Many people are challenged by feeling a sense of having lost control of their lives. In an effort to regain a sense of being in control we may act in ways that make us feel like we’re taking charge. In fact, what may be happening is mostly taking place in our brains. The circumstances that led us to feel like we had no control are still there. Our now believing we had regained some sort of control is really a myth. And the impact of the actions we’ve just taken may have far-reaching, long-lasting effects. In this third installment about our Saboteurs, from the framework created by Shirzad Chamine and Positive Intelligence I’m focusing on the Controller, one of my lead Saboteurs.

Like with all Saboteurs, our Controller overuses and abuses actual strengths we have. Physicians are likely to have many of these strengths, as well as to manifest the Controller Saboteur. Let’s explore what these strengths are and how they bring benefits into our lives and those with whom we interact. These include:

  • Confident, action-oriented, decisive persistence
  • The ability to challenge oneself as well as others
  • An ability to do the right thing, even if it’s unpopular
  • Seeing possibilities and having the ability to activate ourselves and others towards those outcomes

Basketball Team

I like the imagery of a huddle, where someone is taking charge, setting up a strategy, helping everyone feel engaged in pursuit of a common goal. When I’m in this position of taking charge like this, I feel like I’m shifting into another gear. I can recall a night on-call receiving a stat consult on a young woman in a coma with almost no platelets (the blood cells involved in clotting). When I got to the hospital, I immediately went to the hematology lab to look at her blood smear. It was clear from what I saw under the microscope that she likely had a condition called thrombotic thrombocytopenic purpura (TTP). This was one of the diagnoses that, when I learned about it in med school, I remember thinking, “Man, I don’t want to get this.” At that time the mortality was > 90%. However, at the time of this story significant advances had been made such that, with ideal management, cure rates were very high. However, treatment needed to be initiated rapidly.

Shifting into high gear, I saw the patient (who was in the ICU), called the docs and nurses involved in her care together, than mapped out our “game plan.” We all had to play our parts. I contacted the Red Cross who were going to bring in equipment that could help filter out the harmful proteins leading to this condition while infusing healthy ones back into the patient. The residents got a surgeon to insert the special kind of IV line needed for this infusion, and talked them through their concerns about doing this procedure in someone with so few platelets. The nurses provided fabulous care and kept the family up to date about what was happening. Within an hour the Red Cross was in the room and their procedure was underway. By the following morning the patient was awake and speaking, her platelet count was on the rise, and she was headed towards the outcome we all hoped for: a complete cure.


There are way too many times when physicians turn into Controlling authoritarians. While sometimes this may result in short-term outcomes that make it look like this is a good strategy, there are long-term consequences- and sometimes catastrophic results. When a person’s Controller takes over they feel the need to be in charge, no matter who knows best. They will push people well beyond their comfort zone, avoiding any danger signs. They actually get energized when others push back, and then they’re surprised when others feel disrespected or hurt.

When I was a med student a patient came onto our service one night who was having a serious gastrointestinal hemorrhage. She was quite elderly and not a candidate for any surgical procedure. The standard medical treatment at that time was a medicine called Pitressin. Our team contacted the patient’s physician to ask for his management plan and he told us to start her on the medication Pitocin. We told him we thought he meant Pitressin but he persisted in insisting that she receive this incorrect medication, eventually yelling at us, “I’m her physician, you need to do what I’m telling you to do!” The following morning, when he reviewed the chart and her orders (what he had demanded we do), he yelled at us that we never should have ordered Pitocin- that we clearly knew he had made an error and we should have overridden him. All of us who cared for that patient that evening were scarred for quite a while- and the patient received awful care. These are the kinds of results that a Controller run amuck produces.

Yacht Image

If you feel you often have your Controller showing up, there are ways to intercept it and make different, better decisions through mental fitness. The sense of not being “in control” can become an opportunity to explore. There are so many things to discover and learn when you are in uncertain situations. Since so much in our lives is uncertain, that means you can grow in many dimensions as you respond to whatever comes your way. Mental fitness uses the imagery of sailing, saying, “While I may not be able to control the wind and the waves, I can still be an amazing sailor!”

Interested in learning more about Positive Intelligence/becoming more mentally fit? Visit my website at or contact me at for a conversation.