Good morning and welcome to day two of the Mid-Year 22 Conference. I'm privileged to present the W. Kenneth Ryland Memorial Award to Dr. John Mills. Dr. W. Kenneth Ryland, D.O., born 1912 until he died 1989, was born August the 12th, 7th in 1912 in Camden, New Jersey. His patients included Richard Nixon and Nelson Rockefeller. He was the co-founder of the New York College of Osteopathic Medicine in Old West Ferry, Long Island, New York. Personal physician to Nelson A. Rockefeller for more than 30 years, Dr. Ryland treated a number of nationally known figures. He provided osteopathic manipulative treatment to Richard M. Nixon for several years and even traveled with the president in his world trip in 1969 and his trip to China in 1972. Dr. Ryland also provided OMT to Henry A. Kissinger during his stint as Secretary of State. Dr. Ryland graduated from the Philadelphia College of Osteopathic Medicine in 1936. Soon after settling in Manhattan, he began working part-time for the U.S. Steel Corporation. He later became U.S. Steel's chief physician in New York, a position he held for more than 20 years. In 1974, he became a consultant to the company. He was still practicing in Manhattan at the time of his death. He was co-founder and chairman of the board of the New York College of Osteopathic Medicine of New York Institute of Technology in Old West Ferry, New York. He was also founder and the first president of both the New York Academy of Osteopathy and the Academy's Foundation for Research. Dr. Ryland delivered the 1969 Andrew Taylor Steel Memorial Address, an annual lecture presented at the AOA House of Delegates in memory and honor of the founder of osteopathic medicine. It is considered as one of the profession's highest honors. Dr. Ryland was board certified in physical medicine and rehabilitation and was a fellow of the American Academy of Osteopathy and the New York Academy of Osteopathy. He served the AOA, the AAO as a trustee and as a member of its board of governors and he was the 1963 recipient of the Academy's Andrew Taylor Steel Medallion of Honor. He also served as chairman of the board of trustees of Postgraduate Institute of Osteopathic Medicine and Surgery, which is now affiliated with New York College of Osteopathic Medicine. Dr. Ryland received an honorary doctorate of science from Midwestern University of Chicago College of Osteopathic Medicine, a Doctor of Laws degree from the New York Institute of Technology. He also received a Distinguished Service Award from the New York State Osteopathic Medical Society and the O.J. Snyder Memorial Medallion from the Philadelphia College of Osteopathic Medicine. He was known to be a Manhattan socialite. He kept a journal of his life's events, which is now at the Rockefeller Archive Center at Rockefeller University in New York City. He died of complications from lymphoma on 13 March 1989 at New York Presbyterian Hospital at the time he was 76 years old. Today, the W. Kenneth Ryland Memorial Lecture and Medal presentation is a key feature at the annual mid-year conference of the American Osteopathic College of Occupational and Preventive Medicine. Dr. Ryland was a pioneer in the field of occupational and environmental medicine, a longtime member and fellow of the AOCOPF. Established in 1983 by the board of trustees, this prestigious lecture is presented by an individual member or non-member who has demonstrated a desire to see the practice of occupational and preventive medicine excel for the public good. Today, Dr. John Mills will present the Kenneth Ryland Memorial Lecture, Dealing with Difficult People. Dr. Mills graduated from Michigan State University in 1979. He completed an aerospace medicine residency in the U.S. Army and holds an MPH from the University of Michigan and an MS degree from Michigan State in anatomy. He has served as a teacher at Michigan State, the School of Aviation Medicine, and the University of North Texas Health Science Center. Dr. Mills had the privilege of serving as a helicopter pilot during the Vietnam War and holds the ratings of parachutist, senior pilot, and master flight surgeon. Dr. Mills is currently the medical director for correctional programs of UNTHSC. It is with pleasure that I present this award to Dr. Mills. Very nice, thank you. Well, thank you for those kind words. I have no disclosures and I have no conflicts. I generated this lecture mainly because I've been a department chair three times, an associate dean, which at the time was the number three person at the University of North Texas Health Science Center, and I've been a medical director four or five times, company commander in the Army, section chief in the Army, clinical director inside the federal prison system for a federal medical center, and chief of staff at a hospital. So I've had to deal with a lot of people and everybody talks about wanting to get promoted. Well, that's a two-edged sword because there's a lot of difference between being a good doctor and being a good boss, and a lot of times we promote people, particularly in medical schools, positions of leadership because they're good doctors. Then we wonder why they fail as leaders. So and when I was associate dean, every time they hired a new chair, I would go down and sit with a new chair periodically and just give them some tips on how to survive. Kind of a boot camp for department chairs. So as a physician, as a boss, as a leader, you are going to deal with difficult people. That's just part of the ballgame. So just some general tips is you stay composed. One of the major maneuvers that difficult people try to do is get you upset because when you're upset, you say things you shouldn't say, and the more things you say, the more things you can be quoted of. So never sink deeper than you can swim, because you're going to sink deeper than you can say. The more things you say, the more things you can be quoted of. So never sink down to somebody's low. If you're dealing with somebody who's difficult, you don't sink down to their level. You stay professional. You stay composed. If things get just completely out of hand, just turn around and walk away. They can't write you up for walking away. I was in a meeting once with a faculty member who was going to sue the university for sexual discrimination to the position, and she started verbally assaulting her chair, who was a very famous guy, you know, full fellow of the academy. And then when she got done ranting and raving about this person, and I'll admit he was old school, rigid, and maybe not somebody I would want to work for, but all in all, had a distinguished career, and then she started pointing her finger at me and said, I want the guy fired. She didn't want him demoted. She wanted him as a tenured professor. She wanted him fired. And I just looked at her, got up, walked out, because I wasn't going down the road of firing some tenured professor. So things just really get out of hand. Just get up and walk out. And, you know, they're going to be there when you get back. Believe me, they're not going to. It's helpful if you understand why somebody is behaving that way. You know, do they have some kind of behavioral disorder? You know, it happens, even among physicians and other people that you work with. The other thing is, my oldest son died of cancer when he was 21, and I was an administrator at the university. So I think some of the people at the university were wondering, well, why I missed the meetings and why I did this and why I did that. They had absolutely no insight into what was going on in my personal life. So a key element of being a leader is understanding the people that work for you and understand the dynamic around them. You know, is somebody getting a divorce? Is somebody's child into the drug abuse? You know, what's stressing them out? And sometimes that leads them into the path of becoming difficult people, because they've just run out of coping skills. It's always helpful if you can talk to other people who know the individual you're dealing with and say, can you explain why Joe or Susan is having these problems? Do you know something about it? I don't know. Is there, you know, they're in conflict with another co-worker? Something's going on in their personal life. So the more insight you get into somebody's behavior, the better decision you're going to make. And one thing I would, and this just drives me crazy in today's world, just treat everybody with respect. One of my best friends and colleagues is on the complete other end of the political spectrum from where I live as a retired Army officer. And, but I still listen to everything the person has to say, because every now and then he has a point, you know, like, you know, I try to base my decisions on facts, you know, data. I'm a data-driven person. And I hope everybody in the medical field is a data-driven person. You know, we do things because that's the best practice and we can back it up. Not that everything in medicine has best practice evidence. So when you have abusive co-workers, I always view my work unit as a family. You know, they're my work family. And so if somebody in your work unit is being abusive, that affects the attitude of the other members of your work unit. So it's not something you can just ignore because it's not just them that's causing trouble. If they get other people upset and they're not performing at their optimum level, it drags down the performance of the whole work unit. So I encourage you not to just ignore these kind of problems. Just so happens, we cut somebody loose from the work unit that I'm in just before I left. Texas, come here. And we had a ton of emails and texts from this guy being abusive to us, okay, which we handed over to HR. I mean, that's the way the new younger people are. They feel like they got to put everything in a text. You know, they got to vent. You don't have to vent. Because anything you send back to them will be used against you later. So if somebody sends you something, you can say, okay, this thing was read, you know, I've read this or noted, you know, and that's all there is. So that when this person went to HR, and they says, okay, well, where's the text message from the leadership of your work unit? Well, I don't have it. We had a big stack of his. And so, you know, I work with federal prisoners. And I can tell you right now, you know, if there's a problem, you don't put an email. You know, somebody missed an oncology appointment, you know, because the Bureau of Prisons had a ban that was broken down. You don't send them a nasty gram saying, oh, Joe Smith missed his oncology appointment because you don't have a ban. You come up on the phone. You put that email, it's discoverable when it goes to court. And so you try, when you're working with, you know, the big thing is you want to correct the problems. You don't want to set a trap for one of the people you work with. So just be careful about what you put in a text. You know, it's okay to text happy birthday. But when you're dealing with problems, you have to be very careful about what you put in writing because all that stuff could end up as an overhead in court. Somebody asked me what an adequate medical note looked like for a prisoner. And I said, well, just imagine it's blown up 10 by 12 feet in front of a federal judge. And so what do you want in that note? You want a very nice note. And just as a sidelight, when I talk to people about it, you know, I'll walk into somebody's room and they'll start saying bad things about my mother, you know, or start saying bad things about me, you know. And I tell them, I says, just copy it down word for word and put quotation marks that Joe Smith called me, you know, all kinds of nasty things. Because if this ever goes to court, you want the federal judge to know exactly what you were doing. You know, you want to create an atmosphere around the person that's trying to sue you. I've taken care of prisoners for 25 years and I've never lost a penny in a lawsuit. When I was medical director of Tarrant County Jails for almost 10 years, the county didn't pay out one cent over a medical case in 10 years. It was unheard of. But it has to do with documentation. I don't want to get too far off track here. Now, what is the best style of leadership? You know, do you want to be by the book, hard-nosed? Do you want to be everybody's friend? You know, easy going. You know, everybody wants to go see Stan Miller because he's a nice guy. You know, that guy. Well, the truth of the matter is your leadership style should be completely flexible. There are times when you need to be rigid by the book. Everything's going to be followed by the book. And there are other times when you need to be more lenient. Your leadership style should be driven by the situation and you shouldn't be so rigid that you're married to one leadership style that will get you into trouble in certain situations. So flexibility of leadership style is a key element of leadership. Now, when they asked me about what kind of leader you should be, I say, you need to lead by example, which is not necessarily a leadership style. It's a way of life. I don't know if any of you ever heard of Max Thurman. He's a four-star general in the army, retired. He did the organizational planning for the invasion of Grenada, which is a little bit amazing because he was retired and they brought him back off the retirement list to organize an invasion. So that should tell you something about what the army thought about his organizational skills. Max had a videotape where he talked about leadership by example. And I saw this when I was a younger officer and he was actually an artillery second lieutenant. And he got assigned to an artillery unit, you know, battery, I guess, when he was a second lieutenant. And what he said was, Sergeant E7 came up to him and said, in kind of a third party way, would the lieutenant like to learn how to maintain a howitzer and go through repetitive loading drills? And Max wisely said, yes, that'd be something to do. So at the end of the workday when everything was done and the troops are getting showered down, Max and the sergeant would be out there loading, repetitively loading a howitzer and then going through the maintenance of the howitzer. Now, why is that important? It's important because he was demonstrating his troops that he wanted to know how they did their job. He wanted to be a trainer. To be a trainer, you have to be an expert. So if you, wherever you're at, you get people working for you in the EMR and stuff like that, you've got to know that EMR. So when you walk by and they say, hey, I can't get this lab test up on this computer, you help them out and you get recognized as an expert in every facet of your subunit. And that's how you gain respect. Respect is earned. Respect is not given by employees. When I was a aerospace medicine resident, I was on an Air Force base and we were on a bus and we were going to some dog and pony show on the Air Force base and we had a full colonel as our tour guide. And we were going from one part of the Air Force base to the next part of the Air Force base. And because we were in that trip, there was some young private right out of Air Force basic training who was riding on the bus. And the next most junior person on the bus was a captain. So there's like private and then bus full of officers. So the bus driver says, well, we'll just drop this guy off at the enlisted barracks. So we stopped in front of the enlisted barracks. This guy's got two big bags, all this junk. You know what I'm saying? Everything they give you. You know, your two belts and 10 pairs of socks, your extra pair of shoes, your boots, all this stuff. And so all these officers, they're sitting, looking at this kid struggling to get off the bus with these two big bags. And what struck me about this particular event was the full colonel got up and grabbed one of his bags and took it to the guy's house again. And I can guarantee you, to this day, that kid remembers a full colonel carrying his bag. When I was medical director of the Tarrant County Jails, we had like 4,000 prisoners working 24 hours a day, arrests 62,000 people a year, had to get medicine to them within 24 to 48 hours. So it was just a madhouse all the time. And when I was the clinical director, periodically I would show up at two in the morning or 11 o'clock at night and go hit all the nurses stations and ask them how they're doing, if they had everything they needed. And they knew I would be around. And then I would go visit some of the correctional officer stations, say, are you having any problems? And when you're running a 24 hour a day operation, believe me, you need to randomly show up. Those people need to know that, hey, Lieutenant Colonel Mills may show up in the middle of the night. And so, we're not gonna read a comic book, we're not gonna be asleep on our desk, and we're gonna do our job. And vigilance and corrections happens to be an ongoing thing because if some correctional officers are reading a comic book, instead of doing their rounds every 10 or 15 minutes, that's how you find people hanging from towels from the ceiling and they die. And that has not much to do with medical, but if you don't stay on top of the correctional component of it, bad things happen. So, you gotta set an example, and your example influences people more than anything else you can do. There are times when I embrace the servant leadership role, there are other times when maybe it's not so effective, but the message you should get from the servant leadership literature is that if you're a leader, you should be working harder than anybody else in your work unit. People say, well, I'm the boss, you got it, I'm gonna go play golf, because I'm the boss. If you're an effective leader, that's not the way it works. Effective leaders only last for a few years and they have to take a break. Because if you're really doing a good job as a leader, you're staying on top of everything, you're doing your training and taking care of everybody and being the advocate up to the higher levels of authority above you, it's a non-ending job. Because it just, to be really effective, it is a hard job. So anybody who says, oh, I wanna be chief of staff of the hospital, maybe, maybe yes, maybe no. Do you wanna spend that extra time? Do you wanna be a physician and work in an evening dealing with physicians who aren't doing their job or dealing with problems with nursing staff? It's not an easy job. People a lot of times just think it's a title and it's prestige, but to be effective, you gotta ask yourself, is the juice gonna be worth the squeeze? You have to put in a lot of effort to do a good job. And you have to know about the goals and the vision of your work unit. So know your coworkers and the people who report to you. The best example I can give, when I was working in the Terracotta Jays, we had an x-ray unit, we had labs, bunch of nurses, it was a fully functioning medical operation. We had the inpatient lockdown units, psych lockdown units. And so one of my PAs, who was really a good PA, came to me and said, you know, that x-ray tech is behind and shooting chest x-rays like two or three days. And I don't, you know, she says, you need to go to the x-ray tech and tell her to get it in gear. You know, she's got problems. You know what I said to the PA? I said, well, maybe, because she's getting chemotherapy for lymphoma. And she just doesn't feel very good. I knew that, nobody else knew it. So this is kind of an ideal example by knowing what's going on with people and being the kind of leader where people want to share things with you. You know, I mean, that PA went out of that room kind of humble, but that PA was no longer worried about those chest x-rays being two or three days late. Now, when you get new employees, hiring and firing is very expensive business. You know, if you're bringing somebody into the FAA or you're bringing somebody in an occupational health practice, and you're trying to teach them about all the stuff that you do and all the processes, you're not going to be able to hire them. You're not going to be able to hire them. You're not going to be able to hire them. So this is costing you a lot of money just to get them up to speed where they can function independently. So you have to have a training program. It's good if you have it organized like a training checklist. You know, these are the following items we have to learn. We're going to go down the list, make sure you're proficient in each item on the list. You should be an encourager. In other words, somebody new hire, after they've been at their workstation a couple of days, you should come around, ask them how it's going, ask them if they got everything they need, anything, you know, to make their job easier or something they don't understand that they want clarified. You want to demonstrate personal concern. And as a leader, you should go beyond what's expected. In other words, you've got to come circle around, not in two days, but, you know, again, in four days and say, hey, let me sit down, let me show you how to do this in the electronic medical record. And you should have a well-defined scope of their responsibilities. I've seen it not uncommon, it's not uncommon in organizations that they get a new employee and some of the other employees will start dumping jobs that they don't like on the new employee. So you have to make it very clear what their scope is and what isn't their problem. So they're very comfortable. I used to train people, new PAs coming out of PA school, I like hiring new PAs who are really wanting to see patients who weren't burned out, eager to take care of the healthcare of these inmates. I wouldn't let them full calm so they'd been there two months until they thoroughly understood all the processes. You know, how people are brought into jail, how people are searched, how people are housed, how people are evaluated as to how violent they are, how you handle the electronic medical record, how you handle medication dosing, how you look up their medication records, how you interact with the mental health faction, you know, how you interact with the emergency room that you're going to send these people to. They had to understand the whole process before you turn them loose and put them on call at night. Some nurse calls them up and says, well, I want to do this. And you don't want them to say, well, I don't know, or duh, you know, they want an answer. But on the other side of that coin, I always had to deal with the nurses say, if anybody who works for me gives you an answer, do you think it's going to put a patient at risk? I don't care if it's 2.30 in the morning, you call me up and explain the situation to me and I'll give you the final word, which may be supporting them or may be overturning the situation in the interest of patient safety. So this goes back to the kind of problem coworkers. When somebody is not working up to what you expect them to do. My first assumption is if they're a new employee, it's a training deficit. You know, if they've been working there less than six months and they're not doing what they're supposed to do, go back and retrain. Make sure they got a good grip on everything. Ask them, you can just talk to them about, you know, you are putting out the work at the level we expect, like your coworkers are, but you know, what's the issue? Is this a personal problem? You just don't like the job? You know, not everybody's a fit for every job. You know, you can put somebody in a medical coding job and they hate medical coding. You know, it seemed like a good idea when they got the job, but once they get the job, they go, oh, this is terrible. You know, I want to be out talking to people and I'm sitting here looking at charts all day long, looking up numbers. Now, a bad employee. If you have employees, eventually you're going to end up with a bad employee. The good news about bad employees, and this is the good news, is you're not going to fire them. They're going to fire themselves. You're just documenting their behavior, you know? So typically, typically when you get a bad employee and they're heading down the pathway to being the next employee, you're just sitting there documenting. Of course, when you fire them, they'll say, oh, Dr. Mills set me up. No, all Dr. Mills did was document your behavior. One thing you have to remember about bad employees is you're not firing an employee. Employee is actually doing things that are inappropriate for the work unit, not consistent with the mission and values of the institution you're working at. And all you're doing is documenting their behavior. So when you're dealing with bad employees, you just have to document and maintain meticulous records. Now, there comes up the issue of whether you're going to punish or fire somebody. And recruiting people is extremely expensive, and recruiting and training eats up a lot of time and a lot of resources. So I guess you have to make a decision whether the punishment will be a good one punishment would correct the person's behavior, or if the person's behavior, if they've been mentored and you've addressed them concerning their deficiencies and they haven't responded, or they keep gravitating back to their previous behavior, then maybe firing is appropriate. In this thing, I have to mention about the myth of the verbal warning. It depends on the policy of your institution. Some institutions have a written verbal warning, others just have a verbal verbal warning. But when you're dealing with a really bad employee, first thing they do when you go down the road of documenting their behavior and proceeding towards developing enough documentation to justify their firing, first thing they say is, well I was never given a verbal warning. So anytime you correct somebody's behavior or you give them a verbal warning, you have to document it in your computer so it's date stamped that on this day you told the employee that they were violating the institution's personal appearance policy. In other words, some institutions say you have to wear a shirt with a collar and they come in wearing a t-shirt or they come in wearing sandals, you know, things that are violations of your personal appearance policy. So there's no such thing as an undocumented verbal warning. So when you start heading down the road towards dismissing somebody, the first thing you do is talk to human resources and explain to them what the problem is, explain to them what's happened so far, and get their guidance. All human resource departments have slightly different philosophies about dismissing employees, so you need to get them on board and you need them to agree with whatever plan you develop. The other thing is, once you get down and dirty about dismissing somebody, you got them down to their final warning, is the employee is going to go complain to all the relevant leadership, okay? So if you're going to fire a faculty member, they're going to run to their dean. It's assuming you're a chair, they're going to run to the dean, the provost, human resources. If you have like a group of people that are like, handle like people, you know, like people programs where they put emphasis on employee stewardship, and you go to all those people with all your documentation before the employee gets there. So when the employee gets to HR and complains that you're on the verge of firing them, they already know the situation and they're already familiar with the data. So what they do then is just politely listen to the employee and say they'll look into it, and that's pretty much the end of it. So you hit them off at the pass. So you have to understand all punishment is not equal, okay? If somebody's life is completely destroyed, they're going to be if somebody's life is completely built around the institution and they, you know, they want to come to work, then giving them a day off or a few days off without pay is a very severe punishment. Other people hate coming to work, and when you give those people leave without pay, it's not really punishment to them, they're just out fishing somewhere having a good time. So you have to understand the motivations of the employees you're dealing with, what's important to them. Now any high quality work group or institution is going to lose good employees. Now why is that? Why is it? Because if you hire really good, well-motivated people, they're going to continue to grow. And say you have a really good vice chair of the Department of Internal Medicine or something, and the chair is well thought of and it's not going anywhere. After a while, the vice chair chairs learn everything they can do about being a vice chair in addition to their clinical responsibilities. And there's no upward mobility, and so they may go to a different medical school to be the chair of Internal Medicine. And the same is true for any employee. If you've got really good employees, they're going to continue to grow, they're going to get more education, they're going to have more acquire more skills, and they may naturally gravitate to a more responsible position. Now I've seen leaders who get really angry when they're losing key employees, and sometimes they treat those employees badly. And that is a major, major mistake. Because you never know, that employee may go over to say another medical school or another hospital, and after they've been there six months, they go, hey, I really liked it back at my old, my old institution. They, you know, I really, I thought they were, you know, a much better institution than the one I jumped to. Or they may acquire more skills. So they go to a different health science center and acquire some more different set of research skills. And, but they enjoyed living in the town where your health science center is. And so they may want to come back and work for you, but in a different role or a higher level. You know, going back to that example of chairman of Internal Medicine, you know, your chair of Internal Medicine may have taken a dean's job at another institution, and now that job's open. And they say, well, I'm chair of Internal Medicine here at Medical School X, and I want to go back really to what I consider my home institution now that that chair's job is open. So be good to your employees. Make their exit as painless as possible. Make sure you tell them what a good employee they've been, and also tell them they're welcome to come back anytime. And tell them anytime they're in town, please stop by, get ahold of us, we'll go out to lunch, you know, because you never know when that employee you're losing is going to become a new employee again and become a more valuable asset to your institution. So when you're dealing with your employees, you have to gain insight into what's important to them. In other words, you have to get to know the people who work for you. You know, if somebody's children are the most important thing in their lives, you know, get to know the names of the children of your employees and what's important to them. Are they involved in band or sports, you know, and people appreciate you taking the time to understand them and understand their family dynamics. Always do what you can to help people out. So, you know, if somebody's moving their office, you know, there's nothing wrong with going down and help them carry a few boxes, you know. One of the most striking things I remember, and forgive me if I've used this example before, when I was in the military as a captain, army captain, I was on an air force base with a bus and I was probably the lowest ranking officer on the bus and there was a full colonel and there's a few full colonels on the bus and we were going to visit some facility and so some young airmen right out of basic joined our bus ride because we're going to go by his barracks and so his new barracks. So he had two big duffel bags and he wasn't a very big fellow so we got to his barracks before we got to where we're going to take the tour and he was struggling with his bags trying to drag them off to get to his new housing. The senior colonel on the bus got up and helped the guy carry his bags to the front door of his house and I was just struck by that fact. Probably to this day if you could find that young airman, he's probably pretty old by now, but that young fellow still remembers that some senior officer actually helped him and so there's no substitute for leadership by example. So and always be supportive of your employees. You know, you never know when somebody's child is going to be ill or somebody's spouse is going to be ill and if you are engaged with your employees then you can be flexible, you can be supportive. You know, that's the thing that sticks with employees in the long run. The fact that you're willing to go the extra mile to help them out. I guess in conclusion, as we kind of wrap this up, having spent a great deal of my life teaching and training, that really there's only two things you're going to leave on this earth. That's not money. I can guarantee you five minutes after you're dead somebody's going to be spending your money, but the only two things you're really going to leave on this earth are your children, whom you spent time hopefully shaping and molding into productive adults, productive adults, and the second thing is your students because in a way the students are your children because you're shaping and molding them and preparing them to be productive in whatever discipline you're in. So I urge you to take teaching and training and parenting very seriously, much more seriously than other pursuits you have in life. So I'm willing to take any questions we have now. Thanks Dr. Mills. We do have a couple questions for you. The first one is what do you do if you have a bad boss? How do you handle that? Well, the issue about having a bad boss, and I've had some bad bosses, is you have to understand, so that's your first level of supervision. Now your boss is your first level of supervision. Second level of supervision is your boss's boss, and so that issue is you really have to come to understand what the second level of supervision, how they view the problem or the issue. They may not consider it a problem, so if you go to, you know, you have to be a little bit careful or, you know, have a little bit of tact, but try to figure out what your boss's boss thinks of the situation. Now if your boss's boss is very happy with the way things are, then you got two choices. Either put up with it or go to another work group. Now if your boss is unhappy with the situation, then if you can tactfully let the second level of supervision kind of keep them in the loop about what your boss is doing wrong, they can work on some corrective action, or, you know, to either change that person's behavior or or get them to move on to a different work group. So, yeah, I at one time worked for this full colonel, and he was just completely worthless. He couldn't make a decision to save his soul, and probably may be meaningless to those of you who haven't been in the military, but he'd been a division surgeon, and his highest award was an armory commendation medal, which is not a very high award. I mean, it's not insignificant, but it's not not a meritorious service medal or bronze star or anything, and so when I left the organization, his boss gave me a meritorious service medal, which was a higher award than my boss ever had. I think he did it just as a slap in the face of my boss. So, I mean, you know, if you work for a bad boss, you have to figure out what the second level of supervision thinks about the whole situation, and that's probably going to dictate what you do about it, but, you know, life's a precious thing. If you're working in some organization, you're miserable, you know, move on, find a good boss, find somebody who's interested in you, who's going to develop you and give you more skills and make you want to come to work. Any other questions? Yes, thanks, Jamil. This kind of goes well with the next question. How do you handle it when you work for or you have a union shop or government workers that you cannot fire? Oh, well, I've worked in a union shop. When I was medical director of a federal medical center, I worked for an organization where all the doctors and nurses that reported me were at AFGME, which is a very, very tough union there, and I think the last year I worked for the Bureau of Prisons and the Department of Justice in the whole region, which was New Mexico, Texas, Louisiana, and Arkansas, they didn't fire one employee, and I can tell you they had some bad employees. So when I was the medical director, the book on my desk was not Harrison's textbook on internal medicine. It was union labor law was actually the textbook that I kept on my desk all the time. Now, this is a very frustrating situation. It's very hard to pursue excellence when you have a union where you can't fire anybody, but you have to do what you can, and when I was the medical director, of course, I was an administrator, not allowed to vote in the union. Before I was made the medical director, actually, I was a union steward. Apparently, for whatever reason, the union thought enough of me to make me a union steward before I got promoted. So when I was the medical director, they came over and told me, they said, well, Dr. Mills, we're still pulling union dues out of your paycheck, and you can't vote. And I said, well, I did that intentionally because I want you to know I support the union. And so I did everything I could to maintain a good relationship with the union president. And so if there was a complaint or whatever lodged against the leadership of the medical center, then I would sit down, talk to the union, see if we could hammer something out before they filed a grievance, you know, if we could correct something. And so I did the best I could. I did the best I could about making policies which were equitable and which the union could support. Because usually when you get in these absolute union shops, like they have in the Department of Justice and VA and stuff, some of their leadership, you know, they're promoted internally, and some of their leaders aren't very good. So the union actually has, you know, a valid point. You know, if you have leadership that's ineffective, they get frustrated too. So the only thing you can do is be an effective leader, communicate, and be respectful. I have plenty of union stories, but some of them can't be repeated in public. So any other questions?

W. Kenneth Ryland Memorial Award

Dr. John Mills

osteopathic medicine

New York College of Osteopathic Medicine

leadership

Dealing with Difficult People

workplace challenges

strategic communication

occupational and preventive medicine