Random Thoughts from a Restless Mind

I landed on “Cool Hand Luke” while surfing yesterday. Man, was Paul Newman something, or what? For all of his faults, and despite being guilty of whatever landed him in that prison camp, Luke was resolved to fight the injustice of his existence. He was resolved not to lose the essence of who he was, despite the hardships imposed on him by those who would break him, break his will, make him relinquish that which made him, well, cool.

Movies are usually an escape for me. I’m not often prompted to terribly deep thought while watching one. But I wondered, what of my life that occasionally seems so hard is actually hard enough that it bends me from a true course? And if it is, indeed, that hard, how long could I hold out against the constancy of the difficulty, like Luke, before I broke?

Luke, knowing that he may finally be broken, seeks answers in the church he forswore. Looking to the ceiling he challenges God, questioning, demanding. He opens the door, stands there, framed. “What we have here is a failure to communicate”. A last act of defiance, or a capitulation? One is left to wonder: what was His answer?

I’ve been thinking a lot about health care recently. Real health care, not Health Care as in “Health Care Crisis” or “Health Care Reform”, but the kind of health care that is provided by doctors and nurses and all kinds of other health care providers. You know, like making sick people better, and keeping healthy people healthy. The kind of health care that old guys like me (I’m 52, in case you were wondering) got from pediatricians like Dr. Roy in Southbridge, MA in the 60′s, or like my sons get from Dr. Gerace in Westlake, OH today.

I did a lot of thinking about this some 7 or so years ago, too, when I developed the concepts that eventually resulted in Skyvision Centers. My mini-epiphany at that time is that medicine is the ultimate consumer service business. At its core medicine is about one group of people providing a service to another group of people who either want or need that service. It’s the most intimate type of service, too. One to one. Face to face. You and me.

There is a remarkable lack of difference between doctors (and hospitals, for that matter) when you look at the outcomes that arise from that service– how many people get better after receiving medical care for their illnesses. The difference between the top 1 or 2% of doctors and the 50th percentile in terms of real medical outcomes is remarkably small, and much smaller today than it was in the days of my Dr. Roy.

Sure, there are differences in how people arrive at getting better. Some very instructive studies from Dartmouth have shown dramatic regional differences in the U.S. in how much money is spent on treating heart attacks, for instance. By and large, though, the same number of people get the same amount of better no matter where they are treated or from whom they received that treatment, and the quality of those treatments is several orders of magnitude greater and better than it was in my youth.

So what was it about Dr. Roy that people in my generation seem to have so much trouble finding in medical care today? If the treatment of diseases is so much better now why do so many people complain about medical care today? Why is it that Dr. Gerace has people lined up waiting to see him while other doctors don’t? Why do people rave about their experience at Skyvision Centers and complain so bitterly when they need to have a consultation at some of the most famous medical institutions in Cleveland?

I think it’s because Dr. Roy, Dr. Gerace, and I were all, once upon a time, caddies.

Seriously. We spent the earliest part of our working lives on the lowest rung of the service ladder, providing one-on-one service for a single customer. Because of that I think each of us realized that what really sets doctors (and hospitals) apart is what a patient experiences when they visit. The most successful doctors and the most successful medical practices are those who have realized that the central character in the play is the patient. The most successful caddies never forget that the most important person on the course is the golfer. The job of the caddy is to help the golfer perform a well as possible (maximize the health of her game) while at the same time making sure that she has a wonderful experience on the golf course.

Ben Stein wrote a column in the NY Times about his first real job; he was a shoe salesman. Imagine, at 17 years of age, selling shoes. Days filled with all manner of customers and handling the foot of each and every one of them. Customer service and sales is “learning the product you are selling, learning it so well that you can describe it while doing a pirouette of smiles for the customer and talking about the latest football scores” no matter who that customer might be. Tinker, tailor, soldier or spy, junior partner or janitor. Be they humble or haughty, gracious or grating. Totally focused on that one customer in front of you in order to provide them that service. The same can be said for any front line service job. Waitress in a diner, car mechanic, you name it.

My first summer job was caddying, and I caddied for parts of each summer through medical school. As I think about it now after reading Stein’s article it’s amazing how many parallels there are between my first job as a caddy and my career as an eye surgeon. I toted the bags for one or two golfers at a time; I usually have a patient, patient and spouse, or parent and child in the office. I was a better golfer than almost all of the men and women for whom I caddied; I know more about the eye than every patient who visits, google notwithstanding. In both circumstances my success was/is determined by my customer’s (golfer/patient) outcome, their “score”, as well as their view of the experience. Even a career-best round doesn’t feel quite as enjoyable if it took place over 6 hours in the company of a surly caddy!

I’ve told the story of how being a caddy turned into Skyvision Centers; it’s a neat story and I love telling it. For the moment, though, I have a little experiment for anyone who might be listening, and a modest suggestion for the powers that be in medical education (who most assuredly AREN’T listening). The next time you visit a doctor ask him or her what their first couple of jobs were. See if you can predict which of your doctors or dentists (or nurses) had what kind of jobs before their medical career based on the kind of experience you’ve had in their offices or institutions.

Let’s add a little time to the education of the folks who take care of our medical problems, especially our doctors. How about 6 months selling shoes at Nordstrom’s. Or a year of Sunday mornings slinging hash at a local diner. Better yet, let’s get all of those pasty washed-out interns out on the golf course with a bag on their shoulder and a yardage book on their hip, golf hat slightly askew and Oakleys on tight. Let ‘em learn how to take care of a customer without the huge advantage of all that medical knowledge. We’ll take the best of them and turn them loose in offices all across the land. Those who can’t hack it, the ones who can memorize the history of Florsheim but can’t bring themselves to touch a foot, who are scratch golfers but can’t bring themselves to congratulate the hacker who sinks a 30 foot double-breaker, those we’ll hide in the lab, or put them in huge, anonymous medical centers, one more anonymous member of an anonymous team hiding under the brand umbrella of some “World Class Clinic”  where one-on-one customer service never really happens.Because the ultimate consumer service business is medicine.

Just ask a caddy.

Sunday musings…

1) DH. “Designated Husband.” I accompanied Mrs. bingo to Athleta last night for a retail bl00dbath. As I sat in the “husband chair” in the fitting room I offered “assistance” to all of the women shopping without male accompaniment.

Imagine the value of having someone who will honestly answer “do these leggings make my bum look fat?” without fear of the consequences.

2) Microcategorization. The new advertising field of ever more exacting and minutely defining a marketing target. The more that is known about you (age, gender, address, income, subscriptions, job, size, etc) the less varied are the ads directed to you.

My question, for the marketing but also for anyone in their perusal of available new information, how can you grow, how can you become whatever it is that constitutes the next best version of you if all you ever see is stuff that represents who and what you are now?

3) Dreamcatcher. I have been having two sets of recurring dreams, or at least dreams with two recurring themes. Do you get these? Is the dream always the same (not me) or just the theme (definitely me)? Do you try to figure out why they keep happening, and why those dreams or those themes?

One of mine is probably pretty easy, the theme of impending loss. My kids are getting older, becoming young adults, and beginning to start their post-college lives. Standard fare, and easy to see how I would find this both wonderful and sad because I am blessed to have very nice friendships growing with my kids. I am also soon to confront the loss of a parent, and this is quite sad, as inevitable as it might be.

Nope, it’s the other dream theme that’s bugging me. This one finds we with unfinished business, or a task that I just cannot start or complete. It often takes place in a school setting, a test I haven’t studied for, or did not know was scheduled, a project due in hours that will take weeks to complete. Again and again, night after night.

Something’s up in that ol’ subconscious, eh? Does this happen to you? My dreamcatcher isn’t up to the task of late.

4) Peer Pressure. Why is it that some folks, particularly younger people, succumb to peer pressure while others somehow find the will to resist? Why, for example, does one kid accept the offered illegal substance while another says ‘no thanks’? What is it that compels the group to pile on, but one outlier says ‘enough’?

Millions of words have been spilled on this topic of course, and I’m certainly not qualified to add to the psych canon, but I’ve noticed a couple of things in CrossFit Kids groups that remind me of how a certain guy I knew walked away from an entire peer group, twice, rather than cave to pressure.

It’s easy and simple, hard and complex all at once. It has to do with success and succeeding, and getting ‘caught’ in the act of that success. Kids who regularly and routinely succeed at difficult tasks of any kind start to have a stronger belief in themselves that transfers to other stuff. Kids who are held to standards that they must self-police tend to develop a stronger sense that they can make an ethical or moral call without the need for the external confirmation of the group. You count every rep; you move through a full ROM. You make the call, or if judged you accept the call of the judge. CF Kids does not hold the sole franchise for this, of course. The “First Tee” golf program, school chess programs, lots of other places exist where this type of belief in self gained through achievement and accountability exist.

It’s never too late to start this process, of course, because the dangers of peer pressure, groupthink, and the psychology of the mob do not magically disappear when we reach the age of majority. Where do you fall on this continuum? Can you think for yourself in the face of peer pressure? Do you have that inner sense, that mental muscle memory that lets you be confident when you are sure that the group is wrong?

When the time comes are you strong enough to stand alone?

I’ll see you next week…

Posted by bingo at December 2, 2012 8:39 AM

“Hunger can change everything you thought you knew about yourself.”

It’s Thanksgiving weekend, a good time to think about this. Ever been hungry? Not “man, when is dinner?’ hungry, but the kind of hunger that comes from not knowing when, or if, dinner is EVER coming? I haven’t, but I can readily understand what the quote is saying. Peel away the veneer of civilization, chip through the cushion of the societal safety net, turn a deaf ear to the bleatings of the entitled as they moan about “hunger” on an iPhone, and think about what real hunger exposes.

There was a time in America, not too very long ago, when the country was plunged into a Recession. Terrible, unthinkable weather patterns caused crippling drought; people sought to blame mankind for it all. Government was tapped out, reeling from the costs of war and the economic devastation of unemployment and stagnation in private business. People of all ages, from all walks of life knew true hunger for the first time. Real hunger. Clothes falling off your skeleton hunger. The Great Depression.

I have not known hunger, not like the hunger suffered by the denizens of the Dust Bowl years. In our Western world we see this hunger so rarely that it is front page news when we do. No, our hunger is less elemental, more venial than mortal. Embarrassingly skewed to the ‘want’ side of the want/need continuum. How, then, would we behave in the face of true hunger? What would we learn about ourselves if we had no hope for a next meal?

Who among us would save Tom Joad?

Sunday musings…

1) Obfuscate. To lie, just better dressed.

2) Veteran’s Day. Today we remember all of those who have served our country in the Armed Forces. Or, do we? Think about it…when is the last time you actually thought about what it meant for someone you know or knew to serve in our military? Your Dad, an uncle, your sister, or the couple across the street who are now wearing Dockers instead of Dress Blues. All of the CrossFitters who will retire this year, like Paul, Andy, Tosh.

What sort of recognition do you really have of their service? How exactly will you express that?

3) Childhood. Mrs. bingo and I used to whisper in our children’s ear each night: “you’re having a happy childhood.” They have no memory of these whispered exhortations, but they did have very happy childhoods, indeed.

When does childhood end? It’s certainly not the beginning of school. Judging by my experiences it most certainly isn’t in college, either! Perhaps it’s that first job, or the first time you pay the rent out of your own checkbook, or pull out a couple of bucks to tip whoever. The birth of your first child is certainly a wake-up call; maybe that’s when your own childhood concludes. Mrs. bingo and I always said we’d consider ourselves grown-ups when we owned our own washer and dryer.

Could it be, though, that childhood never ends? I think of friends, a few much older patients, others who have never lost that child-like sense of wonder at the world around them. For sure, some folks are forced to grow up much too quickly and take on the responsibilities we associate with the end of childhood when the calendar says that they are much too young to be considered an adult. But is even their childhood truly over?

All childhood really does end, of course. We do, eventually, all move on to something that looks like all grown up. But our childhood remains there for us, all of the wonder of discovery, all of the memories, all of the people who brought us up. It’s all still there, ready to be called upon when we need a little boost, when we need to remember who and why we are, to feel again what it felt like to have few responsibilities and fewer cares. It gets a little better as we get a little older, too, doesn’t it? Childhood memories seem to be wired that way.

You are never too old to have a happy childhood.

I’ll see you next week…

It’s funny how stressful situations remind one of the truisms of life. We are now Day 7 without power in the White house, our own “Little House on the Prairie” complete with fireplace and communal bed (shared by 3 dogs). The tiny generator we were able to score powers the fridge and the sump pump (we had 6 flooded basement episodes in 2011) but not the furnace. The temp just went UP to 52 in the house.

And yet, it’s OK. We have food and we can cook. We have wood and offers of more if we need it. Randy has become a wizard at building and stoking a fire. Me? Grunt work like foraging for wood and fuel, and starting an epically awful beard. The extent of my pique, such as it is, is refusing to wear a tie to work until the power is back on.

We’re OK largely because we have CHOSEN to be OK. It’s a bummer, and it’s a nuisance, but it’s the hand we’ve been dealt, one that is not nearly as bad as others in Sandy’s aftermath. Our attitude is in stark contrast with others on display. One neighbor, a city councilwoman no less, de-camped to a hotel after bitterly complaining about the noise of the generators, our “little engine that could” especially. “We just couldn’t take it anymore.” Really?

My staff and most of our patients handled stuff with an equally sanguine attitude, re-scheduling when necessary, coming in early or staying late, whatever. The few folks who copped a bad attitude stuck out so painfully it was comical. The gal who hung up on me when I told her I couldn’t examine her pinkeye without power (M’am, all I have is a flashlight and a toothpick). The patient coming for a surgical consult, appointment confirmed by automatic email Monday night by a computer that was as dark and dead as the rest of the office when she arrived on Tuesday, who screamed at us for 10 minutes on the phone on Wednesday. Really?

Our circumstances often arrive unchosen and uncontrollable, and most often we are left with no choice but to react to them as well as we possibly can. While the circumstances are beyond our control we certainly can control our attitude, our outlook. We are in control of how we will approach the task at hand. We are in control of how we will approach the person at hand.

Frankly, I don’t know if a positive attitude makes the tasks any easier, or makes it more palatable to get through something tough like this Sandy thing What I DO know is that it is always easier if I come across someone in similar straits, or someone I’ll need for help, if they are at least trying to “put a good face on.” I think this goes for everyday life, too, and making this your baseline choice (a good attitude) might make it easier to keep your chin up when the chips are down.

Attitude is a choice. Your attitude says more about you than it does about your circumstances.