Firefighter, Lighthouse, or Stoic
Know Your Reflex
The UPIC audit letter lands on your desk. Or your office manager gives two weeks' notice. Or you have three prosthetic deliveries scheduled today and your top referral wants you to come to their office for an evaluation/consultation. Pick your unexpected event poison.
Now watch what you do in the first ten minutes? Do you start solving the problem as it is unfolding? Do you gather the team and rally a response? Or do you go quiet and work the problem while your stomach knots?
You have a default. Most of us have never named it — and in a small practice, where you're usually the only one at the wheel when things go sideways, that unnamed default runs the whole show.
Stress isn't the surprise — your reaction is
Leaders are more stressed now than they were at the peak of the pandemic. That's a recent finding from the Center for Stress Intelligence, a Brunswick Group project, from a story in the Harvard Business Review. No shock there. What's more useful is where they point next: not just self-care, but self-awareness. You can't manage a reaction you can't see.
Their assessment sorts leaders into default patterns under pressure. Three are easy to spot on any bad day in a practice:
The firefighter runs at the problem and starts fixing immediately. Priceless in a true emergency — but a firefighter can start swinging before anyone's sure what's actually burning, leaving the team scrambling to keep up. (Personally, I do not like this categorization…I was a volunteer firefighter for 20 years, and while it may look like that is how we respond, there is actually quite a bit of “size up” that you do before you enter a hazardous environment…or you die. But I digress…it fits the theme!)
The lighthouse steadies everyone: calm, optimistic, "we'll get through this." Morale holds — but relentless optimism can gloss over the hard facts that need facing today.
The stoic goes cool and logical, works the problem by the numbers. Clear-headed while others panic — but can miss that the front desk is rattled and needs a word, not just a plan.
None of these is right or wrong. Each has a strong side and a blind side. And here's the freeing part: your default isn't your destiny. The best leaders aren't locked into one mode — they notice which one they're in and shift when the moment calls for a different one.
Working with your reflex, not against it
You can't change a reflex you haven't named. So start there.
Say your default out loud. Tell your team: "When things go sideways, I tend to go quiet and start problem-solving. If you need me to slow down and check in with people, say so." That one sentence gives your staff permission to manage you a little — which is a gift when you're underwater.
Practice the moves you don't reach for — in low-stakes moments. If you're a “firefighter,” deliberately pause and ask questions when the schedule is only mildly annoying, not when the building's on fire. Build the muscle before you need it.
Stress-test yourself in the moment. When you're mid-crisis, two plain questions cut through: Is what I'm doing reducing the confusion or adding to it? Is it moving us toward the goal, or just keeping me busy? Busy and useful are not the same thing.
The bench of one
Here's where small practices get exposed. The single most important move, the Center for Stress Intelligence authors argue, is also the simplest: don't go it alone. Some of a leader's cognitive load can be carried by systems and by colleagues — if you've built for it.
A key principle I learned as a firefighter is that a crisis does not create problems, it exposes them. When we are not prepared for the unexpected, it can really throw everything off. So even though you can’t plan for every unexpected event, you can work with your team to “game plan scenarios” and share responsibility to create continuity and consistency. Frenetic activity can lead to burnout and if you do not train for disruption your activity will appear frenetic (much like the general impression of firefighting!).
What does that look like in reality?
Cross-train for the two or three things only you can do. If the practice stops when you're out, you don't have a team — you have a bottleneck with a payroll.
Build a team whose defaults balance yours. If you're a stoic, keep a lighthouse near the front desk. If you're a “firefighter,” put a steadier hand on the follow-through. A leadership group of identical reflexes has one giant blind spot.
Get the practice out of your head and into your systems. Documentation, denial tracking, prior-auth status, outcome capture — when those live in your software instead of your memory and your inbox, a bad Tuesday doesn't ride on one exhausted person recalling what happened. That's not a software pitch; it's the difference between a crisis you manage and a crisis that manages you.
Test it before the bad day
A reflex isn't good or bad. It's fast and unexamined — which is exactly what makes it useful in a crisis and dangerous when it's the only tool you own.
You already test alignment before it costs a patient a sore, and you check a weld before it fails under load. Turn that same habit on yourself. Learn how you react under pressure now, while things are calm — because the letter is coming on some ordinary Tuesday, and you don't get to choose which one.
You can't control whether it lands. You can decide to know yourself before it does.