There is a particular silence in a clinical consultation that has no equivalent anywhere else I have worked.
It arrives after the words run out — after the physician has shared what is known and what is not, after the patient has processed enough to understand the shape of the uncertainty ahead of them. The results are inconclusive. The path forward is not yet clear. There are several possibilities, none of them fully formed, each of them carrying different weight.
In that silence, the physician has a choice.
They can fill it. Reach for the nearest coherent explanation, even if it is premature. Offer a probability as if it were a certainty. Perform confidence because the room seems to be asking for it.
Or they can stay.
Stay in the uncertainty. Acknowledge it plainly. Sit with the discomfort of not knowing, and in doing so — and this was the clinical insight that has never left me — communicate something more valuable than any premature answer: I am here. I am thinking with you. This is real, and we are navigating it together.
The Skill Medicine Almost Never Names
Narrative Medicine — the clinical framework developed at Columbia University that grounds much of my work — teaches what it calls narrative humility: the ongoing recognition that the clinician is never the only expert in the room.
The patient is an expert too. An expert in their own body, their own history, their own experience of illness, their own values about what kind of survival is worth the cost of treatment. Narrative Medicine insists that clinical excellence requires attending to that expertise — not just the data, but the meaning the patient is making of the data — with the same disciplined attention a physician gives to a symptom presentation.
This might sound like a soft skill. It is one of the most difficult things I have ever practiced.
Because the instinct, especially in high-pressure clinical environments, is to lead with certainty. To organize the information quickly, to name the working diagnosis, to move toward the plan. The ability to resist that instinct long enough to truly hear the full picture — including the parts that do not fit cleanly — is a clinical competency that takes years to develop.
It also happens to be exactly what the most effective organizational leaders do.
Where the Clinical Map Meets the Organizational Territory
In healthcare organizations especially — and increasingly in any complex organization navigating rapid change — leaders are regularly called to manage situations that have no clean diagnosis.
A department is underperforming, and the data does not explain why. A key physician is disengaging, and every formal indicator says everything is fine. A strategic initiative is generating resistance that appears passive on the surface but feels fundamental underneath. A team is functioning, technically, but something in the relational fabric has frayed in a way no org chart can capture.
These are not problems that yield to premature certainty. They are problems that require exactly the clinical posture I spent years developing: close attention, suspension of premature conclusion, and the willingness to hear the story the data cannot tell.
In clinical medicine, we have a name for the gap between the patient’s presented complaint and the actual underlying condition. We call it the difference between the presenting problem and the working diagnosis.
In organizational consulting, I find the same gap — almost universally.
The presenting problem is always what leadership articulates: a communication breakdown, a performance issue, a culture initiative that isn’t landing. The working diagnosis, excavated through careful narrative inquiry, is almost always something deeper: a story about who this organization is, what it values under pressure, who belongs here and who is a guest, what success is allowed to look like.
Getting to the working diagnosis in an organization requires the same discipline as getting to it in a clinical consultation: you must be willing to sit longer than comfort allows in the space between the presenting complaint and the full picture.
Narrative Humility as an Organizational Leadership Practice
One of the most significant shifts I observe when physician-executives and other clinically-trained leaders step into organizational leadership roles is this: they often struggle with the ambiguity of management in a way that feels fundamentally different from clinical ambiguity.
In clinical medicine, uncertainty is tolerated because the field has rigorous frameworks for navigating it: differential diagnosis, evidence-based protocols, peer consultation, case conferences. The uncertainty is acknowledged as a structural feature of medicine.
In organizational leadership, especially in healthcare systems, ambiguity often carries a different charge. The expectation — explicit or implicit — is that leaders should have answers. That uncertainty in a senior leader is a liability rather than a form of rigor.
This expectation is damaging for two reasons.
First, it prevents the kind of genuine organizational inquiry that surfaces real problems rather than presenting ones. Leaders who perform certainty discourage the candor that would give them better information.
Second, it closes off the relational possibility that narrative humility creates. When a clinical leader says to their team, “I am not certain how to navigate this, and I want to think through it with you,” they are not demonstrating weakness. They are practicing the kind of shared inquiry that produces the best outcomes — the same kind of shared inquiry that, at its best, characterizes the relationship between a physician and a patient navigating uncertain ground together.
What I Carry From the Clinic Into Every Organization I Enter
I left active clinical practice to build MyelSyn Consulting. I did not leave medicine.
What I brought with me is a specific set of practices: the habit of attending carefully to what is said and what is conspicuously not said; the willingness to sit in uncertainty without rushing to fill it; the commitment to narrative humility — the recognition that I am never the only one who understands what is happening here.
These practices translate. They translate to a boardroom navigating a leadership transition. To a hospital department working through a period of significant change. To a nonprofit team whose mission alignment has quietly eroded. To any organization where the presenting problem is, as it almost always is, the surface of something deeper.
The most effective leaders I have encountered share something with the most effective physicians: they listen before they prescribe.
Not because listening is passive. But because the story — fully heard, before the intervention begins — is the most accurate diagnostic tool available.
If you lead in a healthcare organization and are navigating the particular challenge of bringing clinical training into organizational leadership, I would welcome a conversation. This work is close to my heart and central to what we do at MyelSyn Consulting. Visit myelsyn.com to get started.
