First published on Monday, 02 November 2015
There are truly transformative leaders in occupational and environmental medicine and their leadership is of a certain type. One of the distinguishing characteristics of our most effective leaders is that they have toiled in the fields and worked behind the scenes and not on stage. They are quiet leaders, and although they do not draw attention to themselves, they make the difference in quality of life for their workers under their responsibility and the effectiveness and decency of the organizations they serve. Leadership in our field has come from excellence and problem-solving, not grandstanding. Even the one great and illuminating exception to the propensity for grandstanding was not only excellent and supremely confident, but judicious in knowing when to be loud and when to be silent. (We’ll get to that in a moment.)
Recently I had a profound and unusual professional experience. I had the opportunity to curate the papers of a distinguished occupational physician to get them ready for a university archive. Ernie Mastromatteo has been one of the foremost leaders of our field in the last half of the twentieth century. Ernie started in Toronto in the 1940’s and was active until about ten years ago. He is best known for having chaired the TLV Committee of ACGIH for decades and doing it remarkably well and with exquisite patience, but had many other accomplishments. During his long career he made contributions in public health as well as occupational medicine. He was a living link between worlds: he spanned two generations (postwar and the modern era), two countries (Canada and the US), two disciplines (occupational medicine and industrial hygiene, which when he began were not separate fields), and both poles of our field, occupational and environmental medicine (in which he had a passionate interest); he moved back and forth among academia and the public and private sectors and among government, labor and management. His range was truly astonishing but there was even more to the man.
We all knew that Ernie was a nice guy, but there in his papers was evidence of a deeper humanity. He never expected anyone to read his files and which he had not sorted or redacted before he became ill. Yet in them are numerous cases where he had offered an opinion to an injured worker or their family, steered someone in the right direction, found a viable solution to a worker’s problem that management was stone-walling, figured out a way to finesse the system so a hazard would get controlled, backed a program that he knew would be unpopular with employers, or called attention to a problem nobody else had spoken up about. It was all good work, done quietly, through networking, persistence, and deep knowledge of the field. And during his long career, he was renowned for giving young occupational physicians a hand wherever he could and for supporting the organizations, such as ACOEM and OEMAC, that form the infrastructure and civil society of the occupational medicine community. This is what I call “quiet leadership”.
Another example of a leader in occupational medicine who gets far less attention than he deserves is Harry Mock. We all know the story of Alice Hamilton. She was a truly transformative leader in our field whose life was truly inspiring. But although they worked at the same time, we don’t hear much about Dr. Mock. He was active at the turn of the last century and eventually became the medical director of Sears Roebuck & Co. ACOEM was founded in his office, near the Chicago stockyards, in 1916. Harry Mock lived well into the 1950’s, and along the way he started the first teaching clinic in occupational medicine in the US, made Sears the national model for health promotion in the workplace (with educational programs for immigrants and low-paid workers), promoted women workers as the equal of men for any job they could do, and wrote a superb textbook, one of the first and still one of the finest America has produced. He helped shape occupational medicine as a progressive medical movement in the first half of the twentieth century. This is leadership.
Moving forward in time, we meet the great exception. Irving Selikoff was the premiere leader in occupational medicine of the latter half of the 20th Century, although he thought of himself more as a lung doctor. When we look at his career, we see some features in common with Harry Mock in the first half: an interest in building institutions that will outlive one person and advance the field well into the future, a willingness to work with colleagues from all sectors to solve problems, a first-rate mind that attacked new problems fiercely and imaginatively, and a generosity to young occupational physicians. On the other hand, Irving was hardly quiet – he was noisy and passionate and vocal and not afraid to push and push hard for the rights and protection of workers – but Irving knew exactly when to push and how hard. Without him, we would not have made half the progress in preventing occupational cancer we have in the United States.
In this talk I have tried to emphasize the difference between a mover and shaker on the one hand and a truly transformative leader. A truly transformative leader needs very little force, very little bravado, very few threats to achieve a goal. The mover and shaker, on the other hand, has to move something, sometimes anything that can move will do, and has to shake something to get anything done, and in so doing the mover and shaker provokes pushback to the moving and causes damage from the shaking, damage to the institution, and insecurity to the people he or she is leading.
The worst leaders, aside from those who are downright venal, are those for whom moving and shaking become an end in itself, who feel that they do not exist as leaders unless there is a mark of their power indelibly stamped on the people who serve them. These are the narcissists and the sociopaths who cross the line and cause lingering damage, sometimes in the form of fragile institutions that depend too much on a single individual and always in the form of shame and insecurity in the people who they are supposed to be leading.
Notice, however, that I said that the transformative leader uses very little force, very little bravado, very little threats to achieve a goal. I did not say that he or she used no force, no bravado, and no threats. I assert that there is a time when these are necessary but that the truly transformative leaders knows when not to use them and uses them sparingly when they are required.
Irving Selikoff was just such a leader. Irving could be very tough. I once saw his unrestrained wrath when he publicly and brutally and publicly eviscerated a prominent apologist for chrysotile asbestos. Irving did not grandstand; he just knew exactly what to say and when and where to say it and with how much passionate intensity. It was like he was dissecting the guy while he was still alive, examining his motives and methods and confronting him with the consequences of his misdirected life. Nobody who witnessed that moment could ever doubt afterward that banning exposure to asbestos worldwide is a moral issue, not just a question of labor regulations and public policy.
Leadership in our field requires finesse, patience, and deep insight. That makes many people uncomfortable, because they want a fighter, who can dash in guns blazing and set things straight. But the field we work in a very complicated, highly structured setting, full of regulations, management systems, compensation eligibility requirements, reporting requirements, rigid definitions, and accountability. It doesn’t matter that these systems often fail us; you still have to work within the system to have a hope of the right outcome. Push too hard and the structures break or jam and then who gets hurt? Usually the injured worker, that’s who.
Anyone can shoot from the hip and react to events as they unfold. A truly transformative leader in occupational medicine knows the score, understands the problem, acts from a position of insight, and thinks before acting.
Up to this point, we’ve talked about transformation leaders in occupational medicine such as Alice Hamilton, Harry Mock, Irving Selikoff, Ernie Mastromatteo, and [in the original keynote address] Joel Gaydos. We must recognize that there are also false prophets in occupational medicine, just as there are in any field. We will discuss those at a different time.
A few years ago Kathryn Mueller and I coined a slogan for occupational physicians: “We protect the health of the people who make our world and keep it running.” Every generation, we need transformative leaders, not to transform occupational medicine but to transform us. We need transformative leaders to make this mission relevant again and to reassert our values for a new era.