Is This Future Unstoppable?

Recently I sent an email asking people to describe where they see medicine heading in the next ten years. Most responses were pretty bleak: long lines, rationing, impersonal care, managing populations instead of individuals, physicians being absorbed as simply cogs in a large machine.

Is this future unstoppable?

floating granite ball

It reminds me of this huge granite sphere outside the Ripley’s Believe It or Not Museum in Gatlinburg. It’s extremely heavy and is rotating with tremendous momentum on a fountain of water.  There are always people putting their hands on the slick ball of rock trying to spin it faster or slow it down. But the rock is too heavy with too much inertia.  I want you to remember that image. We’ll come back to that.

Dave Logan is a professor at the University of Southern California Marshall School of Business.  He taught me many things but perhaps nothing as practical as this tip on how to answer to any question and seem enlightened. You know the scene; you are standing in that semicircle, pretending to be engaged in the conversation. But your mind is on basketball recruiting, your sixteen year old driving on her new license, what you are going to get your wife for your tenth anniversary next week. And then you suddenly realize the conversation has stopped and everyone is looking at you, because you‘ve just been asked: “And what do you think about that?”

Instead of panicking, Dave said to look off in the distance, take a sip of your drink, a deep breath, look the person right in the eye and say, “It all comes down to trust and communication.”  I’ve actually used that line.  It does work, because it’s true.

Let’s talk about trust.

When my son was three years old, he needed a pretty big surgery. Since I am an anesthesiologist I got to go back to the OR and hold him as he went to sleep. As I placed that mask over his face for him to breathe the gases, as he looked right at me, the trust he had in me was overwhelming. And when he was asleep, and I gave him to the anesthesiologist, Steve Auden, I had entrusted him with what was most precious in my life.

Time and again we are privileged and honored with the opportunity to hold the lives of our patients in our hands. And no matter what you do in this profession, there is always a doctor-patient relationship.  It is based on trust, it is sacred, it is worth fighting for, and it is in jeopardy unless we unite and lead.

Physician leadership is powerful.  And our leadership is not just needed in the boardrooms of the private sector. It is needed were our laws are made.  I am not here to debate the merits of things like Affordable Care Act, Kentucky’s House Bill One, the Optometrist Bill, and others.  I will tell you that I am not comfortable with the way these laws affecting health care are passed.  Are you?

We need to be there to defend the rights of our patients – in the boardrooms, in the executive suites, in Frankfort, in Washington. Like my son, trusting me with that anesthesia mask over his face, our patients, our loved ones, our neighbors, our city, our state, our country, our world trusts us.  They count on us to be there.  They assume we are there.  And we can’t let them down.

The Greater Louisville Medical Society offers leadership development opportunities that can help you feel comfortable in your own skin when you might be outside your comfort zone. My experience is a prime example of how this works. In 2002, Dr. Fred Williams asked me to take over the medical student mentoring program. I enjoyed it. This led to my being asked to run for secretary.  Later, Dr. Rob Zaring arranged a leadership class at GLMS with the American College of Physician Executives, which got me interested in their other courses. Then on this past Friday I graduated from USC with a Masters degree in Medical Management.  And today I begin the journey as your president.

So how in the world do we change things?

We have to be united and effective.

Another valuable lesson from Professor Logan is from his book titled Tribal Leadership. In it he talks about the evolution of effective organizations or “tribes.” A level one tribe would wear t-shirts that say, “Life sucks.” They are like cave men or prisoners.  A level two tribe has t-shirts that say, “My life sucks.” Picture the DMV on a bad day.  A level three tribe says, “I’m great and you’re not”.  This is how too many professional organizations operate. The focus is on getting ahead, awards, and accolades. It is very competitive.  The jump from “I am great” to “WE are great” is huge. This is a level four tribe. Level four tribes share common values and have focus. For these tribes the sky is the limit.

When I was accepted into the pain fellowship program at the Mayo Clinic, I was at first intimidated. Did I measure up? Was I good enough? How would I stand out?  One day, during my first month, Dr. Ronald MacKenzie stopped me in the hall to see how things were going. After a little small talk, he asked, “Do you know what makes this place great?”  I expected him to quiz me about the many discoveries and Nobel prizes. And then he pointed over my shoulder to a janitor sweeping in the hallway. “It’s because that person, and everyone else who works here, believes what they do is important to our mission.”  That’s level four culture – the secret to the Mayo Clinic. It’s that simple.

Remember that huge granite ball spinning in front of the Ripley’s Museum? A couple of years ago I was standing across the street watching this little kid who was determined to stop that rock from spinning. He had both hands on the rock but nothing appeared to be happening. Eventually some other kids thought it looked like fun and started pushing the sphere as well. Nothing changed.  Eventually some teenagers came over and joined in.   Now there were kids on all sides of the rock. I could tell, even from across the street, that the spinning rock was beginning to slow down. Until it happened! The rock quit rotating, stopped, and then began moving in the other direction.

We have all that we need: ability, passion, work ethic, and trust. But we must be nimble, be flexible, able to improvise. We MUST BE UNITED. We can choose not to accept the future as inevitable. We can put our hands on that huge granite ball and start turning it back in the other direction.

The final passage of Rudyard Kipling’s poem “If” contains perhaps my favorite line of poetry:

If you can fill the unforgiving minute with 60 seconds worth of distance run,                                      yours is the Earth and everything that’s in it.

That unforgiving minute is now. It all comes down to trust and communication. We know we have the trust. We MUST communicate. We must unite. Here are the actions you can do today which will help unite us:

Number 1: Download the GLMS smartphone app now (members only).

Number 2: Follow me this year on TWITTER (@jamespmurphymd). If you don’t know, ask any teenager and they’ll walk you through it.

Number 3: Because communication is a two-way street, email me at president@glms.org and tell me what you want our future to look like.

If all else fails, call me (502-589-2001).

The Greater Louisville Medical Society is our organization, our tribe, our road to a place where medicine is both science and art, where our community enjoys wellness, and the sacred bond between us and our patients is secure.

Imagine that future. Let’s go there together. Let’s get connected. Let’s unite. Let’s start the journey today.

Dr M speaking

Note: This article is the text draft of an address I made to the members of the Greater Louisville Medical Society on May 19, 2013. It was first published in the July 2013 issue of Louisville Medicine and the speech can be viewed online at the GLMS Vimeo Channel.

‘Twas The Audit Before Christmas

surgeon santa

‘Twas the day before Christmas, and all through the clinic,
My patients were fuming, and I was a cynic.
My routine was stung by Affordable Care.
I’d hoped the ridiculous rules would be fair.

In precerting drugs, how the auditors hovered.
Prescriptions for sugar pills only were covered.
The managed care mischief and benefits cap,
That sounded so good, was merely a trap.

Then out in the foyer arose such a clatter,
A patient’s co-pay was the crux of the matter.
Away to the window I flew like a flash,
Shut down the computer and asked him for cash.

He wasn’t abreast of the new plan in place,
That had cut off his nose in spite of his face.
When what to my wondering eyes did appear,
But a government man, just a tiny bit weird.

He showed me a warrant so lively and quick,
That I prayed to the Lord, “This must be a trick.”
More than just illegal, this wasn’t a game.
And he whistled and shouted transgressions by name.

“You downcode! You miscode! You don’t even fix ‘em!
You’re sloppy! You’re stupid! More crooked than Nixon!
I will file my report! From on top you will fall!
Now cash you’ll pay! Cash you’ll pay! Cash you’ll pay! All!”

As dry heaves, that before a wild emesis fly,
When I met this obstacle, thought I would die.
So onto his ribcage, my fingers they flew,
Which gave him no joy. He ain’t ticklish too.

And then in a twinkling, he wanted the proof,
And documentation for each little goof.
So I drew in my head what I thought would astound,
But this audit’s ridiculous claims did abound.

He addressed all inferred, and he read what was put,
In our policy manual, which was thick as a foot.
A bundle of charges he wanted paid back,
‘Cause this was an audit, and he was a RAC.*

His knee, now it bucked! It’s simple, so very.
It started to hemorrhage and looked downright scary.
It no-mattered at all was he friend or a foe,
For the loss of his blood made his suffering show.

His stump of a leg I held tight, no conceding.
My hands they encircled his thigh to stop bleeding.
He’d had a bad cut, from his leg to his belly.
His bandage was only petroleum jelly.

I asked why he’d only done something to soothe.
“ ‘Cause that’s all,” he said, “that my plan would approve.”
An i.v. for fluids and lowering his head,
Soon gave him to know he had nothing to dread.

He spoke not a word, nor called me a jerk.
Physicians just do this. It’s just how we work.
Then thinking about his life saved, I suppose,
Giving a nod, from the stretcher he rose.

He then took his report, his scathing epistle,
And into the trash, threw it down like a missile.
And I heard him exclaim, as he drove out of sight,
“Don’t ever give up. We need you in the fight.”

doctor santa

Adapted by James Patrick Murphy from the poem “A Visit from St. Nicholas,” a.k.a. “‘Twas the Night Before Christmas” by Clement Clarke Moore

*RAC stands for Recovery Audit Contractor

TWITTER at @jamespmurphymd