No one has to listen to you. Lead anyway.
Almost 25 years ago, I became Chief Resident. It was my first real leadership role. I wanted the job, and I got it.
The job also came with an extra $1,000 a year.
That thousand dollars gave me one thing: control over the call schedule. It was my only real power. I made the schedule, and people were expected to follow it.
But there was a catch.
Someone would get sick. Someone else would get delayed while traveling. One resident even changed their residency during my first week. Suddenly, I was on the phone — not giving orders, but asking for help.
“Any chance you could take Friday? I know it’s not your night. I know. I owe you. I really owe you.”
That was the reality. My title said I was in charge, but I spent the year asking my peers for favors they could easily turn down.
I thought this was just a problem with residency, something I’d outgrow once I had a real leadership job.
How wrong I was!
The Secret the Senior People Already Know
What no one tells you about your leadership in medicine is that authority rarely works, even when you have it.
You might think leaders above you give orders that everyone follows. They don’t.
The department chair can’t force a chronically late surgeon to be on time. The chief medical officer can’t make a colleague change her prescribing habits. They can ask, make a case, or rely on relationships, but they can’t command. The person across the table is an independent professional who answers to their license, not to their boss.
And there’s a second reason the order-giving fantasy falls apart. If you push a physician hard enough that they walk, you don’t just lose a colleague. You lose months of recruiting and, depending on the specialty, a replacement cost that can run well into six figures. Everyone in the building knows this. The doctor knows it too. It quietly changes every conversation.
Most new leaders imagine leadership as a ladder, where authority grows as you climb. In reality, that’s not true in our field. No matter your position, you’re still trying to influence people who don’t have to listen.
So leading your peers isn’t a lesser form of leadership — it’s the real thing. Even those with big titles rely on influence. They’ve just become so skilled at it that it looks like authority from the outside.
If that’s true — and it is — then the skill you think you’re missing is actually the one everyone depends on. Let’s learn it, not as theory, but as something you can use right away.
People are generally better persuaded by the reasons which they have themselves discovered than by those which have come into the mind of others.
– Blaise Pascal
When You Can’t Command, You Sequence
Years after residency, I became chief medical officer at a state psychiatric hospital. One day, a fairness issue came to me.
Two psychiatrists shared a ward. One was senior, the other junior. Both wanted the same week off — spring break for the local schools.
The doctors at the hospital were unionized, and our contract was clear: if two people request the same time off, seniority wins. The senior psychiatrist had filed, so by the rules, the week was his.
The junior psychiatrist was upset, and understandably so. If seniority always decided, she would lose every popular week, every holiday, every summer — this year, and every year they worked together.
I could have simply made a ruling. The contract supported me: “He filed, he’s senior, that’s the rule.” Two sentences and the issue would be settled. Authority would have technically solved it.
But resolving and solving aren’t the same. If I ruled, she would lose and he would win, but both would have to keep working together, now divided. One would be unaware of the other’s needs, the other would be resentful. Using my authority would only hurt the team.
So I didn’t make a ruling. Instead, I went to talk to him.
I didn’t start with the problem. I started with a question.
“Tell me about your ward partner. What do you know about her?”
He looked at me a little sideways. “What do you mean? She’s good. We get along fine.”
“Does she have kids?”
“Yeah. Young ones, I think.”
“Do you know when their spring break is?”
A pause. “Sometime in March?”
I told him the exact week. The same week he’d requested.
He saw where this was going, and he did what most of us do when we feel a fairness argument coming. He reached for the rule.
“Look, I filed first, and I’ve got seniority. That’s the contract. I’m not trying to be a jerk about it. And I’ve already booked a cruise.”
“You’re right,” I said. “You do. And I have to honor it. If it comes down to the rule, the week is yours, and I’ll make sure of it.”
That was important. I made it clear I wasn’t there to take anything away from him.
Then I asked the question that really mattered.
“I just want you to think about something. Don’t decide anything today. If every time there’s a week worth wanting, you get it because you’re senior, not because the two of you talked it through — what does that do to the two of you a year from now? Five years from now? You’re going to share that ward for a long time.”
He didn’t answer. I didn’t make him.
I said, “Just sit with it,” and I left.
Pay attention to what I did and didn’t do — the order matters.
I asked before I explained. My first words were a real question I didn’t know the answer to: what did he actually know about her? It wasn’t a trap. It was genuine curiosity, which is disarming because it’s not an accusation.
I let the facts speak for themselves. When I told him the dates, I didn’t add, “so you can see why this is unfair.” I simply shared the information and let him connect the dots. The space between knowing she had kids and letting it matter was where the solution could grow. If I had filled that silence with my own conclusion, it would have been mine, not his.
I shifted the question he was considering. The contract made it about his week versus her week, and by those rules, he always wins. I quietly reframed it: a week off this year versus a strong partnership for years to come. Suddenly, winning the week didn’t seem like much of a win.
I didn’t push for a decision on the spot. Forcing a yes in the moment is just compliance, and that can turn into resentment. I gave him space to decide on his own.
A couple of days later, he came and found me. He had talked to her and decided to withdraw his request. He moved his week back by one. What still makes me smile is that he admitted his own kids weren’t even in school anymore. It was just habit and a bit of entitlement. He had already called the cruise line, and they rescheduled him a week later with no extra fee. Sometimes, good decisions get rewarded.
He solved it more completely than I would ever have dared to ask. And he repaired the relationship himself, which is the only way it actually gets repaired.
When you can’t give orders, you guide someone through a series of small, honest realizations until they reach the conclusion themselves. Ask questions before sharing facts, share facts before framing, and frame before leaving space for silence. And don’t try to close the deal yourself.
A leader is best when people barely know he exists… when his work is done, his aim fulfilled, they will say: we did it ourselves.
– Lao Tzu
When It Doesn’t Work
I’d be lying if I said this always works.
Sometimes you do everything right, and the person still says, “The contract’s the contract. I’m taking my week.”
It happens. Influence doesn’t always work. If someone claims their method always succeeds, they’re not being honest.
So here’s what to do when it doesn’t work.
You follow the rule. The senior person gets the week, and you don’t punish him for using a right he truly has.
Then you talk to the junior partner. Don’t avoid the conversation.
Tell her it didn’t work out this time, and take responsibility. Then ask the question most leaders forget: “How can I make this up to you?”
Because what’s really at stake is bigger than a week off. She’s not just losing a vacation — she’s learning about you. She’ll see whether you stood up for her or just hid behind the rule. The outcome is the same — she loses the week — but whether she trusts you next time depends on how you handle it.
You can lose the issue but still keep the relationship. That relationship is what lets you try again. So protect it most on the days you lose, not just when you win.
Then try something else. The approach that didn’t work this time might just be the wrong fit for him. Maybe he responds to data, or maybe he listens when a respected peer brings it up instead of his boss. Maybe he cares more about reputation than relationships. You need more than one approach. Good speakers adjust to their audience. Good leaders do the same, just with fewer people.
Leadership Lessons From Public Speaking
I’ve spent the last couple of years in competitive public speaking. One thing you learn is that you can’t force an audience to feel anything.
You can’t make a room trust you or tell people to care. You have to earn it by how you start, what you ask, where you pause, and whether you let them reach the point themselves instead of forcing it.
A group of peers is just like an audience. So is the colleague you hope will change their practice, even though you can’t order them to. So is the department you need a favor from, even if you have no authority. None of them has to listen to you.
I used to see that as a problem.
Now, I think it’s the most honest part of leadership in medicine. No one has to listen to you, so anything you accomplish, you earn.
That’s not a weaker form of leadership. That’s the real thing.
The One Practice
Before you try to influence a peer, write down something you truly don’t know about their situation. Start your conversation by asking about it.
Don’t ask something you already know. Ask a real question.
That one step sets the whole process in motion. It puts you in a mindset of curiosity, not argument. It brings out a fact the other person might not have linked to the problem. And it gives you the right to ask the question that really matter — how this will affect your relationship in the future.
You don’t have authority over them. You never really did over anyone. Go earn the only thing that ever worked.
