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LONDON JOURNAL OF PRIMARY CARE, 2016
VOL. 8, NO. 3, 37–38
http://dx.doi.org/10.1080/17571472.2016.1163939
LANDSCAPE
Vulnerable leadership
Louise Younie
Clinical Senior Lecturer, QMUL, London, UK
© 2016 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted
use, distribution, and reproduction in any medium, provided the original work is properly cited.
CONTACT Louise Younie m.l.a.younie@qmul.ac.uk
At a medical humanities educator workshop, a few years
ago, we asked participants to bring an image or poem
that they resonated with from the ‘Out of Our Heads’
website.
1
Images and words were shared with the group
along with why they had been selected. Towards the end
of our semi-circle was a senior clinician and an educa-
tor. His chosen image was one of a patient, sat in foetal
position on a waiting room chair (http://www.outofour-
heads.net/oooh/handler.php?id=459). He had chosen
this image because it reminded him of the patients’ vul-
nerability. He paused. It reminded him also of his own
vulnerability.
During the coee break a fth-year medical student
shared with me how his words had been the most useful
utterance she had heard for months, having just com-
pleted her nals. I probed a little deeper. She told me
of student stress and bravado. To hear someone further
down the line able to talk about his own vulnerability
was, to her, like a breath of fresh air.
I have pondered this anecdote for a number of years
in the context of medical education and medical prac-
tice, and more recently in the light of my own dance
with death through cancer. Why is it, I wonder, that we
so rarely share our experiences of vulnerability either as
students or qualied health professionals? I know from
my own experiences that vulnerability and being a
patient go hand in hand. As a patient there is little choice,
but to embrace our fragile state when our mortal body
has been assailed by some kind of pestilence. But for the
healthy doctor who wields power in the lives of those
struck by disease, vulnerability can be and often is held
at arm’s length. Research suggests, however, that feelings
of professional uncertainty do abound especially for stu-
dents and young doctors in emotionally laden situations.
[1] So it may be that we feel vulnerable but do not share
or talk about it. A student writes about sitting in a breast
cancer clinic and in one day hearing three people receive
a diagnosis of breast cancer, the youngest being just a
couple of years older than herself:
We were discussing how it is almost taboo to show
emotion about things like this, not only on the wards
but also when chatting afterwards to other students.
There is an unwritten rule that you have to prove …
that you can cope with hearing/having to give bad
news and be absolutely ne with it. That’s the mark of a
good doctor- leaving it all in the hospital.[2]
Anatole Broyard [3], a writer who died of prostate
cancer disagrees. He invites the doctor to ‘let the sick
man into his heart’, to share ‘the wonder, terror and
OPEN ACCESS
Why this matters to me
Vulnerability is often considered a weakness and something to avoid especially within the competitive medical
culture, yet my belief and experience is to the contrary. It seems to me those in leadership who can engage
with their own vulnerability are potentially exercising great strength and courage as well as bringing relief and
release for others looking up to them. Also in engagement with patients, being able to touch our own vulnera-
bility allows us to draw closer to those forced into vulnerable situations through situations beyond their control.
Key message
This paper challenges the notion of the powerful doctor and vulnerable patient, instead highlighting the gift
of our shared vulnerability and humanity.
38 L. YOUNIE
and be ‘strong’, the strength of sharing vulnerable spaces
may be one of the most generous things we can oer our
peers, students or patients.
Note
1. www.outofourheads.net. Creative reective work is
collated from medical students predominantly at the
University of Bristol. There is also sta and patient
contributions on this website.
Disclosure statement
No conicts of interest.
ORCID
Louise Younie http://orcid.org/0000-0003-3412-993X
References
[1] Schei E. Doctoring as leadership, the power to heal.
Perspectives in Biology and Medicine. 2006;49:393–406.
[2] Younie L. A reexive journey through arts-based
inquiry in medical education [EdD Dissertation]. Bristol:
University of Bristol; 2011.
[3] Broyard A. Intoxicated by my illness. New York (NY):
Ballantine Books; 1992.
[4] Brown B. Daring greatly: how the courage to be
vulnerable transforms the way we live, love, parent, and
lead. New York (NY): Gotham Books; 2012.
[5] Executive Coaching Network. Leadership eectiveness:
great leaders balance strength with vulnerability.
[cited 2016 Jan 12]. Available from: http://www.
executivecoaching.com/leadership-eectiveness-great-
leaders-balance-strength-with-vulnerability/
[6] Seppälä E. What bosses gain by being vulnerable. [cited
2016 Jan 12]. Available from: https://hbr.org/2014/12/
what-bosses-gain-by-being-vulnerable
[7] Nouwen HJM. Out of solitude: three meditations on the
Christian life. 2nd ed. Notre Dame (IN): Ave Maria Press;
2004.
exaltation of being on the edge of being’. That is where
our shared humanity lies. When doctors distance
themselves and batten down the hatches they may
never get beyond their own shores of understanding,
and their patients are left to voyage the seas unac-
companied and alone. Brene Brown [4] is a researcher
and storyteller who has written a great deal in the
field of vulnerability. She postulates that allowing
ourselves to be seen and known, that is, making our-
selves vulnerable, allows us to connect in meaningful
ways with others. A leadership website explores the
balance of strength and vulnerability and how shared
vulnerability can lead to inclusiveness, teamwork and
enhanced credibility.[5] Vulnerability in the context of
leadership, says another site, ‘implies the courage to
be yourself’, ‘replacing professional distance … with
uncertainty, risk and emotional exposure.[6] These
ideas could apply equally well to interactions with
patients or peers.
My colleague at the educational workshop who
shared the vulnerability that he can feel as a doctor ies
in the face of the prevailing medical culture. His words
worked to build community and connection. He shows
his soft underbelly, strong and courageous enough to
leave himself exposed and open to attack. Henri Nouwen
[7], a Christian mystic, oers a perspective of vulnerability
as strength and a gift.
When we honestly ask ourselves which person in our
lives mean the most to us, we often nd that it is those
who, instead of giving advice, solutions, or cures, have
chosen rather to share our pain and touch our wounds
with a warm and tender hand. The friend who can be
silent with us in a moment of despair or confusion, who
can stay with us in an hour of grief and bereavement,
who can tolerate not knowing, not curing, not healing
and face with us the reality of our powerlessness, that is
a friend who cares.
We could change the word ‘friend’ above, for ‘doctor’, and
although we are often called upon to give advice, to lead
