Yu C. The space between: reclaiming presence in physician leadership. Can J Physician Leaders 2025;11(3): 131-135. https://doi.org/10.37964/cr24796

The leadership problem we’re not naming

Physician leadership today sits inside relentless complexity: cascading decisions, contested priorities, moral distress, and the ambient hum of urgency. The common fix is to do more — optimize another process, add another tool, accelerate the pace. But the more we accelerate, the narrower our attention becomes, and the less we perceive what actually needs our care.

This viewpoint explores presence as a practical leadership capacity: not an escape from complexity but a way to perceive it with higher resolution. Presence is not a mood or a luxury. It is the disciplined ability to notice what is happening — within and around us — so that judgement gives way to discernment and reflex gives way to choice. As Viktor Frankl observed, “Between stimulus and response there is a space. In that space is our power to choose our response. In our response lies our growth and our freedom.”¹

Presence as a leadership technology

Presence becomes actionable when it is translated into skills leaders can practise together:

• Recognizing involuntary thoughts — Judgements and interpretations arise automatically — conditioned, rapid, and often invisible. Treating them as events in the mind, rather than truths to obey, creates the small wedge of freedom from which wise leadership proceeds.
• Anchoring in sensory awareness — The nervous system’s direct signals — breath, posture, temperature, muscle tone — are a reliable reference when narratives are noisy. Sensation widens the perceptual field and stabilizes attention in high-stakes moments, echoing Jon Kabat-Zinn’s insight that “mindfulness means paying attention in a particular way: on purpose, in the present moment, and nonjudgmentally.”²
• Allowing non-ordinary states (safely, briefly, purposefully) — Deep quiet, shared stillness, and other state-shifts can loosen habitual cognition and reveal overlooked options. These are not curative claims; they are contextual tools for seeing differently so we can lead differently.

Practised together, these skills reduce reactivity, increase relational intelligence, and improve the quality of collective decisions. The “technology” is humble: attention, breath, and the willingness to pause long enough for better options to emerge.

Why this matters system-wide

Presence is often framed as self-care. In leadership it is system care. When a leader can recognize an involuntary judgement (“this will never work,” “this person is difficult,” “we don’t have time”), name it as a thought, and return to direct data (what is actually being said, sensed, and needed), the tone of the room changes. Psychological safety rises. Creativity becomes possible. Meetings consume less energy and produce clearer agreements. Small shifts compound.

As Snowden and Boone remind us in their framework for leading in complexity, different contexts call for different kinds of responses³ — and presence is what enables a leader to discern which is needed in the moment.

Crucially, presence scales because it is non-proprietary and low cost. A one-minute pause before a difficult agenda item. A practice of briefly naming the assumptions in the room. A closing round of sensations (“one word: how does your body feel now?”) to calibrate nervous systems before the next task. None of these requires new funding lines, and all of them reshape culture.

Lived experience: one example (illustrative, not evidentiary)

Recently, a nurse practitioner invited me to facilitate a short group session at her family health team in Perth, Ontario. Ten participants — physicians, admin, learners, and community members — gathered in a newly prepared space. We set 31 minutes aside for shared stillness supported by a simple, standardized ear-acupuncture protocol (the NADA⁴ approach) and followed by integration dialogue.

What happened next was ordinary and instructive. One participant described a vivid, grounded forest journey. Another said she found her “zen spot.” A physician noticed she woke feeling unusually refreshed. An administrator, seated between a psychology student and a public-sector leader, reported an almost palpable calm radiating from both sides. The conversation afterward was unhurried, respectful, and specific — people spoke from direct experience rather than from opinion.

Two days later, the leadership debrief focused not on “did it work?” but on “what it made possible”: interest in a repeating, team-led offering; a plan to train facilitators from within; and curiosity about how brief, shared stillness might become a normal feature of team life. This is not presented as clinical proof; it is a leadership vignette about culture change initiated by a small, shared practice.

From concept to cadence: making presence habitual

Leaders do not need to become meditation teachers or adopt new identities. They need cadence — tiny, dependable practices that create space between stimulus and response:

• Open with orientation (60–90 seconds) — Before major items, invite the group to place both feet on the floor, lengthen the spine, soften the jaw, and take two quiet breaths. No mystique; just physiology.
• Name the mind — When stakes rise, normalize the sentence, “Notice what your mind is supplying right now — assumptions, judgements, predictions. They’re thoughts. They’re conditioned. They arrived on their own.” The aim is to loosen identification, not to suppress thinking.
• Return to data — Ask, “What do we actually know from direct observation?” Separate sensed facts from interpretations. Decide from the wider field.
• Close with calibration (30 seconds) — One-word check-out (“ready,” “cloudy,” “steady,” “tight”). This trains leaders to read the room as a nervous system, not just a set of roles.

These moves are deceptively small. Their power is cumulative. Culture is what we do repeatedly — especially under time pressure.

Addressing common objections

“We don’t have time.” Then we especially need to stop losing time to reactivity. A one-minute pause often saves 15 minutes of unproductive debate.

“This feels soft.” Presence is not softness; it is precision. It reduces error born of narrowed attention.

“What about evidence?” This viewpoint does not claim therapeutic outcomes from any single practice. It argues that state management and shared attention are legitimate leadership competencies that improve the conditions under which evidence-based care is delivered.

The invitation

Presence is not a specialty. It is a human capacity we can normalize in leadership without jargon or fuss. Start small: one minute of shared stillness before your next contentious agenda item. Name thoughts as thoughts. Ask for direct data. Notice the shift in tone. Repeat weekly. Then decide what, if anything, needs building out from there.

The space between stimulus and response is where leadership lives. We can cultivate that space — together.