October 7, 2026 Salus Forum

So, you know, Jack’s saying, all right, how do we change the culture? That’s one of the elements. I also wanted to follow up with Jenny regarding a related matter. As we think about competencies for leadership, let’s clearly distinguish between competence and confidence. What I’m worried about right now, and you’re describing it. Jenny, you’re in a difficult situation. I think palliative care in a hospital setting is often in the middle often of conflict between patients and a variety of specialists.

You’re thrown into a rich environment to begin with, where you’ve got to work with people and so on.

But what I see with a lot of learners is they’re competent, but not confident. So the question is, how can we train competence? And that’s where Jeremy and I have had discussions about volume. You don’t need a certain number of things, but volume helps breed confidence. So how do we need to change the summary? How do we need to change the culture of family medicine? And then how do we get to leaning in. In the feminist writing, leaning in is central. Because you can’t be a leader unless you’re willing to roll up your sleeves and do things.

Jenny

I wrote in the chat that Jeremy’s been trying to teach me confidence since he met me. And he remembers this very clearly when I was chief. I literally told him, please don’t call me chief. Like don’t say the C word in front of me. So, I mean, you’re hitting it with the nail on the head. I don’t know how you build confidence, because I do have a lot of learners and one of the biggest points of feedback I give to a lot of my learners is related to the matter of self-esteem. At some level, they have high esteem. I say to them, you know what you’re doing. Just go into the room and don’t apologize. Just introduce yourself confidently. It’s ironic because I need to do better on that. And I don’t know if I have confidence. That’s probably a rhetorical question for me. At least right now, because I can’t answer it. I would just assume that the more experience or the courage for me to throw myself into those really difficult experiences can allow me to gain that confidence eventually. When I think back on like, oh, wow, like I went through that experience and it was really hard. But it worked out in that way.  That’s already more than probably a lot of people would have done. I think maybe the first part of confidence is just having the courage to step up. Maybe that’s what it is.

Warren

It’s Clinical courage.

Mark

This relates to a sidebar that Jenny, Jeremy and I had several months ago. Jenny and I had this imposter syndrome. I find that that’s very common among people who are their own severest critics, which is a good thing. Therefore, in this model, this ideal, you need the Jeremy’s of the world who literally say, no, you’re the real deal. You’re empathetic and you’re competent. And that will inculcate this confidence. A caring, empathetic mentor is really needed.