Recently, I was discussing the Stoic dichotomy of control with a group of senior clinical leaders. Of several concepts we explored, this one seemed to create the most tension, as if I had unintentionally challenged a deeply held belief about what it means to lead.

This surprised me. The Stoic argument that there are some things that are “up to us” and some things that are not has been central to my work as a clinical leader and coach. However, that phrase “up to us” is important. When we hear the word control, we often think about our ability to shape events, influence outcomes and make a difference. The Stoics were pointing to something different. They were asking what is truly ours to own. Our intentions, our choices, our values and our actions sit within our control and are for us. In contrast, the responses of other people, their thoughts, interpretations, decisions and behaviour, ultimately sit with them.

The more we discussed it, the more I understood why this distinction felt uncomfortable.

Clinical leadership rarely happens through authority alone. Whether we are leading teams, changing services, improving culture or supporting colleagues, our effectiveness often depends on our ability to influence: building relationships, negotiating competing priorities and bringing people with us. For many clinicians who move into leadership roles, influence is not simply a skill; it becomes central to how they see themselves as leaders.

So hearing “you cannot control whether someone agrees with you” can feel like something important is being taken away, as if influence doesn’t matter. 

But I think that misses the deeper point. The Stoics were not saying we are powerless. They were reminding us that we are not omnipotent.

Influence is real, but it has a boundary

Much of modern leadership thinking draws on Stephen Covey’s Circle of Concern and Circle of Influence. Covey encourages us to invest our effort where we can make a difference. It reminds us that we have agency. What we say and do matters.

However, I wonder whether healthcare creates a particular challenge with recognising where influence ends and control begins.

Clinicians spend years developing what I sometimes describe as Medicine’s Prime Directive: “If there is a problem, I should fix it.”

This mindset is essential.

But leading people is different.

People are not passive recipients of our advice or expertise. They have their own experiences, beliefs, values, fears and motivations. They listen, interpret and decide through their own lens.

We can influence people, but we cannot own their response.

Where does my circle end?

Increasingly, I think less about one expanding circle of influence and more about two circles.

My circle and your circle.

They touch and they connect. Influence can pass between them, but my circle cannot cross into yours.

I can listen deeply, seek to understand your perspective, communicate clearly, share evidence and build trust.

But I cannot force you to agree with me. I cannot make you see the world exactly as I do. That final step belongs to you.

And perhaps it should, because respecting where my circle ends is also respecting where yours begins.

This does not mean accepting all choices or behaviours. Recognising that I cannot control another person’s actions does not remove my responsibility as a leader to respond to them.

If someone behaves in a way that is harmful, unsafe or inconsistent with our shared values, their behaviour remains their choice. I cannot step inside their circle and make them choose differently. But the consequences of that behaviour are mine to manage.

As leaders, we can set expectations and decide what behaviours we challenge. When behaviours fall below the standards required, we can control the consequences.

Letting go of control is not the same as letting go of accountability.

The leadership trap of caring too much

This distinction matters because many of the most committed clinical leaders I meet do not struggle because they care too little. They struggle because they care so much.

They carry responsibility beyond the boundary of their control: the team conflict that persists despite thoughtful attempts to resolve it, the change programme where some people continue to resist despite months or years of effort.

They also carry the gap between intention and interpretation.

The temptation is always to believe there must be something more we could do. Perhaps if we find a better argument, provide more support or work even harder, we can create the outcome we are hoping for.

Sometimes that reflection is exactly what is needed. Feedback, adapting our approach and understanding our impact all matter.

But there is also a point where healthy influence quietly becomes an attempt to control an outcome that is no longer ours. Commitment becomes attachment. Responsibility becomes ownership.

And that is exhausting.

Letting go is not giving up

Letting go of what we cannot control is not the same as not caring. It is choosing where to place our energy.

We can still bring our experience, compassion, curiosity and our authentic selves to the boundary where our circles meet. Then we have to allow others the dignity and responsibility for their own choices.

When we stop trying to control what was never ours to control, we can focus on the quality of the conversation rather than trying to control the reaction; on our behaviour rather than their judgement; on living our values rather than guaranteeing their response.

The paradox of clinical leadership

Perhaps effective clinical leadership requires us to hold two ideas simultaneously:

“I have more influence than I realise.”

And:

“I have less control than I would like.”

The first prevents helplessness. The second prevents exhaustion.

Leadership is not about pushing our circle into someone else’s. It is about bringing the very best of ourselves to the place where our circles meet, while having the humility to let go of what happens beyond that boundary.

Author

Dr Paul Molyneux

Paul is a Consultant Neurologist and Coach.

Declarations of Interest
Senior Facilitator at Doctors Training and Director for The Thriving Life Consultancy