MEDICAL LEADERSHIP &CIVIL NON-CONFORMITY:QUESTIONS, ENGAGEMENT, AND PUSHING BACK THE CURTAIN ON MEDICAL SECRETS
JOHN HENNING SCHUMANN, MD
MAY 19, 2013
CIR/SEIU CONVENTION
RONALD SCHUMANN (1946-2013)
BIASESDisclosures
• Blogger (ad-free)• Writer: publications, sites• Radio• Consultant, legal work
Academia-Program Director
Primary care, Longitudinal relationships
Community health, underserved, mission-driven
2012 ELECTION
SECURING PC FOR EXP MCD POPS. NEJM 2.10.11
MEDICAL LEADERSHIP
CENTER FOR CARE & DISCOVERY
LEADERSHIP: MY STORY
Called non-profits, for-profits, AMCs
Mission-driven purpose
Sharing spirit
All junked for $$ including teaching and clinical care—all to preserve research
No money no mission
The brass ring of idealism
LEADERSHIPDomain change: from operations to patient experience
A response: start a blog
How to blog? anonymously
What are the goals?
Who is the audience?
CIVIL DISCOURSE
CONFORMITYHospitalized Peer Pressure
What do the (big) (best) (other academic) (top rated) (non-profit) (clinical leader) places do?
MAN IN GRAY (1956)
DOCS IN WHITE COATS
INTERVIEWEES
CONFORMITYMan in the gray flannel suit
Doctors in white coats
my pediatrics evaluation
Interviewees in their dark suits
Unions? For a higher purpose
LESS CONFORMING
HOWARD MCMAHAN, MD OCILLA, GA
YEOMAN FARMER
COWBOY ARCHETYPE
NON-COMFORMITY
The yeoman doctor, out on own
The farmer
The cowboy, the individualist
Last of a dying breed
Non-union
HOSPITALISTS
FASTING GROWING IN U.S. HISTORY
DON’T CALL ME A CONFORMIST
CONFORMITY, REDUXMinions of hospitalists—unionize?
We are mostly employees now
There’s been a ‘widgetization’ of medicine
• Bad: loss of autonomy, perhaps creativity• Good: systemization and quality control
Hell’s Angels (conformity of a different sort)
CIVIL DISCOURSE 1:COLLECTIVE BARGAINING
CIVIL DISCOURSE 2
CIVILITY 3
labor unions
Trade groups (NPA)
Political organizations
New media (social)
Conformity (non) of a certain kind
FUNDAMENTAL QUESTIONSBloggery:
What pisses me off?
Waiting
Jargon
Shoddy communication
(Lack of) Empathy—
putting yourself in your patients’ shoes
ENGAGEMENTPatients
Systems
Learners
Colleagues
Management
Collectivism—Preaching to the choir—you are the leaders of the bunch 13k, 200 here you are the 1% of the 11.7% (111000 residents and fellows total in US)
PULLING BACK THE CURTAINTelling stories: advocacy
MEDICAL SECRETSMake a commitment to find out or tell-
Get Curious!
1. WHY DO PATIENTS WAIT SO LONG?
2. HOW MUCH IS THIS GOING TO COST?
2. HOW MUCH IS THIS GOING TO COST?
Neel Shah is here
MCR data
2. HOW MUCH IS THIS GOING TO COST?
3. WHO DO I WORK FOR?
The patient, right?
It’s not always clear—dual and triple loyalties when you work for others…..
Easy examples—utilization review
Hard examples-I’m in a department and my chairman tells me to refer to my own neurologist or surgeon when it’s less convenient for a patient
4. HOW WILL I MAKE AN IMPACT?
Those of you in this room are not just going to be punching the clock.
What is your passion?
What will you do to make a difference?
5. HOW DO I DO THE RIGHT THING?
6. WHAT DO I DO WITH ERRORS?
7. WHAT AM I AFTER?
Prestige/power, possessions ($), or purpose?
I was asked to become CQO—it aligned with my goal of leadership, but not my passion/purpose—it’s really hard, and not my strong suit.
8. WILL I STAY TRUE TO MYSELF?
Your identity has been subsumed into your profession. It becomes too easy to view people as constellations of disease, diagnoses, drugs….
Why did you go into medicine?
What gives you meaning?
How can you avoid the pitfall of cynicism when it’s in the air around us?
9. AM I OF THE SYSTEM OR OUTSIDE OF IT?
We are all most definitely OF, but are we toe holding in the other world?
10. ARE YOU AN INDIVIDUAL OR A HOME?
THANK YOU