Pulse Diagnosis​

Professionalism, Power and Presence

Professionalism is often taught and assessed through the idea of leadership in medical education. There are good reasons as the influence of a discipline can be realized through professionalism and leadership.1 Further, the sense of power and influence that an individual within a profession enjoys can affect their presence and capacity as a human being.

Stage development is a pertinent feature of medicine, ethics, morals and the ability to influence others. I would like to explore power and stage theory as a tool for developing Chinese medicine in the US. Leadership author, Janet Hagberg, synthesized a stage model for identifying personal development in relationship to power. She describes six stages are divided in two parts, internal and external.2 I use it to create a framework for this article.

Leadership in terms of power stages has value for several reasons. The ability to assess a patient’s level of personal power in life can lead to important clinical interactions that make a difference. Knowledge of one’s own stage can affect the ability to heal at the level of both personal and social systems. As a teacher, the ability to assess the power stage of a learner can affect how interactions take place as well as the selection of learning partnerships in the clinic and classroom.3

Internal Stages

External stages of power move thus: powerlessness, to power by association, to power by achievement. People in the latter part of the first three stages can marshal resources, meet goals, manage people, make things happen and make a living. The latter stage of competence is often seen as the pinnacle of professional ability.

External Stages

Internal stages evolve from power by reflection, to power by purpose, to power through wisdom. In this second half of the journey, there is integration of the capacity to act with the capacity to reflect. Internal power emerges out of our inner self, our souls, our deepest values, and is more related to whom we really are and what our life purposes are. When these stages are active we find meaning and a sense of calling within our work, we explore our inner passions, thus creating long-lasting effects that are rooted in consciousness, community and connectedness.

Stage by Stage

The first stage has feelings of powerlessness. The person may feel trapped, insecure, and dependent with low self-esteem. We often see such attitudes in first year learners, especially during the first term. On the shadow side, these learners experience frustration and hopelessness, resorting to distractions from study. It is necessary to overcome fear and develop self-esteem in order to generate a transformation out of this stage; this can occur by facing inadequacies, developing skills and moving away from attachment to outcomes. Other ways to move from out of this stage are to find allies, get support, share with others, take responsibility, confront self, and seek mentors.

Characteristics of the second power stage involve learning about the culture in which one participates and apprenticeship.4 Power comes through association with peers and mentors, which brings new levels of self-awareness. During this cycle it is important to get feedback, develop competence that is reflected in credentials, become involved, take risks, develop networks, and develop independence. There is a process of learning about and enjoying the journey. The shadow of this stage can be expressed as naivety and chameleon-like behavior. Obstructions to moving out of this stage are lack of confidence and the need for security.

Third power stage people are competent. They display technical expertise, and confidence. They have the badges of success: titles, degrees, stature, money, self-esteem and recognition.5 They can be dynamic and competitive given their ambitions. The mature individual in this stage contributes knowledge to the field. On the shadow side, they can have egotism, greed and bravado. Integrity is a catalyst for transforming such a shadow. Stagnation and confusion can be transformed by: (a) creating crises and accepting the change crisis can bring (b) appreciating solitude and serious self-reflection (c) trying new activities that cause different thinking processes (d) designing rituals (e) reflecting upon next stages (f) building a network (g) and doing long-term visioning of one’s life.

Individuals who operate in the fourth stage communicate insight and perspective. They can shift perspective from subjective to objective points of view, creating interplay on the bounds between the intrapersonal and interpersonal, intracultural and intercultural systems.6 The sense of personal power shifts from self value through competency towards a focus upon a mission.2 These people have influence. They provide skilled mentorship, have well-developed personal style and display true leadership with strength. They have rediscovered sacred ground. In the shadow of the fourth stage, these individuals may find themselves playacting, confused and misunderstood. Under these circumstances it is important to let go of ego and face fear, while identifying the mission and purpose of this life. Other factors that can assist the transformation that occurs at this stage include a willingness to release control going beyond the intellect and connecting to wisdom. To do this one must face one’s own shadow. This takes deep transformation and courage, courage to move beyond potential losses. It requires finding grace within the darkness. Movement out of this stage occurs when staying accountable to someone who knows your story.

The fifth stage is truly the expression of the deepest heart’s desire. Here, one accepts self as that with calmness, courage, and awareness of the needs of the group. There is humility and a deep sense of clarity about one’s mission in life. This is the arena of practicing mystics, they have elusive qualities, and are generous in empowering others. In the spirituality of this stage there is surrender.

The shadow of stage five includes pseudo-innocence, which I would suggest is a sign that person is at an earlier stage. It also includes a perception by others that one is impractical or undeveloped. The catalyst for movement is universal understanding. Failure to understand the universe will hold people at this stage back as will faithlessness and fear of loss.

In the sixth stage, the essential question is how close am I willing to come to the flame? This is a deeper life that is consumed by a spiritual fire and self –sacrifice. People in this stage have integrated the shadow, are unafraid of death, and demonstrate compassion for the world. Such people include Moses, Buddha, Christ, Sun Simiao, Mother Teresa and Ramana Maharshi, the Dalai Lama and Nelson Mandela. They each possess extraordinary qualities and yet are in touch with their own humanity. The shadow of stage six is that these people can be out of touch with danger and appear too sacrificial. And – it is their own humanity that prevents them from achieving the vision they hold for humanity within their own spiritual framework. Ultimately, their cause and followers bring about emancipation.


Awareness of the power stage for oneself and the other is a feature that can be important for life. The usefulness of such knowledge can be realized in the clinic in teaching and learning and profession building.

The achievement of the possibilities of a collaborative medical environment requires transformative leadership with the capacity to move a collective through power stages effectively.7 To do so requires tools to assess the stage and state of the profession.


  1. Turner B. Medical Power and Social Knowledge. Thousand Oaks, CA: Sage; 1995.
  2. Hagberg JO. Real Power: Stages of Personal Power in Organizations. Third ed: Sheffield Publishing Company; 2002.
  3. French JRP, Raven B. The bases of social power. In: Cartwright D, editor. Studies in Social Power. Ann Arbor, MI: University of Michigan Press; 1959.
  4. Evetts J. The Sociological Analysis of Professionalism: Occupational Change in the Modern World. International Sociology. 2003 June 1, 2003;18(2):395-415.
  5. Klein G. Sources of Power (How People Make Decisions). First ed. Cambridge, Massachusetts: Massachusetts Institute of Technology; 1998.
  6. Kegan R. In Over Our Heads: The Mental Demands of Modern Life. Cambridge: Harvard University Press; 1994.
  7. Kenny RM. The Whole is Greater: Reflective Practice, Human Development and Fields of Consciousness and Collaborative Creativity. World Futures. 2008;64(8):590 – 630.

May 2012