What the rules of general surgery can teach us about leadership

Daniel J. Sinnott
Daniel J. Sinnott
Guest Columnist

“We don’t take a trip, a trip takes us.”

So said author John Steinbeck in his book “Travels with Charlie.”

Recently, that quote became very real to me when I became ill while out of town on a business trip.

A trip to the emergency room was followed by an admission to a hospital with a diagnosis of acute pancreatitis caused by gallstones. To treat this condition, my gallbladder had to be removed, or as the surgeon later said, “We need to remove the gun and any remaining bullets.”

The surgeon assigned to my case at the local hospital was talented and direct — exactly what I needed. As he explained the surgery I got a sense he really did not want to perform the surgery. Though it was just a gut feeling, there was something in his words that made me pause. I mentioned my “sense” that he was apprehensive about performing the surgery. He met my question with a question in return. “Are you aware of the fourth rule of general surgery?” to which both my wife and I responded “no” even though we have been in health care our entire careers.

It was at that time that he shared the Four Rules of General Surgery.

  • Rule 1: Verify everything and do not rely on the information provided by others.
  • Rule 2: Once you agree to accept the patient, take total control of the patient’s care.
  • Rule 3: Never make promises you can’t keep.

The first three rules seemed pretty self-explanatory, and very appropriate not only for surgeons but for leaders as well. Then there came the fourth rule.

  • Rule 4: Never mess with the pancreas.

I must say that as a patient experiencing acute pancreatitis far away from home, this scared the hell out of me. Of all the other organs a general surgeon was trained to treat, the pancreas had its own rule, and it was very clear that it was not to be messed with. Even with this new information about the fourth rule, my wife and I ultimately agreed to proceed with the surgery to remove the gall bladder.

While deep in thought the morning of my surgery, I thought about how the first three rules of general surgery applied to leadership. But that fourth rule, “Never mess with the pancreas?” There was no way that one could apply to leaders. And then it dawned on me: all I had to do was swap out pancreas for integrity and the fourth rule would apply to leaders as well.

The pancreas is so vital to our physical existence, and it should be protected at all costs. The same is true for the integrity of a leader, which I define as the ability of a leader to be trusted. With integrity, great things can and do happen. Without integrity, a leader will be unsuccessful because no one will trust that person.

I am happy to report that the surgery went well. The day after surgery I asked the surgeon “Would you like to know my four rules of leadership?” to which he replied, “Sure.” Here are my four rules of leadership that I hold so dearly.

  • Rule 1: A leader needs to be visible and not try to lead an organization while sitting behind a desk.
  • Rule 2: Every leader must have credibility, meaning those you lead must believe you.
  • Rule 3: Every leader must have integrity, meaning that those being led must trust the leader.
  • Rule 4: Every leader must be authentic, meaning that they need to be themselves and let others get to know them.

I wasn’t sure if my four rules were resonating with my surgeon because of his cold hard stare, until he took out his phone and said, “Can you please repeat those so I can share them with others?” 


Daniel J. Sinnott is the president and CEO of Sinnott Executive Consulting, a leadership development company that specializes in developing the business and leadership skills of leaders preparing for or already in the C-Suite.

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