How big is my ego? The trouble with a career in medicine is that you spend four years in a classroom and not managing people. It is impossible to gauge the size of your ego if you don’t have a stack of small unit leadership situations with which to calibrate it. The most needed quality as a physician leader (or any leader) is humility. Athletes and prior military folks tend to adjust nicely to life in medicine. They’ve been burned before. They’ve been in high-pressure situations such as swim meets, football games, or live-fire situations where they made decisions. Inevitably, they made a few bad decisions along the way and had to face transient humiliation in front of colleagues and subordinates. It’s good to take one on the chin in front of 30 or more people. Your brain has to make a choice. Not a multiple-choice question on an exam, but an actual choice. The only way forward is to confront the fact that you were wrong and learn from it. Iterate this a couple of hundred times and you have a much clearer picture of the size of your ego. Still too big? No problem, ask for some extra duties and get more comfortable looking like a dumbass. If you develop the habit of keeping your precious MCAT, USMLE, Phi Beta Kappa ego in check, then you will leapfrog 99 percent of physicians.

How big are my love handles? In the Marine Corps, if you are soft and overweight, you will not be taken seriously. In the civilian world, this type of standard is considered superficial and demeaning. Be advised: Weight standards are not superficial or demeaning. In medicine, you might not be doing wind sprints whilst carrying ammunition canisters, or high-rep pull-ups, but you still have a basic standard of discipline to maintain. A fit body conveys patience, another crucial skill in leadership. Waking up early and working out changes you physiologically. No time for early-morning gym sessions? Fine, do them at night. Maintaining a lean, toned, and healthy body takes time. For some, it can take years, depending on your baseline weight and fitness level. Years of patience (and persistence) with yourself will manifest as a trim waistline and some basic endurance capabilities (jogging 3–5 miles at a decent clip without stopping). This outward manifestation of fitness and physique is powerful. Fitness sends a message to those around you that you won’t give up on them, just as you won’t give up on yourself.

How badly do I crave name recognition? The defining benchmark in academic medicine is a physician’s number of publications. More broadly, having your name on papers gives you a sense of pride and builds your brand on a particular subject, as a published expert. The only problem with this culture of name recognition is that it is not grounded in reality. With the task of organizing an upcoming laboratory inspection, for example, nobody cares how many papers you’ve written in an obscure medical journal. Leadership is not about you. It’s about service. Every year I see kids post photos of themselves on Twitter announcing they have been selected as Chief Resident. As if this is some vanity game. Those same kids are in for a rude awakening when their Chief duties begin, and they are asked to cover for their colleagues who call in sick. Don’t be a CV monkey. You need to accept that if you take on extra responsibilities for the sole purpose of fattening your CV, akin to racking up publications, people will see through you. Are you really who you say you are? Or did you win a popularity contest? Get over your desire for name recognition. It’s your ego chiming in. It won’t go well.

Who am I sleeping with? You have a need for intimacy and deep connection. You may also have a need for casual intimacy. Take the latter need with great caution. Many years ago, as an intern, I would throw a get-together at my urban apartment once a month. My roommate at the time was a little older (and arguably wiser). A few attractive nurses walked in the door, and we enjoyed the evening. My roommate said, “What are you going to do?” I said, “I want to see the brunette again.” He said, “You don’t want to shit where you eat.” At the time, it sounded condescending. After a few months, I understood what he meant. We’re in the business of caring for some of the sickest patients in the city, county, and state. And you’re trying to sleep with the nurses? Unless you plan on marrying one of them and starting a family, be careful about casual intimacy with any hospital staff. There’s enough tension in hospitals as it is. You don’t need the added drama of a failed romance complicating the delivery of patient care. As you progress through medicine, you will see giants fall for various reasons. One of the more common ones is mismanagement of your zipper.

Where’s my journal? There’s a reason Marcus Aurelius’s Meditations was never intended to be read by anyone. Aurelius, the Emperor of Rome, never wanted to be Emperor. He was more interested in philosophy and writing. The role was thrust upon him. Meditations is his deeply personal attempt at managing his own emotions and mental state to better execute his leadership mission. In leadership situations, you must learn to keep your mouth shut. Verbal diarrhea is a manifestation of anxiety and internal conflict. Once, I met a high-ranking physician of a national organization. Whenever he was anxious, he would ramble on about half-formed thoughts, conjectures about the state of the industry, and gossip about colleagues in medicine. These interactions were awkward for me because they reminded me of a younger version of myself. I used to do the same thing. You can easily and cost-effectively avoid such ramblings by keeping a fresh set of pens and notebooks at your home desk, work desk, and in your backpack. Anytime you feel anxiety or another half-formed thought, record it in your notebook. Develop the habit of daily debriefs with yourself. What worked? What didn’t work? How could you improve for the next day? Odds are, in residency, fellowship, or a busy private practice, you’re not going to have time to see a therapist. While therapy is immensely useful, journaling is a highly effective proxy. For best results, your journal should be within arm’s reach at all times. Otherwise, you will unconsciously resist using it and won’t realize the benefits, compounded over time.

Who’s in my Rolodex? We have many obligatory contacts stashed in our iPhones or hospital-issued mobile phones. The same goes for our Google contacts. A Rolodex is a paper-pencil rotating spool of blank cards about the size of a business card, organized alphabetically. For family, close friends, and mentors, keep their contacts in a handwritten Rolodex. You will face leadership decisions that are difficult to make on your own. Write or phone a friend. Write your parents. Putting your rationale for choosing X over Y in hiring decisions, expense decisions, or regulatory decisions in written form will force you to critically appraise your thoughts and allow your inner circle to do the same. The best decisions are made when you are able to detach from the situation and from your thoughts. Mentors are usually happy to do this. If you don’t have a circle of mentors, build one. Don’t be alone and afraid.

Overall, these are important aspects to consider as a physician leader. Humility is key, and being able to accept and learn from mistakes is essential. Maintaining a fit body not only conveys discipline but also patience, another crucial skill in leadership. Name recognition should not be the driving force behind one’s decisions, and it’s important to avoid casual intimacy with hospital staff to prevent unnecessary drama. Keeping a journal and developing the habit of daily debriefs can help manage one’s emotions and thoughts in high-pressure situations, and maintaining a Rolodex of trusted family, friends, and mentors can provide valuable support and perspective when making difficult decisions.

The author is an anonymous physician.