Dec 092014
 

A friend recently pointed me to an article in The New Yorker titled “Better All the Time,” written by James Surowiecki. I subscribe to the magazine, since New York City is one of my favorite places in the world, and there is always something of interest to read.

Like my friend, I was struck by the similarities and parallels that we are observing and learning about our own culture at Brody. So many have clearly stepped up to the plate and have contributed in the most positive way to the work that is at hand.

For certain, I can think of no one who would be satisfied with an average doctor, or a so-so nurse or other provider. Our staff can’t be anything but excellent in everything that we offer. After all, we are dealing with the lives of human beings. This is not merely a game that we play.

Yet, our athletes clearly play their games as if they are engaged in life and death struggles. It’s as if the games that we watch and play can reveal the truths that are embedded in our day to day lives.

I’ll summarize the article here, if you don’t have the time to read all of it:

Professional athletes had always worked out, of course. But historically, practice was mainly about getting in shape and learning to play with your teammates. It was not about mastering skills. People figured that either you had those skills or you didn’t.

Bob Petrich, a defensive end for the San Diego Chargers in the 1960s, told an interviewer that most NFL players of his era even scorned the idea of lifting weights.

“Most of the guys had this mental attitude that if you’re not good enough the way you are, then you’ll never be good enough,” Petrich said. The prevailing philosophy was “What you are is what you are.”

In the summer of 1976, Kermit Washington was in trouble.

What Washington did next changed the NBA: he called a man named Pete Newell and asked for help. Newell had been a legendary college coach, and was working for the Lakers as a special assistant. But his coaching skills were being wasted, because, as David Halberstam wrote in “The Breaks of the Game” (1981), NBA players didn’t want to admit that they “still had something to learn.”

Today, in sports, what you are is what you make yourself into. Innate athletic ability matters, but it’s taken to be the base from which you have to ascend.

You might think that this pressure to improve reflects the fact that the monetary rewards for athletic success have become immense. There’s something to this. It has become economically rational to invest a lot in player training.

Yet money isn’t the whole story. What we’re seeing is, in part, the mainstreaming of excellent habits. Everyone works hard. Everyone is really good.

The value system that we are experiencing and exploring here at the Brody School of Medicine and at Vidant are in parallel with this. There has been a renewed understanding for the value of excellence – not just as a concept, but in practice.

We are on a continuous learning curve. Excellence is the criterion for success in every one of our units and in caring for our patients.

Creating rapport with each of our patients, deploying even the simplest of tasks – it’s all about performing as if this is vital to our game.

How can I perform better today? How proud of the work will I be at the end of the day?

Have a great day, too!

Paul

Nov 192014
 

Colleagues,

It is an understatement to say that much has happened since April this year.

Our department chairs and dean’s administrative team have been working tirelessly to address the changes needed for a thriving Brody School of Medicine in the future. We have worked to communicate these issues and actions through our web page (Preserving the Mission), departmental meetings, and an initial town hall meeting in October. Across the school, many faculty and staff are engaged within the departments, leading a whole variety of changes. These challenges and agendas are being worked through in both the basic science and clinical science arenas.

I recently attended the annual meeting of the Association of American Medical Colleges. Every conversation that I heard there bore some familiarity and resemblance to the conversations that are currently taking place in Greenville. The difference in the conversations is the context. We, in Greenville, know where our considerable strengths exist. Based on these strengths, our success will be determined by employing principled strategies that could be implemented anywhere, overlaid with our local knowledge and needs. Understanding the local culture, climate, epidemiology and economy will be a major component of our ultimate success.

Knowing that there was so much good work still to be done at home, it was exciting to be able to anticipate coming home. Reassured that across the nation we are all in transformation, I am more fortified than ever with the sense that we are on the right track. It will take the continued commitment of every one of us to fully achieve the goals that are essential for the future of the school.

Because of all the changes that have been initiated, everyone has a “need to know” how any or all of the change agenda will affect them personally.

My most meaningful conversations have been in the hallways, one on one. Each and every time, I can tell that the conversation was helpful to us both. Shared anxiety was replaced by mutual understanding.

Almost every conversation begins with a clear recognition of the serious nature of what we are doing. I can tell that folks realize that we must make changes in how we do business. Specific concerns are discussed in these encounters. The initial doubts about the “why” and the necessity of the planned changes reaches clarity.

What is still evident is the pervasive concern that we may be missing opportunities, and that even with the most careful thought, every nuance or unintended consequence cannot be anticipated. For example, with the dissemination of the clinical faculty compensation plan, it is clear that fine tuning and adjustments must take place at the individual unit level. I have established a Compensation Advisory Committee that will work with these issues, with a goal of addressing the pieces that continue to need answers and revision.

Even as we speak about the compensation plan, the concern I have is that folks will believe the only important thing is “the money.” The emphasis is important of course, given the changes in health care and in our own state budget, but the perceived urgency is a function of timing and the need to implement the process. We will likely learn much from the implementation itself.

There are other elements that also need emphasis. What about the passion, motivation and dedication of all who serve at the Brody School of Medicine? The personal engagement and vitality of all individuals at an emotional level will be essential for us to achieve the necessary positive outcomes that will continue to support our unique mission. It is through our focus on mission-driven aspects of our work – education of the next generation of physicians and scientists, the creation of new knowledge, improvements in the health and health equity of the citizens of eastern North Carolina – that we will be able to gain our own personal energy, as well as continue the teamwork that defines our culture.

We will remain an intact medical school, no matter what. The school is not for sale as some have feared. Our unique faculty and staff talent is critical to the needs of the school and the region. Our relationship with Vidant Medical Center is vital to both of our futures. Both institutions must become more efficient as we experience changes in the health care environment. We must make decisions based on information versus intuition or traditional practices. The more informed we become, at the individual and collective levels, the better the decisions will be.

There are challenges and hurdles and we will overcome every one of them. I know that we can, and I believe that we have the very best school of its type in North Carolina.

I look forward to a hallway conversation with you sometime soon,

Paul

Sep 022014
 

You never know what will happen after a chicken salad sandwich. As it turns out, that was not the problem. The real problem caused me to have some unexpected abdominal surgery and spend time experiencing first-hand the fabulous care provided by physicians, nurses and staff from the Brody School of Medicine and our partners at Vidant Medical Center.

Why I’ve disappeared is not important right now, except that in many ways this absence has been a gift as I have regained insight

  • about our profession,
  • of our hospital,
  • about our health care system,
  • about my own physiology.

There is no need to address the specifics for now. Just know that I am on the mend and your generous support has been keenly felt. Please accept heartfelt thanks to all of you, for both myself and my family. It has been a long journey but quite an adventure. I am looking forward to returning to Brody and to the incredibly important and noble work we all do. I don’t know exactly when that will be. I am allowing my daily recovery and improvement to dictate the exact timing. I am in regular communication with university and Brody leaders and have every confidence in them and you to keep Brody moving forward.

As you know, it is not my style to provide answers but to open a conversation. So, here are a few intriguing questions, particularly for our medical students:

  1. What does it mean when a patient uses large quantities of potassium and phosphate?
  2. Describe the pros and cons for the use of a nasogastric tube.
  3. What is the first convincing sign of relief of a bowel obstruction?

When you have a moment, come see me and I’ll tell you the rest of the story.

Paul

Jul 172014
 

Hello Brody Pirates,

As I write this, there are a whole variety of activities and happenings that are influencing my thoughts.

Recently, we all experienced the Fourth of July annual celebration. This national holiday accents the real significance of one of the most profound developments in the history of our country. During these festivities, there are those of our colleagues who were “on call” and otherwise serving the citizens of eastern North Carolina. Even then, there was time to reflect on all of our relationships, including those close to us. I would include our personal families as well as the members of our professional teams. What are the unmet personal goals and ambitions that are only possible based on the culture and country that we live in? In what ways does all of this thoughtfulness bring meaning to the Brody School of Medicine as we support our mission?

It is easy to find a simple answer. In real terms, all that is necessary is that we work hard and serve well. Of course, the challenge is to apply this approach to every day experience, with all practical detail. Achieving clarity in our real world context demands much in the way of careful thought and implementation.

About two months ago, I received an email unexpectedly. It came from one of my patients who had a kidney transplant about 28 years ago. The patient and her kidney are in really great condition.

My patient and her dog, UsherThis remarkable grandmother has given me permission to post her picture here, and is in remarkably good health. She admitted that the secret to her success lay in the regular consumption of cherry pie, washed down with a popular fermented beverage. One has to eat the whole pie to assure success, she admitted!

You may share my skepticism that this is not the whole answer to her success. For certain, she has a vibrant sense of humor. Maybe it is the fact that she continues to work and engage life in the most positive manner that has contributed to her success.

For certain, there are more biologically complex and profound answers to this survival experience that we have not yet discovered.

There are similarities with a complex set of conversations that we are having within the School. As an example, the leadership team of both Vidant and the Brody School of Medicine met recently for an hour to engage in a discussion of two complex and challenging clinical cases.

The group attempted to resolve and explain some unexpected outcomes and came up with many plausible answers for the issues that were presented. The conversation was emblematic of the complexity of many of our processes. When faced with these complexities, we typically apply basic principles and then venture well beyond. There are many other applicable dimensions to consider, including human factors and behaviors, interdependent medical processes and extrapolated assumptions based on biological diversity.  The best minds use all of this information in creating opinions and the necessary solutions. Even then, this is sometimes just the beginning of an even more complex process.

Unavoidably however, it is human nature to look for the simplest of answers. It takes real world experience and professional discipline to find the very best explanations.

Our tripartite mission here at “the Brody” simply defines the priorities. It takes constant attention to the contemporary dynamics of medicine for our mission to refresh and remain relevant.

Best regards,

Paul