This is an important core competency for any physician executive. Here, the author shares what he has learned in 30-plus years in front of audiences.
Do most Americans really think public speaking is worse than dying?
"Speaking in public" was among the top 10 fears of more than 8,000 Americans responding in a National Comorbidity Survey published in the American Journal of Psychiatry.1
"Public speaking" makes the top 10 of fears as measured by what Americans search for on the Internet, according to Bill Tancer's book Click.2
"Speaking before a group" is the No. 1 item on "The Worst Human Fears" list in The Book of Lists by David Wallechinksy (1977).3
I like public speaking, but I also still get nervous before a keynote address. I have made presentations to hospital associations, medical societies, biotech conferences, one university commencement ceremony, medical school grand rounds, college classes, MBA classes, and patient advocacy groups.
Since public speaking can be an important core competency for any physician executive, I would like to share what I have learned from giving hundreds of talks to a variety of audiences over the past 30-plus years.
Because early humans who feared dangerous situations were more likely to reproduce, being afraid is thought to be selected for by natural selection. This theory explains why fears of snakes, bugs, heights, water and sickness are so common because they were dangerous situations that early man faced often.
Scott Berkun, in Confessions of a Public Speaker, does a brilliant job of linking our fear of public speaking to the way the brain was designed for maximum survival of early humans.
“Our brains ... identify the following four things as being very bad for survival: standing alone, in open territory with no place to hide, without a weapon, in front of a large crowd of creatures staring at you."4
All speakers are afraid. Professional speakers simply know how to control their fear. Two of America’s best speakers knew this simple fact:
- Mark Twain: "There are two types of speakers: those that are nervous and those that are liars."
- Edward R. Murrow: "The best speakers know enough to be scared. ... The only differences between the pros and the novices is that the pros have trained the butterflies to fly in formation." 4
Being prepared is the best way for me to deal with my fear of speaking and of making a fool of myself in front of a large crowd.
For me, being prepared starts weeks or months before the speaking engagement date. Many of my speaking gigs are arranged by a leader's personal assistant who is not a content expert and is usually most interested in my fee, title, CV, the paperwork the organization needs to have filled out and my learning objectives so that continuing education credits can be arranged.
One time, an assistant and I were discussing a genomics keynote and had agreed on all the basics (fee, date, subject, deadline for slides). I was disappointed when she said, "Oh, this might not work out. The convention planning committee says it has to be a futurist."
I replied that I think about the future every day and that seemed to allow her to put a check mark next to another requirement. The speech was well received and successful.
I am amazed how many times I have to ask about the target audience and what a perfect keynote would look like from the senior leadership team perspective. I try to arrange for at least one phone call with the senior leadership team so that I can make sure we are all on the same page.
Although I admit I can be annoyed when the client asks to see the PowerPoint slides many months ahead of time, such a practice has led to successful keynote presentations and return engagements.
One religious health care organization was uncomfortable with some of my slides that they thought were too critical of physician shortcomings in quality initiatives. Knowing the sensitivity and revising the offending slides helped me facilitate a successful medical staff/hospital board retreat in the Midwest.
Being prepared also means arriving at the speaking site well ahead of time. I have had a few near disasters. I was almost late to an Institute of Medicine meeting in Washington, D.C., because I went to two wrong IOM locations before finding the correct place.
Another time, I flew from Iowa City, Iowa, to Chicago, Illinois, on the first morning flight, thinking I would have plenty of time to arrive at the hotel to give the keynote. I was not happy when the taxi driver responded to my directions by asking, "Which Marriott?"
I felt really stupid, but the taxi driver was really smart because he asked me what I did for a living. When I answered I was a physician, he guessed correctly which hotel was the most likely venue. Now, I insist on having the street address, phone number, and email address of the conference while I travel.
Being prepared means practicing my speech over and over again.
It also means making sure I have a hard copy of my slides printed out and a memory stick with the slides, and I have emailed the slides to the meeting planner ahead of time.
If the projector explodes or the remote refuses to advance the slides, I can always wing it without slides if I am fully prepared.
Most speakers do not practice. Real pros do practice. Berkun explains in great detail how he practices a new speech: "Since I'm more afraid of giving a horrible presentation than I am of practicing for a few hours, practice wins."
Author Malcolm Gladwell is famous for his freewheeling, informal speaking style that commands at least $100,000 for an hour presentation.
Journalist Gideon Rachman once shared a speaking gig with Gladwell and asked him how he does it. Gladwell's answer was surprising. "I know it may not look like this, but it's all scripted. I write down every word and then I learn it by heart. I do that with all my talks, and I've got lots of them."5
I don't earn that much per keynote and I don't write down every word and memorize them. But I do practice, and I am so familiar with my material that I can keep going no matter what logistical disaster happens.
I always try to get to the room where I will speak at least an hour before I go on. I want to make sure my slides project well. I want to make sure there is a clock or a timer visible from the podium.
Since I like to wander from the podium, I want to have a lapel microphone. I want to locate a glass or a bottle of water so I can take a sip during the speech if my throat gets dry. I want to hang out with the multimedia guys so they like me. I want to know where the light switches are in case there is a problem during the speech.
And most importantly of all, I want to meet and get to know several members of the audience before the keynote. I introduce myself, inquire where they are from, and ask them what they most want to learn.
If I am going to need a volunteer from the audience, I try to identify a willing extrovert to call on before the talk starts. I want to know the names of as many participants as possible because it will help calm my fears and because by mentioning audience members by name during the speech you make them want you to succeed.
If there is no visible clock or timer, I try to get an audience member to agree to lend me a watch so I can end on time.
If I have done all described above in the preparation phase, the delivery is often anticlimactic. Once I start, I am rarely nervous, and I really do enjoy myself. Having bombed rarely, and having connected often, I have learned what audiences really want.
Again, Berkun nails it when he states that lecture-goers want to learn, be inspired, be entertained, become hopeful, meet others in their field, have a positive experience and please the bosses who made them sign up for the course. 4
It is also important to take into account the lessons of John Medina's Brain Rules. According to Medina, 10 minutes is the maximum amount of time people can pay attention to anything.6
This 10-minute rule may explain why TED (Technology, Entertainment, Design) conferences are so successful. TED talks are either eight minutes or 20 minutes long.
Donald Bligh in What's the Use of Lectures? documents that heart rates and attention are at their peak at the start of lectures and steadily decline over the course of the talk.7
If you add in the ubiquitous presence of Internet access through laptops, tablets, and smartphones, the savvy keynoter knows that:
- Some of his audience will not be listening at all to the speech
- Boredom is the key rival to the speaker.
Now that conferences encourage twitters and bloggers, there are even more listeners who are multitasking and making it harder for me to connect.
I have learned that there are three keys to giving a successful keynote:
- Knowing what my take home messages are.
- Telling the audience what I am going to say, saying it and then summarizing what I have just said.
- Encouraging audience participation before, during and after the lecture.
I use every trick I can think of to make sure I do not bore my audience with a one-way lecture. I ask questions and have the audience vote. I call on the volunteers I have recruited just before the lecture starts. I encourage questions at any time during the presentation.
I leave the stage and plunge into the audience. I call on people whose body language indicates they either agree or disagree with what I am saying.
I ham it up, and I make provocative statements. Boredom is the enemy.
For example, I have given many lectures on personalized medicine and genomics. I usually try to get an audience member before the lecture to agree to be a guinea pig. During a lecture, I will walk into the audience and interview a volunteer with a fictitious story about flying to their home, taking a blood sample and doing a genetic profile.
I will then ask the victim if they want the good or bad news first. I will make a joke about how I am violating HIPAA regulations and tell them what diseases the tests say they are at risk for. I will always have the audience applaud the brave soul who has given up their blood and privacy so the conference can be a great learning experience.
Last, but not least, I have learned that one must always finish early. Audiences love it when they get out five minutes early, and many resent it when you keep them past the deadline.
I am amazed at how many presenters go way over time. There is no surer way to alienate listeners.
Speaking is a core competency for any physician executive. Becoming a great keynoter can be learned, and I hope these tips will make it easier for you than it was for me.
Kent Bottles, MD, is a medical keynote speaker and health care consultant specializing in the future of health care and health care leadership. He wrote this article for the American Association for Physician Leadership® in 2010.
- Kessler RC and others. Social Phobia Subtypes in the National Comorbidity Survey, American Journal of Psychiatry 155 (5): 613-9, May 1998.
- Tancer B, Click, New York: Hyperion, 2008.
- Wallechinksy D and others. The Book of Lists, New York: William Morrow, 1997.
- Berkun S. Confessions of a Public Speaker, Sebastopol, California: O'Reilly, 2010.
- Rachman G. The Secrets of Malcolm Gladwell, Financial Times, 2010. https://www.ft.com/content/ee66b188-4897-351a-802c-b041c66e6262
- Medina J. Brain Rules, Seattle, Washington: Pear Press, 2008.
- Bligh J. What's the Use of Lectures? New York: John Wiley & Sons, 2000.