Human meaning is not given before language in and by some detached, prelinguistic domain and then labeled with words. Rather, language itself, always already ardently at play in our lives, is constitutive of the realities of our experience, opening up to us a uniquely human world. Language is the bridge between the created present and the uncreated future, affording leaders of medical schools with an underused opportunity to transform academic medicine. In creating and exchanging meaning, good leaders translate ambiguity into clear messages that convey the rationale for change and enroll others in a compelling strategy that fosters alignment and commitment. Because language influences our thinking and emotions, it is most powerful and effective for tackling challenges that rely heavily on conceptual, innovative solutions as opposed to those problems whose solutions are simple and technical in nature. However, many leaders in academic medicine spend much of their time in the domain of content, where issues are understandable, strategies are familiar, and solutions are seemingly apparent. Complex problems cannot be tackled by solely addressing content; the issue in question must be situated within an appropriate conversational context to provide a basis for action. Leaders do this by creating linguistic distinctions that prompt cognitive shifts in others, jarring them loose from their entrenched worldviews. This property of language--its ability to bring forth, out of the unspoken realm, innovative ideas and possibilities--will determine the future of our health care system and our world.

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