If I Can Learn to Become a Great Speaker, Anyone Can

Do most Americans really think public speaking is worse than dying?

“Speaking in public” is in the top 10 list of American fears according to the National Comorbidity Survey of more than 8,000 respondents published in the American Journal of Psychiatry. (1)

“Public speaking” makes the top 10 list of American fears as measured by what we search for on the Internet, according to Bill Tancer’s book Click. (2)

“Speaking before a group” is the number 1 item on “The Worst Human Fears” list in The Book of Lists by David Wallechinksy published in 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 wide variety of audiences over the past 30 years.

Natural selection

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 in Africa.

Scott Berkun in Confessions of a Public Speaker does a brilliant job of linking our fear of public speaking to the way the human brain is 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 the best American speakers of all time 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; she is usually most interested in my fee, my title, my CV, the paperwork her organization needs 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 telephone 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.

Arrive early

Bqqeing 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 (IOM) meeting in Washington, DC, because I went to two wrong IOM locations before finding the correct place.

Another time I flew from Iowa City to Chicago 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, telephone number, and email address of the conference with me 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, 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.”

Malcolm Gladwell is famous for his freewheeling, informal speaking style that commands $80,000 for an hour presentation. Gideon Rachman recently 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)

Now I don’t get $80,000 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 away 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 AV 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 their watch so I can end on time.

It’s showtime

If I have done all described above in the preparation phase of giving a keynote, the delivery itself 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 lecturer goers want to learn, to be inspired, to be entertained, to become hopeful, to meet others in their field, to have a positive experience, and to please their boss 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 that people can pay attention to anything. (6)

This 10-minute rule may explain why The 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 then steadily decline over the course of the talk. (7) If you add in the ubiquitous presence of Internet access through laptops, tablets, and smart phones, 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

I have learned that there are three keys to giving a successful keynote:

1. Knowing exactly what my take home messages are

2. Telling the audience what I am going to say, saying it, and then summarizing what I have just said

3. 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 the lecture I will walk into the audience and interview the 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 news or bad news first. I will make a joke about how I am violating HIPPA regulations and then 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 their 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 your 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.


(1.) Kessler RC and others. Social Phobia subtypes in the National comorbidity Survey, American Journal of Psychiatry 155 (5): 613-9, May 1998.

(2.) Tancer B, Click, New York: Hyperion, 2008.

(3.) Wallechinksy d and others. The Book of Lists, New York: William Morrow, 1997.

(4.) Berkun S. Confessions of a Public Speaker, Sebastopol, alifornia: O’Reilly, 2010.

(5.) http:/blogs.ft.com/rachmanblog/2010/02/ the-secrets-of-malcolm-gladwell/

(6.) Medina J. Brain Rules, Seattle, Washington: Pear Press, 2008.

(7.) Bligh J. What’s the Use of Lectures? New York: John Wiley & Sons, 2000.

Kent Bottles, MD