Category Archives: politics

It’s a Bad Day, Uncle Groper

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What if your favorite uncle, whom you have always regarded as funny, warm, loving, and virtuous, if a little odd, were accused of sexual harassment or assault?  This is what it feels like to learn of Al Franken’s assault on Leann Tweeden in 2006.  I feel nauseated, embarrassed, disappointed, and confused.  I have liked Al Franken for a long time, ever since his Stuart Smalley bits on Saturday Night Live.  It wasn’t until I listened to his recent memoir, Al Franken, Giant of the Senate, that I learned more about him and liked him even better.  He’s a little too sarcastic and biting for me sometimes, but after hearing his stories of how he became a Democrat and what motivated him to run for office, his family’s emotional journeys and how things work in the Senate, I came to see him as a respectable public servant with the interests of his constituents and all Americans at heart.  I have recommended his book to many of my friends.  I have regarded him as a champion for all things progressive, including women’s rights and equality.

And now all of that is thrown in the blender with allegations that I assume are true.

How do I reconcile this?  How does a person, whom I still believe respects women at his core, behave like this?  Ever?  Do I throw away everything about him that I believed was virtuous, everything he has said and written that I agree with, his decades-long marriage, and relabel him as a misogynist because of this one revelation?  Do I assume that because now we know of one, there must be dozens of others?

I am forced to compare my response to allegations against him to that of allegations against Roy Moore.  I don’t know anything about Roy Moore, but he’s an ultra-conservative Republican (I am a heavily left-leaning independent), so if he goes down for sexual assault, I’m not that bothered, and I’m judgmental of people who defend him.  I must concede that neither party can claim moral superiority.  Just this week at least three articles examined the precedent set by Bill Clinton’s sexual escapades from which he plainly escaped a rightful accounting; the precedent his (and Hillary’s) dismissal of all allegations set for everything we see now, and why he should have resigned after admitting his abuse of power.  And today Nate Silver laid out an excellent case for Al Franken to resign now.  I agree that that would be the epitome of Walking the Talk, aside from not having committed the groping in the first place.

My inner conflict now churns on two levels.  First, I must decide what I now think and feel about Al Franken, whether I can still trust him, and how I will interpret any of his words or actions hereafter.  I feel betrayed, and the positivity needle in my mind has how swung a few degrees more toward cynicism, which I hate.  Second, I must examine my immediate reactions when such allegations are made against my political opponents.  I think we can agree that there are some cases of flagrant misogyny, based on years of evidence of poor principles and lack of respect in multiples realms of a person’s life, and we are not concerned with their political leanings—assholes are assholes regardless of party.  But if and when a reputable conservative were to be accused, would I give him the same benefit of the doubt that I wanted to give Al Franken today?  Shouldn’t I try harder to be both objective and compassionate, and rise above my political biases?  Is it appropriate to say we all make mistakes, and that we should give people a chance to prove that they now know better?  If I am willing to say that for Franken today (and I’m not sure I am), will I be willing to say it for, say, Jeff Flake tomorrow?

We all need to decide for ourselves how much we are willing to abide by the standards to which we hold others.  It’s easy until we find ourselves in hot water. So do we lower our standards or rise to the occasion?  Perfectionism and shame loom heavy when we aspire to live a virtuous life, and we can also become arrogant and judgmental.  Then again, looseness with integrity is no way to lead, either.  I wonder what I would do if I were in Al Franken’s shoes tonight.

Hopey, Changey Hero Making

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IVY Litt 11-8-17

NaBloPoMo 2017: Field Notes from a Life in Medicine, Day 8

Funny how I just wrote last night about connecting new dots to old dots.  It just happened again tonight!  A couple of weeks ago I responded to an online ad for an IVY Ideas Night with David Litt, author of Thanks Obama: My Hopey, Changey White House Years, entitled, “How to Inspire, Persuade, and Entertain.”  Litt was a senior speechwriter for President Obama, so I thought I could learn new tips for presentations, and feel a little closer to the president whom I miss so much.

I’ve done public speaking since eighth grade, when our speech teacher first taught us abdominal breathing and I discovered the thrill of holding the attention of a room full of people with only my words.  I work at an academic medical center and I hold zero publications, but my CV documents over 10 years of professional presentations to various audiences.  I thought I was pretty good at this speaking thing.

Three years ago I came across this TED talk by Nancy Duarte, whose ‘secret structure’ of great presentations I have used since I subsequently read her book, Resonate.  Essentially, she recommends that we invite audiences on adventure stories, create active tension between what is and what could be, and most importantly, make the audience the hero.  I have done this better and worse since then, but I always recognize the framework when I see it.  Those familiar with this blog know that I am also a fan of Simon Sinek, whose central message is that we perform at our best when we are crystal clear about our Why.  “People don’t buy what you do, they buy Why you do it,” he says.  Barack Obama employs both authors’ principles with eloquence and finesse, which I noticed reading We Are The Change We Seek, a collection of his speeches as president.  The best speeches delivered in this construction create audiences who are inspired, motivated, and empowered to hail a meaningful call to action.

Obama is could be core values

That’s basically what David Litt conveyed tonight.  When asked what advice he was given that served him best, he said, “Imagine someone in your audience will tell their friend tomorrow about your talk.  What is the one thing you want them to say about it?”  What is the Why of your talk?  Even though he no longer writes speeches for the most powerful person in the world, he expressed a desire to continue inspiring, empowering, and promoting personal agency in all whom his work touches. Make each and every audience member their own hero.

It turns out, however, that this approach applies to much more than public speaking.  On my 50 hour, 500 mile, aspen-pursuing weekend in Colorado last month, I described to my dear friend my favorite moments at work.  At the end of a patient’s day-long physical, after I have spent 90 minutes listening to their stories of weight gain and loss, work transitions and complex family dynamics, and reviewing their biometrics and blood test results, I meet with them for an additional 30 minutes to debrief.  This is when I present an integrated action plan compiled by the nutritionist, exercise physiologist, and myself.  It is a bulleted summary of our conversations throughout the day, centered on the patient’s core values and self-determined short and long term health goals, and crafted with their full participation.  I get to reflect back to my patients all that I see them doing well, and shine light on areas for potential improvement.  It’s an opportunity to explore the possible—to Aim High, Aim Higher, as the United States Air Force exhorts.  I often present the plan with phrases like, “Strong work!” “You’ got this,” and “Can’t wait to see what the coming year brings!”  My friend turned to me as we wound through autumn gold in the Rocky Mountains, a bit tearfully, and said, “You make them the hero of their own story.”  Yeah, I do, I thought, and I got a little teary, too.

Words are powerful.  They are our primary tool for relating to each other, for making another person feel seen, heard, understood, accepted, and loved.  You don’t have to be a public speaker or a presidential speechwriter to make a positive difference with your words.  At work, in your family, with your friends, with people on the street and in the elevator—what is the one thing you want someone to remember from their encounter with you?

Eat What You Kill

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NaBloPoMo 2017: Field Notes from a Life in Medicine

Sounds like a mantra from a survival reality show, right?  Akin to “Eat or be Eaten,” “Kill or Be Killed.”  It’s also a common reference to the prevailing business model in our American scarcity-minded, competition-driven, fee-for-service healthcare culture.  How ironic, the application of these words to this profession.  It was explained to me essentially as, “Every man for himself, and you’re a minion.  You are expected to be ‘productive’ in this business to justify your compensation and contribute to the bottom line.  We measure productivity by number of patients seen and accompanying collections.  Pull your own weight or there will be consequences.”

Of course, from a capitalist business standpoint, this makes sense.  I provide a service that others require.  I should offer it widely, accommodate customer expectations and demands, expand my suite of offerings early and often, and charge for everything.  The more I can get customers to consume and pay, the better off my business.  I have a fundamental problem with this approach when the practice of medicine focuses on business first and patient care second.  Nobody admits to this attitude, of course it’s about patients first, everybody says.  Then my colleague makes a suggestion for patient care improvement, or I express concern about conveyor belt medicine burning doctors out.  Inevitably, the primary response from leadership is something along the lines of ‘that costs too much,’ and ‘that’s the only way to keep the lights on.’  I understand the math.  I despise the premise.

Medicine and healthcare delivery should always transcend the detached, transactional, and ruthless nature of the free market.  Chris Ladd, a conservative thinker and writer, describes this idea eloquently here.  It occurred to me today, replying to Stacey Holley’s comment on my post about spending time with patients, that even those who profit from our flawed American system are also terminally distressed by it.  Insurers, hospitals, pharmaceutical companies and their executives live in a constant state of fight-or-flight defensive posturing, fearing for their livelihoods in market share, revenue, solvency, and survival.  How tragically ironic.

Personally, I have difficulty envisioning a single-payer, government run healthcare program as the primary delivery system in the United States.  Our culture is simply far too individualistic, too fundamentally ingrained with ‘every man for himself.’  However, I think we can still work with the concept of universal healthcare, wherein all people have access to basic preventive and catastrophic care, regardless of income or status, without risk of bankruptcy.  A strong argument can be made that the only entity who could or should be truly invested in the health and well-being of all of us, throughout our lifespan, is our government, particularly in the realms of prevention and health maintenance.  We just need to loosen our societal grip on ‘that’s just how it works,’ and ‘I need to get mine,’ and allow ourselves to be led more by our collaborative, altruistic, and humanitarian leanings.  In my experience, diverse groups of intelligent and energetic people, working toward ambitious and aspirational goals, generate synergy.  This kind of cooperation fosters passion, joy, inspired creativity,  and magnificent innovation.  Who knows what novel solutions we may invent, if we only put down our spears and work together?  And isn’t that the hallmark of American ingenuity?

Medicine and health should be a heartening, collaborative, communal effort wherein we all do our best to help ourselves and each other reach our highest potential.  We are better than our current system, in which truly everybody suffers more than necessary.  I refuse to accept ‘Eat What You Kill’ as any kind of descriptor for my work or that of my colleagues.  We can do better, imagine and create more for ourselves and one another, than this primitive notion.  I know there’s a healthier mantra inside me somewhere…

What can you think of?