I have had a lot of jobs, maybe more than most people of even my vintage. In the workplace, as well as in other domains, my basic premise is that leadership is earned. It is not granted by role or rite of passage. Once achieved, leadership is not sustainable without continuous proof of concept: what did you do today, or at least yesterday? In other words, leaders must demonstrate their value in a ceaseless and tireless way. For physicians, in a world dominated by administrators and insurance plans, our leadership may best be rendered through what is called “expert authority”—where a physician's unique and extensive knowledge of diseases and therapeutics, and of human nature, serves as the basis of his or her authority and the platform for leading.

Expert authority, like the leadership it seeks to exercise, must be earned. It is earned by having the capacity to know what works medically and why; translating the complex into the comprehensible; speaking clearly and concisely and in language meaningful to others; having the emotional intelligence to understand and respond to the concerns of others, particularly patients and families; and working well in teams and being able “to manage your boss.”

Be grateful to those who do good work. Find opportunities to thank them and enable them to shine. Find ways for them to do more. Don't be afraid to push people; they usually need it. When you do, make sure that you let them know you believe in them, and then support them. Don't be afraid to set high standards; no one I know has died of hard work.

Measure, measure, measure. Establish metrics that are understandable to your mother. Because when your efforts meet the undying forces of clotted interests, as they surely will, you will need to prove that what you are doing is working. Then despite any criticism that is raining down on your efforts, you can resolutely point to the evidence that what you are doing is working (and kindly acknowledge their concerns).

Enjoy the journey. The Spanish have an expression: se hace camino al andar—the road is made by walking it. You will be surprised by where you go and by the places you will discover, in yourself and in the community you call work.