Why Doctors Must Unlearn Their Uncertainty-reducing Reflex To Be Effective Leaders
Doctors learn to turn uncertainty into certainty.
A patient walks in with vague symptoms.
We collect information and narrow down the possible causes.
We rule things out. We arrive at an answer.
This habit is not optional; it saves lives.
Medicine Is All About Closure
Medical training is essentially a long apprenticeship in closure.
Every exam question has one right answer. Every case presentation ends with an assessment and a plan. Any delay can be risky.
Uncertainty is treated like a fire alarm: you notice it, control it, and put it out.
If you spend too long with uncertainty in medicine, people can get hurt.
So we come to believe, often without question, that not knowing is dangerous.
Leadership Is Different Terrain
Then one day, a physician moves into a leadership role and finds that the instinct that made them a great clinician now works against them.
Leadership often feels like being in constant fog.
There is no CT scan for low morale, no lab test for people feeling unheard, and no imaging for culture drift or ethical discomfort.
The hard truth is that in leadership, rushing to find answers can do more harm than waiting.
It usually shows up in meetings.
Someone says:
“Our team feels disengaged.”
“Communication is broken.”
“There’s growing resentment.”
The physician-leader’s mind races, quickly coming up with and discarding possible explanations, and then starts looking for solutions.
Before anyone has finished reacting, the leader says, “Okay, here’s what we’ll do.”
It’s efficient, but it’s too soon.
People nod, but nothing changes.
Why Speed Backfires in Leadership
In medicine, fast closure builds confidence.
In leadership, fast closure erodes trust.
Why? Because people do not need answers first.
They need meaning first.
They need to know:
“Was I heard?”
“Was this understood?”
“Does this matter?”
When leaders rush to solutions, people feel processed instead of respected. It’s like interrupting a patient mid-sentence because you think you already know the answer.
Accurate? Maybe.
Trust-building? Rarely.
Fast closure builds confidence in medicine but erodes trust in leadership.
Fast closure builds confidence in medicine and erodes trust in leadership.
The Manager’s Reflex vs. The Leader’s Pause
In 1977, psychoanalyst and leadership scholar Abraham Zaleznik published a now-classic article in Harvard Business Review asking a deceptively simple question: “Managers and Leaders: Are They Different?”
Zaleznik observed that managers “embrace process, seek stability and control, and instinctively try to resolve problems quickly — sometimes before they fully understand a problem’s significance.”
Sound familiar? That’s the diagnostic instinct that physicians bring into leadership.
Leaders, Zaleznik argued, work differently. They “tolerate chaos and lack of structure and are willing to delay closure in order to understand the issues more fully.”
Think about that. The very quality that makes you uncomfortable in meetings, the feeling that you should have an answer but do not, might be exactly what leadership requires.
The Turbulence Metaphor
Clinical medicine is like flying at night with instruments that show you exactly where you are and what you need to do to stay on course.
Leadership is like flying through bad weather without instruments. In these conditions, you need to rely on your judgment.
You must remain steady, communicate clearly, and help others get through the experience.
That skill is not taught in medical school, at least not when it comes to leading people.
You must learn it intentionally.
Why This Feels So Uncomfortable
Doctors equate uncertainty with incompetence.
Leadership flips that script.
In leadership:
Saying “I don’t know yet” can build credibility.
Sitting with tension can increase trust.
Delaying closure can prevent turbulence.
The discomfort physicians feel isn’t failure. It’s muscle soreness from using a leadership muscle medicine never trained.
The One Practice That Changes Everything
Next time someone raises a problem, try this:
Do not offer a solution until you’ve named the uncertainty.
Try saying:
“There’s more here than we understand yet.”
“Let’s first understand why this barrier exists before tearing it down.”
It will feel wrong.
It will feel slow.
It will feel unsafe.
That is the start of leadership.
You’re not failing at leadership.
You are building the foundational skill Zaleznik described: the willingness to stay with uncertainty long enough for genuine understanding to emerge.
That discomfort isn’t a problem to solve. It’s a signal you’re in the right place.
This is Part 1 of a four-part series exploring how physicians can navigate the manager-leader tension in healthcare. The series draws on Abraham Zaleznik’s “Managers and Leaders: Are They Different?” (Harvard Business Review, 1977), reinterpreted for modern healthcare leadership. The article was republished in 2004.
Next week: Why being right too fast quietly breaks trust.
