This week, I found myself deeply absorbed in a book that made me pause and truly reflect.

It’s called The Life-Changing Art of Self-Brain Surgery, by Dr W. Lee Warren, a neurosurgeon, Iraq War veteran, and trauma survivor. The book is really about self-awareness and how we rewire our thinking. But tucked inside it is a story about a young surgeon named David that I haven’t been able to get out of my head, because honestly, it’s not really a story about surgery at all.

At its heart, it’s a story about leadership.

A nurse called Dr Warren while he was visiting family in Texas. She was frantic. The surgeon covering his practice, David, was mid-operation and struggling. He kept stopping the procedure. He was asking the theatre staff what Dr Warren would do in this situation. The patient had been under anaesthetic for far longer than she should have been.

Dr Warren took a FaceTime call from another room. He could see David standing over the patient, looking uncertain. He asked what was going on.

David explained. He’d taken an approach to the spine that kept running into heavy bleeding. He couldn’t get properly exposed. Something, he said, seemed off with the patient’s anatomy. Dr Warren asked him to show how he’d entered.

The problem became obvious straight away. David had started just a few centimetres too far to the side, going straight through a large muscle rather than along its natural border. A small deviation at the beginning, less than an inch, had put the entire trajectory of the surgery in the wrong place.

Dr Warren talked him through the correction. Over the next half hour, David adjusted his approach, re-exposed the spine cleanly, found the disc herniation and decompressed it safely. The patient made a full recovery.

Afterwards, Dr Warren called David’s former professors and references. What he found out stopped him cold.

None of them had ever seen David operate independently. Not once. His whole training had taken place inside a structure where someone more experienced was always there, suggesting, guiding, quietly catching the things that were slightly off. His credentials were outstanding. Top medical school. Elite residency. An extra year of specialist fellowship under one of the best surgeons in the field.

On paper, he was exceptional. Alone in an operating theatre, he had never truly been tested.

His former chief said something that really stayed with me: “We really did David a disservice. It never dawned on me that every case he ever did was with another surgeon, so we did not realise he wasn’t developed enough to practise independently.”

Dr Warren draws one clear conclusion from this story.

David’s problem was not his intelligence, his technical skills, or his care for his patients. His problem was a lack of insight into how to recognise when his approach was off and when something needed to change. He had been blaming the patient’s anatomy rather than honestly looking at his own performance.

I read that and wrote four words in the margin. – Connect this to leadership.

Because time and again, I witness this pattern in the organisations I work with.

Someone gets identified as leadership material.

Sometimes it’s the high performer, the one who consistently delivers results, technically brilliant, always exceeding targets.

Sometimes it’s something a bit different: the person who is wonderful with people, the natural connector, the one everyone seems to gravitate towards. The one who feels like they hold the culture together just by being in the room.

And both of those things matter. They really do. But neither of them is the same as being ready to lead.

Because leadership isn’t about individual brilliance, or even warmth and connection. Leadership is about judgment. The ability to recognise when your approach isn’t working. The willingness to honestly look at yourself rather than blame the circumstances. And the awareness to change course before the damage grows.

So these individuals are given new titles, and there’s an expectation that they will instantly thrive. And then things start to go wrong.

Not because they aren’t capable. Not because they don’t care. But because the organisation never really prepared them. It just handed them a title and hoped for the best.

Just like David, they possess all the right credentials. They’ve always operated within frameworks that quietly bridged their gaps. But, as with David, when the scaffolding is removed and true independence is required, untested abilities are suddenly revealed.

Most organisations don’t have an honest answer to the question David’s story is really asking:

Did we actually develop this person, or did we just promote them and cross our fingers?

When David’s approach was off, one patient was at risk, not just of a poor outcome, but of serious, lasting harm to her health and her life.

When a leader’s approach is off, the harm is quieter. But it is just as real.

I believe that leadership is one of the most significant responsibilities one human being can hold over another. When we place someone in a leadership role, we are handing them something really important: the daily experience of another person’s working life. Their sense of purpose. Their confidence. Their belief that they matter. Their mental health.

A leader who can’t see when their approach is off, who deflects rather than reflects, can gradually erode someone’s confidence without either of them even noticing it happening. They can create an environment where people feel unseen, unheard, and like they don’t really matter. Not through cruelty, but simply through a lack of awareness and skill the role demands. People don’t just leave those environments. Sometimes they leave carrying real wounds that take years to heal.

This, to me, is the essence of people-first leadership. It’s not a soft or sentimental notion – it’s a profound responsibility. Because when leadership fails people, the consequences are real and lasting.

David could have seriously harmed his patient, not from any bad intention, but simply because he wasn’t ready in a way he didn’t yet know.

Unprepared leaders do the same thing, quietly, in organisations everywhere.

The good news in David’s story is that when he finally received honest feedback, when someone took the time to genuinely help him see what he couldn’t see himself, he changed. He went back into a proper developmental environment. He built the judgment and self-awareness that his original training had never really demanded of him. The last time Dr Warren heard from him, he was doing really well.

Growth is always within reach.

But it must be pursued with intention. It must be invested in. It begins when leaders and organisations summon the courage to ask an honest question, one that is all too often overlooked:

Are we truly developing our leaders and taking seriously the responsibility they carry over people’s lives, or are we just handing them a title and hoping the rest follows?

Inspired by a story in The Life-Changing Art of Self-Brain Surgery by Dr W. Lee Warren