MEDICAL LEADERSHIP &CIVIL NON-CONFORMITY:QUESTIONS, ENGAGEMENT, AND PUSHING BACK THE CURTAIN ON MEDICAL SECRETS

JOHN HENNING SCHUMANN, MDMAY 19, 2013

CIR/SEIU CONVENTION

RONALD SCHUMANN (1946-2013)

BIASESDisclosures

• Blogger (ad-free)• Writer: publications, sites• Radio• Consultant, legal work

Academia-Program DirectorPrimary care, Longitudinal relationshipsCommunity health, underserved, mission-driven

2012 ELECTION

SECURING PC FOR EXP MCD POPS. NEJM 2.10.11

MEDICAL LEADERSHIP

CENTER FOR CARE & DISCOVERY

LEADERSHIP: MY STORYCalled non-profits, for-profits, AMCsMission-driven purposeSharing spiritAll junked for $$ including teaching and clinical care—all to preserve researchNo money no missionThe brass ring of idealism

LEADERSHIPDomain change: from operations to patient experienceA response: start a blogHow to blog? anonymouslyWhat are the goals?Who is the audience?

CIVIL DISCOURSE

CONFORMITYHospitalized Peer PressureWhat 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 suitDoctors in white coats

my pediatrics evaluation Interviewees in their dark suitsUnions? For a higher purpose

LESS CONFORMING

HOWARD MCMAHAN, MD OCILLA, GA

YEOMAN FARMER

COWBOY ARCHETYPE

NON-COMFORMITYThe yeoman doctor, out on ownThe farmerThe cowboy, the individualistLast of a dying breedNon-union

HOSPITALISTS

FASTING GROWING IN U.S. HISTORY

DON’T CALL ME A CONFORMIST

CONFORMITY, REDUXMinions of hospitalists—unionize?We are mostly employees nowThere’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 3labor unionsTrade groups (NPA)Political organizationsNew media (social)Conformity (non) of a certain kind

FUNDAMENTAL QUESTIONSBloggery:

What pisses me off?WaitingJargonShoddy communication(Lack of) Empathy—putting yourself in your patients’

shoes

ENGAGEMENTPatientsSystemsLearnersColleaguesManagementCollectivism—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 hereMCR 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 reviewHard 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