate his meals first,

Mac ate last.

As the older scouts looked out for the popular ones to mold into their ever-dominant image.

Mac looked out for the strugglers.

As we ignored and mocked the "troubled" Scout.

Mac saw potential in everyone and pushed them to be better.

What I observed in high schoolers was that their domineering, abusive, sarcastic, and demeaning leadership was actually rooted in insecurity.

Mac showed me humble, servant-hearted leadership.

Toxic Healthcare Leadership is the Norm in Healthcare.

You may be asking, why does this matter to medicine?

Medicine has profound leadership problems. Problems born from the normalization of abusive training & indoctrination within an inherently oppressive healthcare system.

It is difficult to be kind all the time when you live in a state of cut, throat survival and are pushed beyond your human limits your entire career. Extreme stress on healthcare professionals is no longer reserved for war-time medicine. Especially in a pandemic where shaky pre-pandemic infrastructure is exposed and collapsing all around us, as well as the unsustainable workload and emotional toll of normalizing young people dying in droves.

I mean, are we surprised that these conditions create monsters?

Just as the chief resident berated me for not knowing who she was, we have more of a habit of acting like the 220 lb high school line-backers than wise, battle-tested, thoughtful leaders in our field and community.

We bully, demean, mock and berate those below us. We "eat our young."

One cannot blame the product of years of a deeply ingrained toxic culture at an institutional level on one person or a few- the entire system must be examined, uprooted, and rewired.

So What can we do right now to deal with Systemic Toxicity in Medicine?

Historically, knowing what we know about dismantling malignant and deeply ingrained toxic leadership, we know 2 things:
1.It is possible to dismantle &
2.It will take some time.

So what is it going to take to build a world where people in medicine care about each other right now?

A culture of humble caregivers who know their value and seek the best in others.

What would it look like for people in medicine to be like Mac?

Imagine a health care field of battle-tested, thoughtful, mentors of patients and staff, who do not treat others like garbage. Imagine leaders who celebrate small achievements, call out people of integrity and hold them in high esteem. Imagine, when someone fails or falls short, you do not publicly reprimand, but you bring them to a place of restoration and chart a path forward. It means trusting those "below" you with leadership and walking alongside those who want to be like you.

Medicine would be an incredible place if we had more leaders like Mac.

What you can do Now if your Leadership is Toxic?

While you need to seek out wise, humble leaders, what do you do if you find yourself under the charge of a malignant leader?

Realize what you can control

  • Take care of your own little corner of the universe. Take great care of yourself and everyone around you to the level of your bandwidth. Over time this will build & you will develop influence where you are. This may not be from a place of positional power, but relational influence. Do your best to create a place of leadership from the person you are. This is the most challenging, but also the purest form of leadership. Be gracious to your team.

  • Remember, they are the result of their upbringing and are part of a broken system

    • Many people in medicine have been raised in an abusive structure that values many things, except the people working on the front line. How can you expect a well-rounded thoughtful leader to naturally be formed if they have spent their entire life steeped in this culture? Be compassionate with them while also upholding your boundaries in kind ways as much as you can control.

  • Approach them for a conversation and come with a plan.

    • Try starting with this: "When you have a chance can we have a conversation?" Then when the conversation happens do not attack, take a moment to affirm the challenge of their position, your respect for them (this may take a little extra effort), and that you are putting your best foot forward. Then state your "concerns." Present your concern graciously, you do not know the pressure they are under and try to approach the conversation. Be gracious, intentional, and thoughtful.

  • Allow time for mutual trust to develop.

    • With your new boundaries set, and history with a contentious existence with this person, it's going to take time to get to a better place. Trust takes time, from both ends. Consistency tends to disarm people slowly but last the longest.

  • Bring your concerns to higher leadership

    • If nothing happens, or worse the situation becomes even more caustic, Bring it to the supervisor. Is this something that can be addressed with the leadership team or does this mean you may need to change your position to a different department? Maintain your professionalism, kindness, and grace above all else.

  • Prepare to leave.

    • If the company will do nothing to improve this situation, & you have exhausted all attempts to make the situation better it may be time for you to leave. For some people, this is a simple "I am done", for others, this may take planning, preparation, and thought as you network, apply and interview for other positions. The process of leaving a job well is a whole different blog in itself, but the most important thing is: do not burn a bridge, because your professional reputation as a whole transcends all jobs. Be gracious as you leave and be proud you took the steps necessary to do what is right for you.

Hopefully, some of these thoughts are helpful. More important to me is that you learn to recognize excellent leadership and seek to emulate their practice.

Medicine is hard. Leadership is hard. Life is hard. So, let's be gracious to each other as we seek the best for our teams, patients and communities.

Jono Lippman, PA-C is a California native, Armenian American, former camp counselor, backpacking guide, and creative director who somehow found a career in medicine. I have never been able to get away from my passion for teaching and mentoring. The thing that drove me insane when I was in school was the poorly organized approach to content coupled with a culture that says “if I suffered through it, you should suffer through it.” As a married, parent of three, going through PA school I needed to do better. So I created my own notebooks, which have become “Quill Notebooks”. To me, a notebook is empowerment and focus. I created Quill Notebooks because every student of medicine deserves a guide.
I can be found at


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