A Practical Guide to Advancing Your Career: Laboratory Medicine Maxims

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Joseph Simone, an academic physician, authored Simone’s Maxims to guide professionals through the many complexities of academic medicine (1). With workplace burnout and negative culture widespread in clinical laboratories, training programs, and pathology/laboratory medicine departments (2, 3), we revisited and adapted Simone’s Maxims. The following maxims are intended to help professionals navigate institutional and leadership dynamics in both academic and nonacademic settings in laboratory medicine. Institutions do not return the love. Institutions should not be personified. Institutions do not have feelings. They are built to sustain themselves, not to support or protect the individuals that operate within them. Believing otherwise can obscure how institutions truly operate and lead to misplaced blame or unrealistic expectations. Emotional attachments to an institution are ill-advised. Rather, focus on your experiences and connections with colleagues. Appreciate them deeply, as nothing lasts forever, and the only constant is change. Institutions have infinite time. Institutions follow their own agenda and goals. They plan for the long term and shift leadership and priorities as required. Individuals, however, have a limited productive period relative to an institution’s timeline and may or may not be included in the institution’s evolution despite their efforts, past or present. There is no place for blind loyalty to institutions. Align your work with the institution only when it supports your timeline, values, and goals. When aligned, all parties are happy. When not, only the individual is disappointed as the institution will move on. All institutions have troublemakers, status seekers, and incompetents. Troublemakers disrupt for ego or personal agendas, status seekers pursue visibility over results, and incompetents are well-meaning but ineffective or uninformed. Their presence makes the work harder for those who care and want to improve the institution. Every institution has these types, though some manage them better. Do not internalize the dysfunction, as you are not responsible for fixing everything. Leadership matters. Leaders are at least as important as the system in which they operate. They can change systems, cultures, and structures that may last far beyond their time at the institution. Leadership can make an impact both positively and negatively. Understand your direct leaders, the institution’s leadership, and how they are (mis)aligned. The best leaders develop and empower people, not just systems. They create conditions in which everyone can grow. Great and effective leaders are humble; listen and protect their team(s); have little regard for titles, awards, and tenure; value dissent; and can adapt quickly to changes. Leaders are often chosen based on irrelevant characteristics for success. Many mistakenly equate laboratory skills, confidence, charm, or commanding presence with leadership ability. Individuals with these characteristics are more likely to self-promote and to be noticed. In contrast, quieter individuals may be overlooked. Leaders often select other leaders based on similarity or perceived “fit” and not on objective performance. This reinforces groupthink, rewards political agendas over merit, and overlooks diverse and unconventional talent. In reality, good judgment, empathy, and follow-through matter far more. Yet many institutions default to degrees, titles, or CVs. Unfortunately, these can distract from characteristics such as emotional intelligence, adaptability, and integrity, which better predict successful leadership. Leadership is vulnerable to the Dunning-Kruger effect. The Dunning-Kruger effect describes how people with low ability overestimate their competence (4). In leadership, this means that poor leaders may mistakenly view themselves as successful and reject constructive feedback. Their decisiveness and confidence are often mistaken for competent leadership, even if substance is lacking. Such individuals often rise unchecked, are more likely to make poor strategic decisions, ignore dissent, and overreach. The organization will suffer as those with talent are likely to be lost or driven out. Meanwhile, capable leaders often underestimate their competence (imposter syndrome) because they realize the complexity and uncertainty in the leadership role. They may avoid leadership roles (sometimes unconsciously), or current leadership may overlook them. This leaves Dunning-Kruger effect-prone individuals to fill the gap—another loss for the institution. In conclusion, navigating a fruitful career in laboratory medicine requires more than technical expertise. It requires understanding institutional dynamics and leadership behaviors. The maxims presented here offer an approach to engage wisely, strategically, and sustainably. By embracing them, professionals can align their efforts with their goals, maintain perspective amid workplace challenges, and build resilience in unpredictable or imperfect environments. Rather than becoming disillusioned, individuals can use a framework (Table 1) to stay centered, make intentional career choices, and contribute meaningfully while preserving their own well-being and sense of purpose. Framework of laboratory medicine maxims. Author Contributions: The corresponding author takes full responsibility that all authors on this publication have met the following required criteria of eligibility for authorship: (a) significant contributions to the conception and design, acquisition of data, or analysis and interpretation of data; (b) drafting or revising the article for intellectual content; (c) final approval of the published article; and (d) agreement to be accountable for all aspects of the article thus ensuring that questions related to the accuracy or integrity of any part of the article are appropriately investigated and resolved. Nobody who qualifies for authorship has been omitted from the list. Authors’ Disclosures or Potential Conflicts of Interest: Upon manuscript submission, all authors completed the author disclosure form. Research Funding: None declared. Disclosures: X.M.R. van Wijk received travel support for attending Rocky Mountain ADLM Local Section and ADLM meetings; received consulting fees and honoraria from Dialectica and BD; received honoraria from BD and Abbott; and is a former employee of Beckman Coulter (part of Danaher). J.R. Weincek received travel support from the International Federation for Clinical Chemistry and Laboratory Medicine, European Federation for Laboratory Medicine, and ADLM; received honoraria from ADLM and Bio-Rad Laboratories; received research funding from Bio-Rad Laboratories; and is an associate editor for The Journal of Applied Laboratory Medicine, ADLM.

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