Key Takeaways
- Leverage technology such as AI to streamline administrative tasks while ensuring it enhances rather than replaces the essential human connection in patient care.
In the fast-paced realm of health care, clinicians are continually adapting to new challenges, integrating cutting-edge technology, and balancing complex patient needs—all while preserving the compassionate touch that defines effective practice. Few individuals embody this dynamic intersection of clinical excellence and leadership better than Robert G. Darling, MD.
With nearly four decades in medicine, a 25-year career in U.S. Navy medicine, and experience as the first emergency medicine physician on The White House detail, Dr. Robert Darling MD's journey offers invaluable lessons in resilience, ethics, and adaptability in the rapidly evolving medical field.
One of the more captivating details of Dr. Darling's career centers on his time as a Navy flight surgeon, an experience that included hitching rides in high-performance aircraft like the F-14 Tomcat and the A-6 Intruder. Anyone who's seen Top Gun can imagine how thrilling it must be to strap into the back seat of a Tomcat, catapult off an aircraft carrier, and perform air combat maneuvers over frigid Atlantic waters.
But for Dr. Darling, the true purpose behind these flights wasn't just the thrill. "The Navy wanted me to understand what pilots experience—the physiological stresses and mental pressures," he explains. "When I flew, I wore the dry suit for cold-water regions. A flight might only last an hour and a half, but you'd be drenched. You'd lose a couple of pounds in sweat just from the intensity of the maneuvers and the pressure changes. Experiencing that firsthand made me a better physician for my naval aviators."
That direct insight into patients' real-world stressors underscores a central theme in Dr. Darling's philosophy: healthcare professionals can treat patients more effectively if they understand the context of a patient's life. While most civilian physicians won't find themselves hurtling off the deck of an aircraft carrier, Dr. Darling believes every clinician can benefit from stepping closer to the patient's perspective. "Whether you're taking care of top athletes, construction workers, or older adults in a retirement community, the more you appreciate the daily conditions they face, the better your care will be."
Medicine has undergone seismic changes since Dr. Darling started practicing in 1985. "We had some decent technology back then," he points out, "but AI, quantum computing, and advanced electronic records weren't even on the horizon." Amid these transformations, Dr. Darling remains convinced that no amount of technological innovation can replace the core doctor-patient relationship. "At the end of the day, it's about trust between two human beings," he says.
Dr. Darling acknowledges that sophisticated tools—like AI "scribes" that transcribe patient visits—can free physicians to focus on one-on-one communication. "The danger," he warns, "is when we let the technology become a barrier. It's so important to make eye contact, ask questions, and actually listen to the person in front of you." Healthcare, especially in high-pressure situations, hinges on genuine compassion and empathy. While AI can analyze data at lightning speed, it can't replicate the nuance and warmth of compassionate care.
How does a clinician remain not just competent but exceptional over a nearly 40-year career in such a volatile field? For Dr. Darling, the answer is to commit to continual learning and foster strong professional networks.
Perhaps no role better illustrates Dr. Darling's approach to leadership than his time as a White House Physician. He served under President Bill Clinton and Vice President Al Gore, providing medical care to them, their families, and cabinet members. "I had to pass an extensive security check," he recalls, "and when I arrived, I was one of five physicians among 25 to 30 nurses, medics, and corpsmen."
Working with the nation's top leaders is undeniably high-stakes. But for Dr. Darling, the biggest challenge wasn't the pomp or the protocols; it was maintaining a consistent standard of care. "We talked about how high-profile individuals—be they politicians or Hollywood celebrities—might receive what's often called 'VIP care,'" he explains. "That can lead to dangerous corner-cutting, because people assume these patients are somehow 'above' standard processes."
Instead, he and his colleagues insisted on upholding best practices, even if it meant a tough conversation. "These leaders are still human beings," he says. "They're subject to the same physiology we all are. If they have a viral infection, giving antibiotics isn't the right move. Sometimes they won't like hearing that, but you have to stick to the right course." This approach to executive health and dignitary protective medicine underscores the importance of maintaining medical ethics in all situations.
A defining moment in Dr. Darling's career—one that tested both his clinical reasoning and his courage—came when a high-profile patient insisted on receiving treatment he knew was medically unnecessary. "Whether it's an everyday patient or the President of the United States, there can be pressure to 'just prescribe something' or skip steps," Dr. Darling recounts. "You have to have the strength of character to hold the line."
He speaks passionately about the importance of saying no when a patient demands a treatment at odds with best practice. "There's a certain red line. You have to have the strength of character," he says. "You might even make them pretty angry—or, you know, pissed off at you—but you do it because it's the right thing to do." In Dr. Darling's experience, genuine respect between patient and physician is built on honesty and the clinician's unwavering commitment to appropriate care, always prioritizing patient perspectives and well-being.
Whether in a war zone, in the cockpit of a fighter jet, or in the Oval Office, Dr. Darling emphasizes the same fundamental leadership principle: building a culture of open communication and mutual trust. "When someone's life is at stake—during a code, or in the White House Medical Unit, or even in a daily clinic visit—you want every member of the team to speak up if they see something," he says.
Leaders can foster this culture by:
This approach is particularly crucial in crisis management and disaster medicine scenarios, where clear communication can make the difference between life and death.
At 66, Dr. Darling still practices medicine, runs his own business, and mentors rising professionals. He sees his current phase of life as an opportunity to pass on what he has learned. "Healthcare will keep evolving," he says, "and the pace of change might only accelerate. But the fundamentals—compassion, integrity, and teamwork—will still make or break you."
For students and younger clinicians navigating the pressures of the medical landscape, his message is simple:
Dr. Robert Darling's story is a testament to the power of resilience, ethical leadership, and ongoing adaptability. From treating aviators mid-flight to providing care for the nation's highest officeholders, he has navigated some of medicine's most high-pressure environments. His experience spans from Navy medicine to the White House, and from crisis management to executive health, offering a unique perspective on healthcare strategy.
Yet, his enduring lessons apply to every healthcare setting: never lose the human touch, hold firm to clinical and ethical standards, and keep learning. In a world where new technologies, policies, and patient expectations can shift almost overnight, these values remain an unwavering anchor. They provide not only better outcomes for patients but also a clearer sense of purpose and integrity for every clinician—and that may be the strongest antidote to burnout and uncertainty in healthcare today.
<p>a certain Red Line you have to have the uh strength of of character you might even make him pretty angry or you know pissed off at you or [Music] whatever hello this is Zach with the American Journal of healthcare strategy and you are listening to the clinicians and Leadership podcast series presented by the American Journal of healthcare strategy I am joined today by a very esteemed and accomplished guest with a wealth of experience both in the clinical and the leadership side uh within our Health Care system and and a lot of really cool and and interesting uh areas so uh Dr Robert darling Dr darling do you mind taking a minute or two to introduce yourself and tell us a little bit about your experience and how you got to where you are now sure Zach happy to yeah so uh Dr Rob darling I've been gosh I've been practicing medicine almost 40 years now um I spent most of my uh career in the United States Navy I was 25 years active duty um um started uh in Bethesda Maryland at the military Medical School the uniform services University uh graduated 85 um and 25 years in the Navy initially as a flight surgeon then residency and emergency medicine I had a host of just fa fabulous assignments uh that I think we're going to we're going to talk about I left retired left active duty in 2006 and U started the second half of my career if you will and I'm still at age 66 I'm still practicing I've got my own um business that I'm involved in and I'm doing all kinds of fun things one of my favorite stories and from one of our previous conversations Dr darling was uh you you told this story of getting an opportunity to ride in the back of an F-14 Tom Cat and um I I think you would be hard pressed to if you were to take a poll of of people around the world specifically around the United States of America who who would who aren't insanely jealous of that that chance um especially if you've seen Top Gun Top Gun 2 any any movie with a plane in it you know just how cool the F-14 Tomcat is so I'm I'm curious though besides an incredibly cool experience what what why did you do that what what additional information did you gain that impacted your your your role and your your clinical care and your administrative decisions that were made well as I said uh Zach having attended the nation's military medical school uniform services University I was there with my uh you know I was Navy uh but I was there with my Army Air Force and a few Public Health Service colleagues the whole purpose of the medical school is to train to take care of the warf fighter right so early in my career after I finished my internship uh in 19 well during that time uh you know the Navy said hey um you're not going to go to residency right away you're going to do and you're going to go out you're going to go out to the fleet you're going to go on a ship you're going to be an unders medical officer you're going to be a a flight surgeon and so I decided you know a flight surgeon sounds good so I chose that path right after my internship um well actually I did six months in the ER first and then I went to uh the naval Aerospace Medical Institute in Pensacola Florida uh this is where uh young Naval aviators begin their basic Flight Training and that's also where young Navy doctors go to to learn the how to become a flight surgeon and a flight surgeon is a doctor we're not surgeons well minor stuff but um essentially we become Aero uh Medical Specialists so we take care of Naval aviators um uh because you know that's there's a lot of stresses on the body with particularly the the area I chose I chose to go go on the aircraft carrier USS Theodore Roosevelt so this is an init class carrier you know a 1 1200t long ship 110,000 tons 6,200 men 100 airplanes and one of the things that I was charged with was all right we want you to understand what it's like uh landing on an aircraft carrier uh so any airplane that had two seats or more I would fly in and of course this was 1986 when when Top Gun came out and of course flying in a in a a fighter aircraft U got I 25 carrier Landings during my two years on board the Roosevelt and I also flew in the A6 Intruder so that's uh so in the F14 I was in the back seat in the A6 it was on the right seat pilots in the left seat and I flew on some of the other airplane uh as well so so yeah and the again the purpose of that I got to experience you know air combat Maneuvers uh Landing taking off is very physiologic t physiologically taxing and it helped me take better care of my patients my Naval avag I think like I said before I think that's an incredibly unique experience very very super cool just to get the opportunity to fly in that wide variety of planes but also just to get the opportunity to experience what your your patients were experiencing on a regular basis in their regular lives in their regular job and I I think that that's that's that's an interesting thing I want to camp on just a little bit and I'm I'm curious um obviously that's a unique situation not not every clinician and physician is taking care of these aviators who are flying these multi-million dollar Jets and airplanes and landing on an aircraft carrier that's a unique stressful situation there but what are what are some ways that your clinicians and your Physicians and your administrators can can grow in their perspective of what their patients are going through um and and get better idea of the patient perspective and and how will doing so affect the decisions that they make I'm curious if you have any thoughts on that well yeah um when you think so again being on that so I um when I would fly with them you know um I I I was part of a mission uh and um for example when we would uh when we were flying in the North Atlantic over uh very frigid waters you know I I'd have to put on the the dry suit uh not a wet suit a dry suit and a dry suit is a uh it it basically is uh you're wrapping yourself in rubber so that if you if you were actually had to go into you know uh freezing water you would flip so this is like a um a suit that on on your neck on on arms and legs is is a piece of rubber that prevents the water from coming in so it's very very hot so we would go and fly and do air combat Maneuvers and you know in in a in an hour and a half's time you when you got back to the boat your body was you were beaten up I mean you lost probably a couple of pounds in sweat I mean you were completely drenched from that and again the purpose for me was to understand this is what my air crew were going through or for example um maybe you know you got a minor cold a little a big deal of cold right well when you're in a pressurized aircraft landing on a boat at 140 knots uh a little minor cold if you can't clear your ears um uh it could be a disaster you could blow I've had guys blow out uh eard drums because they didn't tell me they didn't tell me they had a cold and uh they couldn't clear and uh so anyway you you learn the perspective from from the patient from your from your air crew and you learn how to take better care of them as a result so for your your non-military Physicians um how can how can they grow to better understand the patient perspective so even you know we remember I started literally started uh you know I started practicing in 1985 that's a long time ago yeah you know we had technology then we had some decent technology we got incredible technology today right but guess what I I am not you know I think AI as as we're getting into Ai and and um Quantum Computing and all that kind of stuff you know what it's going to be a long time before me as a clinician gets replaced by a computer or a robot because at the end of the day it's about your patients your clients patients clients uh having trust in you the human clinici um uh being able to communicate I tell all these young people put you know when I text text text put it down give me a call let's have a conversation the art particularly this the younger generation um everybody's using technology to communicate but when it comes to Health Care particularly when you have to you know you know compassion compassion understanding it's about uh direct communication with your patient and their family right their families often uh so that art that and it is an art it's becoming more and more of an art to be able to communicate uh with your patients on a very basic human level I I guess I guess AI gets really really good and we and robots get really it's possible we might be able to get you know you can say well this is a robot who's being compassionate it's not a real human being I don't know we got some ways to go yet so I I urge all you all these young Medics Pas doctors nurses whatever to don't forget about basic like what we're doing right now being able to do that and do it well right well that's the you you've mentioned you I think you've nailed on the head the the importance that and the perspective that a clinician brings of understanding like hey it's it's this interaction between you and me that matters most um and and really guides the whole care visit we're regardless of the situation it's it's the physician and other clinicians interacting with the patient and that is where a lot of the decision making comes from I know um and I know particularly in civilian medicine um you know doc well we we have to document what we do right we have to but there I can't think of anything more annoying because this happened to me it's just the nature of the way medicine was Gone with the electronic medical record is I come in and I see my doctor and you know they're not really looking at me they're asking questions but they're documenting um everything and so I guess we started using and I haven't I've never used one myself but you know we've got these scribes these days um that that are that that's that's a good thing and they so Dr patient we're talking there's a scribe over there documenting everything and I imagine that that'll be one of the benefits of AI that um maybe the the conversation you you the patient has to agree you you record it and then a the AI you know cuts it down into a concise nice note that you can quickly read all right we've documented this but at least I had this what we're doing right now you know I'm I'm curious we've we've talked a little bit about just the the extensiveness of your career working in a variety of different fields within the medical field um um and and over your the course of your career the medical field has changed dramatically I mean you've you've told stories of flying in an F14 comcat in 1986 and here we are in 2025 talking about AI scribes and and new advances to technology that are that are the future of medicine as as one may say how how do you stay on top of a field that has changed so dramatically um especially in serving in in some of the areas that you have such as these high pressure situations as serving in the military and and in the White House how how do you stay on top of an everchanging field well look it's um that part is is never going to change it's it's uh well thankfully um you know we have these smartphones where we can have everything we the good news is you know when I when I was in medical school we memorized a lot we just constantly you know me memorizing memorizing I can remember we would spend hours with three by making our own 3x5 uh flashcards with notes now we've got this wonderful thing right but but but but the end of the day it's reading I read I'm a voracious reader actually between reading but also um I do a lot of audio books uh and I do that while I'm walking my my wanner who we both need the exercise and so I I I can listen to journal articles I do books that usually depending upon the nature at 1.5 or 1.7x uh with my earbuds in while I'm walking at a really good clip so I'm getting my exercise done and um uh and I'm I'm getting information that way uh but also I I like I still getting together with colleagues um and having discussions that is you know colleagues on the same plane who we talk talk about whatever the new topic is and really who others who have thought about it and we compare notes if you will so so that part you just have to really put your nose to the grind and you know read read journals read books and and have colleagues that you can bounce things off of no I I think you highlighted two very important and critical components of of anyone within re really within any profession but especially the medical field just the the importance of being a continual learner um always learning always striving to to update knowledge to reinforce knowledge continuing to grow and and and expand that knowledge base and then recognizing that while we are growing and learning and while you know individuals are are very smart and accomplished they're they're not they don't know everything and it's impossible to know everything and so recognizing the importance of colleagues and having individuals that you can you can lean on and you can ask questions to and hear perspectives and uh because that that's a it's a dangerous thing if we ever find ourselves thinking we're the we're this absolute smartest in the room that's not a spot that I personally want to be in I I've actually been practicing just testing out a little bit is you know chat GPT okay well I I will ask it a fairly complex something I know the answer to a question a complicated clinical problem and uh uh I've been really Blown Away by for the most part the accuracy this and uh it's it's just an amazing technology I never even would have thought this was possible you know but but there it is there it is so to Pivot just a little bit um I'm I'm curious to hear you've you've worked in some high pressure situations working taking care of the crew on a aircraft carrier um taking care of those those naval officers and those those uh those Navy um individuals and working in the white house and having some taking care of some pretty pretty important people there too um and I'm curious in in both of those fields and and in your current position you're you're taking care and you're leading a team in in a world that like we said before is constantly changing and constantly evolving how do you ensure that your team remains resilient and adaptable in the face of these rapid changes one thing to personally be personally be resilient adaptable but how do you encourage that perspective from a across the team sure well um yes so you brought up the white house so I was the first I was honored to be the first emergency medicine physician uh to be selected to serve the president of the United States that happened uh I got the call in 1995 by by the surgeon general's office Navy surgeon general's office that a position was becoming available at the White House during the Clinton Administration and um uh essentially 10 of us raised their hands that they would be interested three of us got interviews and and I won so that was Prett kind of cool so I was the first er do you know in part that's because you know emergency medicine relatively young specialty um you know typically it was Family Medicine you know Internal Medicine doctors general surgeons but anyway I got there uh you know I had already done my residency I was already board certified I had practiced for several years taking care of United States Marines at Camp Pendleton and uh um I had to go through a very very vigorous security background security clearance background took eight months there's all kinds of great uh stories associated with that we don't have time for that right now but um no I mean I I was there our my our job the the the White House medical unit which was a part of one of five Physicians there were and then another 20 or 25 nurses paramedics Corman uh there's 25 or 30 of us during from 1996 to 1999 was I was when I was there and yes I took care of the president United States President Bill Clinton and first lady Hillary and Al Gore vice president Al Gore and their families and the cabinet uh and I think it's you know the team approach is uh is you you got to on top of your game you got to be at the on the very very tip top of your game but you also have to be able to put in perspective that um you know the president of the United States he's the president of the United States but he's still a human being with all the same and there's a tendency in fact there's books written about it um on my shelf here um talking about how throughout history that uh prominent individuals politicians Hollywood a whatever in fact don't get uh the standard of care they get special care which typically they we cut Corners because they're special you can find it throughout history there's a great book that everybody should try it's go when illness strikes the leader written by a friend of mine he's now deceased a psychiatrist from George Washington University he studied this throughout history how how leaders have gotten uh and and we were in when I got there we talked that was very early first thing on we obviously he's the Pres we treat him with utter respect we do everything we cross every T dot every I but we still do it he's he's a patient he's a human being and that had to be you know up and down the chain of command you know as military organization chain of command very important everybody you know I'm the doctor you're the nurse You're now that said everybody has an observation it's just like today you know when a code occurs you know the old days oh the doctor would call it well but what happens today uh before you call a code if you're doing your job right the the physician's usually the one running it but before we say the patients you know we're going to call this you go everybody in the room hey Zach you see anything is it do we make you know every now and then it's the the the the the the most Junior person in the room has something important to say and and um and so that that's very and we we practice that uh at the White House in the White House medical so well and and your in that situation with the code that that most Junior person might have something to say that could result in a life being saved and that's just speaks to the importance speaks to the importance of creating this atmosphere that that encourages everyone having an opportunity to to share something that they think would be beneficial and and to speak up when when they have an idea that that could better serve a patient um whether that's in the code situation or just in an everyday Clinic situation and so Dr darling I have one more question before I let you go today um I'm I'm interested in a in a wide variety of experience that you've had serving you know on the aircraft carrier in the white house and then now now in your current role doing some really cool things I'm I'm curious could you share an example of when your your leadership was tested and how you you handled and responded to that situation well um you know there are instances where um patients uh want you to do something um that you know is wrong and you you know I mean it might be something as simple as um the most common thing is patients coming in you know with an upper respiratory infection and insisting or they you know uh you know we all know it's viral and they want uh they want antibiotics and um I mean I can remember having that conversation a couple of times with President Clinton where dog don't you think I mean really and and that was that was fairly early in the career he he wanted he had a he had a cold and it was clear you know he didn't have a fever there everything pulo and uh you know doc my other doctor always used to give me antibiotics they say Mr President and I went you know I went into the long discussion about viruses and all that kind of stuff now that that's a kind of a minor case but uh you know there's there's there are are similar I guess the point is is that um you're going to be your patients your patience will test you from time to time and I'm not saying that you can't you know negotiate certain things but there's certain Red Line you have to have the strength of of character you might even make him pretty angry or you know pissed off at you or whatever but you you have to um you you at the end of the day got to do the right thing and um you know it's not always going to make everybody happy but uh but yeah that that's happened Lots I I can't think of anything more um right off the top of my head that's h a better example of that but I think that's a pretty good one you know telling patients uh educating them and doing doing the right thing despite that they want might want something else well and I think you highlighted just the importance of having in integrity and being valued and and sticking to those values as especially as you are faced with with tough situations and and having to respond to to tough situations and and and difficult people and especially I mean doing so while still creating as we talked about earlier that that that atmosphere of where people can ask those questions but but recognizing that hey like ultimately I need to do I need to do what's right and having those values and those th that integrity to to do so despite pressure from certain individuals or patients or or situations so Dr darling we thank you so much for joining us today um I I I've enjoyed getting to just interact with you over the past couple meetings that we've had just getting to to hear your perspectives on um how being a clinician in in leadership has has affected your career and just the ways that you have you have served in some some very cool ways very very jealous I don't know if I said this before of your you getting to fly in the back of an F-14 Tom Cat I and I know there's a lot of other people that that that share that sentiment with me so um but we we thank you for coming on today and uh wish you the best as we we get started with this 2025 year well well my pleasure thank you for uh for doing this I I'm in that stage of my career right now where I'm you know in in more more Mentor mode and giving back than I ever that I ever been before and I enjoy doing this so so thank you and and uh uh best wishes to you and and all of your uh everybody who's watching this</p>
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