Leading in the Middle of the Storm

There’s no such thing as a quiet shift in the ER. You may start the day with manageable cases, but within an hour, the pace can explode. When things heat up—multiple traumas rolling in, staff short-staffed, tensions high—everyone looks for someone to lead. What I’ve learned over the years, especially during my time as an ER director, is that leadership in medicine isn’t about barking orders or knowing everything. It’s about humility, trust, and presence.

I’ve worked alongside some incredible nurses, techs, and fellow physicians who didn’t need a title to lead. And I’ve also seen what happens when ego walks into the room—decisions get delayed, people get frustrated, and patients suffer. The ER doesn’t care how important you think you are. It demands collaboration. That’s why I believe the best leadership in medicine happens without ego at the center.

Respect Is Earned, Not Demanded

One of the first lessons I learned as a young attending—and later as a director—was that respect doesn’t come from the badge on your coat. It comes from how you treat people when things get tough. Anyone can lead when everything is going smoothly. But when a trauma code is called, when supplies are short, or when emotions run high, your team watches how you respond.

Do you raise your voice? Do you take over, or do you step back and trust your team? Do you listen when the nurse speaks up? Do you admit when you’re wrong? These small moments build a reputation that lasts far longer than any leadership role.

I’ve tried to lead by example. Not because I think I have all the answers, but because I believe in the value of steady, consistent, humble guidance. You don’t have to be the loudest voice in the room to be the most effective.

Listening More Than Talking

In medicine, especially emergency care, there’s pressure to make decisions quickly. That can sometimes lead to a style of leadership where you’re doing all the talking and very little listening. But that kind of approach creates walls between you and your team.

I’ve found that most staff, from techs to seasoned nurses, know when something feels off. They’ve got eyes and instincts that are sharp. When a team member speaks up—even if it challenges what I was about to do—I’ve learned it’s worth listening. You don’t lose leadership points by considering another point of view. In fact, it usually earns you more respect.

Leadership is also about making space for people to bring ideas, voice concerns, and feel heard. That doesn’t mean everything becomes a group vote, but people perform better when they feel their voice matters. In the long run, that makes the whole system stronger.

Leadership Is a Service

The longer I’ve been in this field, the more I’ve realized leadership is more about serving than directing. When I was ER director at Gadsden Regional, my job wasn’t just to review protocols or manage schedules. It was to remove roadblocks for my staff, create an environment where they could thrive, and make sure patients received excellent care.

That meant taking the overnight shift when someone couldn’t, advocating for better supplies, or simply making sure someone took a lunch break. It also meant checking in with people—not just about their charts, but about their lives. People don’t forget when you show up for them, especially in a setting as intense as emergency medicine.

Leading without ego means asking, “What does my team need from me today?” instead of “How do I look as a leader?” That mindset changes the whole atmosphere of a department.

Letting Go of the Need to Be Right

Ego wants to be right. But medicine, and especially emergency care, is full of moments where the answers aren’t clear. You have to work with limited information and still make critical decisions. And sometimes, despite your best judgment, things don’t go the way you hoped.

In those moments, ego says to blame someone else or hide your mistake. Leadership without ego says, “Let’s review what happened and learn from it.” That approach builds trust. It shows your team that safety, learning, and accountability are more important than pride.

I’ve had to admit when I missed something. I’ve also had to call younger physicians into a room and say, “Let’s talk through that choice.” But the tone of those conversations matters. When correction comes with respect and the goal of growth, people listen.

Being a leader in medicine—whether officially or unofficially—is a responsibility I don’t take lightly. The stakes are high. But that’s exactly why humility matters so much. The ER has a way of stripping you of ego pretty quickly. You’re reminded that you’re not invincible, not perfect, and definitely not in control of every outcome.

But you are part of a team. You are a voice that can bring calm into chaos. And you have the chance to shape a culture where patients are cared for, and staff feel seen and supported.

Leadership without ego isn’t weakness. It’s strength under control. And in a place like the ER, that kind of leadership makes all the difference.