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Re: Leadership versus Consensus

I wholeheartedly agree and applaud your momentous editorial in November 2006 (I am now in standing ovation), pointing out with pinpoint accuracy the differences and defining characteristics between personal leadership and collective consensus building.

However, apparently you and I, and other neurosurgeons who believe in stoic leaders, the power of the individual mind, personal will, fortitude, and moral courage, are now seemingly a minority, going against an oceanic current, a progressive (socialistic) wave of pragmatic followers bent on establishing consensus down a predetermined path.

We are told almost daily by the mass media in the United States that people dislike gridlock and that consensus is a way to stop political gridlock and move forward. Yet, to our founding fathers, gridlock was the very strong medicine needed then (and still needed today) against the malady of runaway government—the checks and balances of a republican form of government—to protect dissenting minorities from passionate, tyrannical majorities.

However, consensus builders do as they have been instructed to do by those above who pull the strings from behind the curtain. They are anti-climatic, antiheroes who are paid by government agencies or progressive businesses to build consensus and smooth the way for the implementation of collectivist or feel good, politically correct policies with little dissent. Those who oppose these agendas are, as we know, the “disruptive physicians” that hospitals, health centers, and organized medicine decry as obstructionist or as it is said in a Cuban phrase, palos estancados (sticks in the mud).

Policy by consensus, therefore, leads to socialism. Consensus builders oil the machinery of socialism and collectivism, and as you magnificently pointed out in your editorial, oppress individual initiative and creativity. Consensus restricts leadership and hampers the human mind so that problems fester unsolved.

It would seem that consensus promotes the free exchange of ideas, but in practice, it does not. As in George Orwell’s 1984 Newspeak and the Thought Police that “safe guard” language, in reality restrict debate, limit expression, and do not allow dissent. In today’s environment, those who go against the current of formulated consensus are ridiculed, silenced, and ostracized as being on the fringes and out of touch. Those who accept their intellectual shackles conform and are easily subjugated and manipulated by the consensus builders. Complaisance, as Aristotle reminds us, is the characteristic of the slave.

Consensus building is the child of committees whose members have shared (diluted) responsibility. Failure, when it comes, goes round and round, and the buck stops nowhere. And that is one reason, as you pointed out, that there are no leaders stepping up to the plate.

Inactivity and complacency, particularly in the case of physicians and neurosurgeons—whether it is the issue of reimbursement, medical prosecutions (eg, miscoding, pain management, etc), or medical liability not being bad enough for all physicians to get together—remind me of the allegory of the frogs in the heated pot. Do you remember the lesson? As you turn the heat up, the frogs are initially comfortable, then a little warm, but not bad enough to jump out of the pot. By the time the pot is boiling, it is too late. They are cooked!

Miguel A. Faria Jr, MD
Milledgeville, GA 31061 USA

This letter was published in Surgical Neurology 2007;67(1):108.

This article may be cited as: Faria MA. Re: Leadership versus Consensus. Surgical Neurology 2007;67(1):108. Available from:

Copyright ©2007 Miguel A. Faria, Jr., M.D.

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