Thursday, August 22, 2013

Control is not a four letter word

I read that Jeff Bezos, the Amazon founder-president who bought the Washington Post, according to an anonymous colleague “makes an ordinary control freak look like a stoned out hippie.”  It sounds a lot like what they said about Steve Jobs. 

Despite their success, you can sense the irritation in the accusations.  So given their success, you have to wonder, is control a bad thing?  Seems to me you have to distinguish: is it control so you are in control for your own reasons, or is it control for the sake of the product or service being produced?

Type I Control Freak (CF1)

The usual “control freak” in a company – or in a family for that matter – is someone who likes to be in control for his or her personal reasons.  Sometimes it is a way to treat anxiety – if you are in control, someone else isn’t, and you won’t be hurt.  Or it could also be someone who is afraid of being fired.  For instance, if she hoards information and divides up tasks so that she is the only one who can operate the unit, who is thus indispensable, firing is made much more difficult.  This is CF1a.

Alternatively, forget weakness.  Some people hoard information to maximize their own prerogatives.  They take vacations when they want and let others work with the left-overs, and so on.  In short, they enhance their own power and use it for their own gain.

Type II Control Freak (CF2)

On the other hand, what about someone who is really smart, or really well-trained?  Or someone who will not make compromises with quality?  Or someone who will work as hard as possible to get things right?  Should they be sharing control (and power) with the less smart, the less trained, the less hard-working, the more likely to compromise quality?  What would you rather own, a true Giovanni Bellini, or one From the School of Giovanni Bellini?  Needing control can be not for the sake of personal power, but for the sake of getting it right.

Not to put myself in the class of Jobs and Bezos, but I was head and sole owner of a medical group.  When it came to business and medical organizations, I knew more than the constituent doctors by far: I had studied it, I continued to study it, and I continued to experience it day after day.  I made so many mistakes that I eventually learned from that no one could match me in mistakes made and lessons taught!  I had been there.

Moreover, as the owner, I had a perspective that was different from others.  I was responsible for the final product, and would have to take pride or shame from that product.  I stood to lose or make money on performance.  Growth that came from smart moves and ability to please patients and referring physicians would accrue to the group’s benefit, and to mine, and less directly to each individual clinician.  So my idea of control was grounded more on CF2, not CF1.

As an example: this may or may not be true, but I recently heard that since I sold my group one of my initiatives was proving successful.  I thought that increased patient accessibility was important, so instead of having “secret” Sunday office hours, we would publicize our availability on Sunday to patients, make the hours regular and fully staffed.  The result would be both improved patient service and improved competitive advantage for our group in attracting patients.  So, what I heard was that the Sunday hours were proving so successful that the clinicians were complaining that they were working far longer on Sundays than they were accustomed to.

If I were still in control, I would point to this as a sign of success.  Yes, it is more burdensome for clinicians, but in an area of high competition, this could prove the difference between failure vs. survival.  It could lead to actual practice expansion in a difficult locale.  But what I heard was that there was now consideration of how to curtail availability so the staff and clinicians could get out earlier.  The leadership intended to let that happen; no rocking the boat.  If I had insisted we find a way to keep the advantage and find a way either to compensate clinicians for the extra work or hire someone else, etc., would that be self-indulgent CF1?  Or would it be virtuous CF2?

Again, that’s not to compare myself to Apple or Amazon, and maybe that’s a crappy example.  But I find myself rooting for Bezos as he takes over WaPo.  There are a lot of changes he can make, and he should be the arbiter!  (One – get rid of Jennifer Rosen, por favor.)  He should find top people there and elsewhere – Jobs’ formula wasn’t to find just better engineers, but ten times better engineers, A++ engineers.  And then team with them and work really hard for a vision that works, time and time again, if that’s where his heart is.

Yes, you have to make compromises because people are people and you can’t get everything exactly right every time all by yourself.  But let’s not surrender to worries about CF1 when you are a CF2.  

Budd Shenkin

Wednesday, August 14, 2013

Another Afternoon in the Pediatric Office

As doctors, we bring our ideals, we bring our training, and we bring ourselves.

The simplest is our ideals.  “To do good,” that’s pretty much it.  Hippocrates’ famous dictum “Do no harm,” is cautionary.  He was wise to caution, because doctors have an inherent predilection to act, to do something, which is why he says, “First, think, what’s the downside?”  “Do no harm” is more quotable, however.  But that’s translated from ancient Greek.  Before the translation, who knows, it could have been, “WTF?”

Medical professional training is less simple than our ideals, and with medical advances the technical training gets harder and harder and longer and longer.  I suspect, but it may not be true, that all the technical training has crowded out training in how to actually be a doctor.  Empathy, understanding, judgment – I’m pretty sure this has to be taught by people actually experienced in being real doctors, not just medical educators.  It has to be personal, in small groups or individually, and it’s mostly look at the way I do it. 

I admire the doctors who really tend to teaching the next generation personally.  I went to one of the best foot orthopedists in the country yesterday, and he had a young woman with him who must have been a resident – so young, oh so young! After he saw me I saw him in the hallway explaining to her, one on one.  This guy is more emeritus than I am, and here he is, passing along his art, the way he does it, the way he understands it, for no payment or recognition whatsoever.  Who knows what he was telling her?  About the foot?  Or about how other doctors – and me, the patient – got the diagnosis wrong.  If it had been my father there in the hallway, I know he would have emphasized the latter.  This guy is old school, so maybe that was what he was doing, too.

And finally, besides ideals and training, we bring ourselves.  We have our own experiences, our own understanding of life that is often hard won, and if we are good doctors, we will pass this on.

Last Monday I used this last tool, myself, and I hope I didn’t do any harm.  Two brothers ages 12 and 13 came to see me for their first visit, just for checkups.  They were brought by their stepmother; their divorced mother and father had both remarried and share custody.  The older boy is at his Mom’s in San Francisco Monday and Tuesday, then over to his Dad’s in Oakland.  The younger one goes to another school and so is at his Mom’s Monday through Friday, as I understood it.  I had a shock of recognition when I heard this, since I shared custody of my two eldest sons with my ex-wife for years and years, splitting up the weeks and having the kids travel back and forth.  I told them I was familiar with their situation and observed that it must be a hard for them.  Or, as their stepmother put it, “The Backpacks.”

In a checkup visit, I try to do some good.  I can do it with prevention – I always deal with exercise, usually with nutrition, etc.  But I bring myself to the visit, and try to figure out how they can leave the room better off than when they came in, rather than a simple “everything’s fine.”  So, since there were no obvious health issues, I persisted in asking them if the schedule was working for them, even though it’s hard.  The stepmother, a nice lady who commented on their and her Myers-Briggs typology, so she’s pretty aware, said “No, it doesn’t.  It’s really a lot of driving, but we make it work.”  Hard on her, clearly, as well as them.  But she was honest and clearly determined to overcome barriers.  One barrier being that the younger one is INT (introverted thinking) and J, so she finds it hard to make contact.

I don’t have a lot of time in these visits, so I tend to shoot things out and hope they work.  I immediately told them that I was divorced also and had shared custody of two boys, which led the stepmother to say, “Maybe you will be able to help us some, then.”  Maybe so.  I had to save time, so I just preemptively said, hoping it would help to frame the situation well, that it might be difficult going back and forth, but it’s a lot better than having to feel deserted by one or the other parent.  Maybe it helped, maybe it didn’t.  Maybe that will resonate.

Later when I was alone with the younger boy I asked him if everyone got along OK, assuring him everything was confidential, as I always do.  He said that he felt that they two boys were asked to clean up the house at his Dad and stepmother’s house, and he didn’t think it was fair, since she was the one who messed it up the most.  I asked him if he could talk about this to his Dad or stepmother and he said, not really.  Do you have anyone to talk to about it?  “My mom,” he said.

The plot thickened – I know this pattern.  So I asked him, “What does your Mom say when you tell her about it?” I asked.

He said, “She says, ‘Well, I guess you should live here with me.’”

I’m so proud that I didn’t comment directly on this.  I was hoping I could bring my best self to this visit.  So, I asked if I could try to help this situation a little.  He said yes.  I told him that it would be best if he could bring up complaints about his Dad’s house directly to them without fear of repercussions.  I went through with him how he could first say something good – maybe how he appreciates how his stepmother cooks for them – and then tag on the complaint.

“She doesn’t cook,” he said.

Right.  “Well,” I said, ”maybe you could say how much you appreciate all the driving she does back and forth?”  Yes, he thought that was valid; I don’t think he had really thought about that, about how hard his stepmother tries.

Then I asked him if I could help by bringing up the issue in a way that couldn’t be traced back to him.  He trusted me and said OK.

So when I got the three of them back in the room, I traded on our common experience to say to them that they might think about having some meetings as a family together, where they could say what was working well, and what was a problem.  The stepmother said, we just had a meeting on Friday, but that was over a problem; maybe it’s a good idea to have one where we can say good things.  I said I thought that was important.  The younger boy kind of looked at his stepmother sideways, warily, but I knew he knew that I was doing what I said I would, and had carried it out OK.

Hard to know what will happen.  Easy to conceptualize, hard to do, especially with the subterranean undermining mother.  Although I understand her.  It’s so hard not to have your kids all the time.  I was watching old videos of our family as I copy them to disk.  My kids stayed at their Mom’s Christmas Eve and early on Christmas morning, but were expected at our house at 10 AM, when their stepbrother, stepsister, and half-brother would also be there for opening presents.  How hard it had to be for their mother to say goodbye to them on Christmas morning.  And how hard it would have been for me not to see them.  I know, because as time went on I didn’t see them anymore for Christmas. 

Divorce just sucks.  I just hope that what I did with these two boys and their stepmother helped in some little way.  At least they know they are not alone, and maybe something I said helped.  Like I say, ideals are important, training sometimes helps, experience certainly helps, but bringing yourself to the visit might be the most important thing of all.

Budd Shenkin

Sunday, August 4, 2013

Violence and Climate Change

An "I told you so" moment - how I love them!  In fact, that was a large part of the reason I started this blog, truth be told.  If I'm right early, I want the credit.  Get those A's, young man!  I don't think I'll ever get it out of my system, and why try?

The point in question: in a previous blog I asserted that global warming plus population explosion will lead to more and more violence -- and even more than that, an entire change in the cultural beliefs and mores of humankind, as the conditions of existence are so severely changed that it could be called a point of inflection for the entire human culture.  The paradigms that we have been accustomed to, where the earth was big and the human race was small, will be changing.

Apocalyptic?  Yes, I guess it is.  But these are our times.

I'll have more to say on this in the next day or two, but in the meanwhile, here is collaborative evidence from the Huffington Post, via

Climate Change And Violence Linked

Shifts in climate change are strongly linked to human violence around the world, according to a comprehensive new study released Thursday by the University of California, Berkeley and Princeton University.
The research, which was published in Science, examined 60 previous studies from all major regions of the globe. The results suggest that changes such as drought, flood and high temperatures strongly correlate with spikes in conflict.
Researchers noted examples including increased domestic violence in India and Australia, assaults and murders in the United States and Tanzania, ethnic violence in Europe and South Asia, land invasions in Brazil, police violence in the Netherlands and civil conflicts throughout the tropics.
Climate Change And Violence Linked, Breakthrough Study Finds by Robin Wilkey, The Huffington Post, Aug 2, 2013.

Budd Shenkin