Jan 142015

This is the time for the traditional New Year’s resolutions. Let me take this one step further.

What do you want to be when you grow up? This is a question I was asked many times in my formative years. This question may not be so personally relevant today, as there are clear signs that my personal “growing up” is not as much of a distant and long term future destiny. However, I think the question still has value – for us individually, and for the organizations we are committed to work within.

Over the holidays, many institutions send their greetings and wishes our way, using the opportunity to brag about themselves and their accomplishments over the last year. To their credit, there are some really good things happening in academic medicine across the country.

We have also realized that it is important to speak about all of the positive accomplishments that are ours to celebrate over the year. It remains an exciting and positive environment for me to have the privilege of leading. These accomplishments are really too numerous to catalog here within the blog, and many, if not all, of these have been acknowledged separately.

We can acknowledge that we have never existed in such highly competitive environments as some of the institutions across the nation. This competition, at the national level, may fuel the need to loudly advertise any advantage that can be perceived in what may be called the “medical marketplace.” Brody’s own Annual Report is linked to the academic calendar and rarely gushes with immodesty. We need to understand that the level of competition in the future will inevitably increase and will occur at the national level. Our benchmarks for performance are no longer measured at the local level.

Our own approach in reporting our performance will continue to be as realistic as possible. This does not preclude championing the positive accomplishments, but we will also fully acknowledge the challenges we must face. To me, this sets the stage for the work that will be necessary to take advantage of the opportunities that we can imagine and see.

One has to work within a strong foundation of reality.

This is why the question – “What do you want to be when you grow up?” – is so relevant. The dynamic of this question focuses attention on the present, and at the same time, projects into the future with anticipation of something rewarding. The future aspiration is what we can become excited about, and is inherently energizing and motivational. The future state is worth the effort as we work towards the goals.

We can all take stock of our many accomplishments over the past several months. Our clinicians have risen to the challenge of increasing access for our patients. This has been close to a “double digit” response over the last six months.

There are success stories from every component of the enterprise. They include our students presenting research, faculty attaining tenure and promotion and staff demonstrating their leadership and loyalty to the mission of the school.

With these in mind, we can commit to working energetically now with a positive vision of the future. Some of our work will consist of “must do’s” and some will be based on our own creativity and imagination.

When the Brody School of Medicine “grows up,” we will be broadly acknowledged as the most effective medical school in North Carolina dedicated to the health and wellness of its region’s citizens. We will be fully recognized as contributing to the economic health of eastern North Carolina in even more meaningful ways. We will be seen as a valuable partner within the state and in all that pertains to the provision of medical care and service and the health maintenance.

I am excited by this continuing work and look forward to all that can be seen as opportunity in the New Year.

I wish you all the very best for 2015!


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!


Nov 192014


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,


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.