Category: Observations

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Observations Policy Reflection Systems

Pondering the Purpose of Policies.

What’s your policy on wearing pants?

We all have a personal policy about pants. My policy is that I shall wear pants on all days unless (a) I am attending a special event where a dress or skirt is indicated or (b) it is a hot day and I must wear something professional, so a dress or skirt is the cooler option.

Hang in there with me. This isn’t actually about pants.

I’ve been chewing on the purpose of policies. Much of my work life is dedicated to the creation and amending of policies for a system.

It makes me feel disappointed to see that policies often cater to the lowest common denominator. They seem to solely focus on preventing undesired behaviors and outcomes. It’s almost as if policies are written for those people or organizations, whether they exist or not, with the worst intentions.

Policies aren’t inspiring. They don’t talk about what could be or what we should strive for. This might be why we find policies tedious to read.

A colleague pointed out that, yes, policies are for the lowest common denominator because people often have the worst intentions.

“Think about the Ten Commandments,” she said. “Like ‘Thou shalt not kill’ and ‘Thou shalt not steal’ and ‘Thou shalt not commit adultery’. Those are really basic things, but we need them. Those are policies to help us get along.”

Indeed, those religious prohibitions are not inspiring. What if we rephrased them? What if we said “Thou shalt honor life” instead of “Thou shalt not kill”? Doesn’t the idea of honoring life inspire more creativity and joy than a fearful instruction to not kill?

I think my colleague would reply that people need explicit directions. A exhortation to honor life does not guarantee that people will stop killing.

In his book Practical Wisdom, Barry Schwartz laments how policies can affect our abilities to do the right thing the right way. If we rely on policies, we ignore the nuances of the situation and stop thinking. When we stop thinking, we lose our wisdom. We end up looking to policies to prevent the worst thing from happening. The prevention of the worst thing, however, does not equal the creation of something better.

Call me naive—you won’t be the first—but I believe that, for most people, they meet the expectations you have of them. If you have high expectations, people will often meet them. (To be clear, there is a balance: Most expectations must be realistic. If they aren’t, people become demoralized.) It’s meaningful to people when they realize that someone believes in them when they may not believe in themselves. High expectations are frequently a form of respect.

(Perhaps I am straying. A significant difference between individual expectations and policies is the relationship. Relationships between people rely on invisible things like trust, hope, and respect. Relationships between organizations rely on visible things like contracts, memoranda, and policies. We often don’t feel like we have total control over what we do as individuals. How can an organization, comprised of potentially hundreds of people, control its behaviors to meet the expectations of another organization without those invisible connections?)

Someone on Twitter recently commented that policies should reflect the morals of the organization. I like that. If policies focus on documentation requirements and payment arrangements, but say nothing about the quality of services, what does that say about the organization? Does a mission statement have any meaning if the policies and procedures do not align with the stated mission? If the policies only comment on how to prevent the worst thing from happening, why would anyone expect extraordinary quality from the organization?

Perhaps I need to reframe, for myself, the purpose of policies. Policies help prevent bad things from happening. That’s good. Prevention is underappreciated: It’s difficult to measure things that didn’t happen. The difficulty in showing that less bad things happened, however, doesn’t mean that the activity of prevention is worthless.

It’s not an “either/or” issue. Policies prevent bad things from happening, which is valuable. But, as I noted above, preventing bad things and creating better things are two different activities. We don’t want to focus our energy on just preventing bad things from occurring. We must also create new things, or we otherwise will not progress.

The primary reason for my personal pants policy is comfort, though there are professional implications, too. Much of my work in the past involved talking to people in atypical places: Sometimes I’d have to step over puddles of mud to talk to the man living in the park; sometimes I’d have to slip between towers of yellowed magazines to reach the elderly woman seated on her bed. These days, wearing pants makes it less likely that male inmates will make unwelcome comments about my legs. Pants prevent bad things from happening to me.

My other clothing policy is to wear bright colors or patterns to work. People—colleagues, patients, strangers—often comment on the shirts I wear, frequently while smiling. That helps build rapport and connections, even if they are initially based on something as superficial as polka dots on a shirt. These relationships, though, often help create better things and situations for us all.

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Nonfiction Observations Reflection

A Thousand Years.

I recently had the opportunity to visit two places in New Mexico: Chaco Culture National Historical Park and the Very Large Array.

The Chaco Culture National Historical Park features now ruined pueblos that people built over a thousand years ago. Construction started on Pueblo Bonito, a structure that archaeologists believe contained over 600 rooms, around 850 AD! Additions and revisions occurred on Pueblo Bonito for the next two hundred years. There are ruins of other pueblos in the area; some of them are now crumbling walls that have succumbed to the eroding powers of the desert winds and blazing sun.

Petroglyphs and the orientation of these ruined pueblos suggest that the people who lived in or visited Chaco appreciated their relationship with the celestial universe. A sun dial, located on a butte that is no longer open to the public, reflects their observations of the equinoxes and solstices. People, then and now, witnessed the directional relationships the buildings have with the stars.

The Very Large Array, on the other hand, was constructed over forty years ago. The 27 enormous dish antennae, arranged in a Y configuration, sense radio waves coming in from the universe. These antennae function as a giant “eye” and funnel the signals they receive to a supercomputer. Scientists analyze data from this supercomputer to describe events that have occurred in the universe: Stars exploding, the birth of new stars, and the location of black holes.

The antennae are arranged in straight lines, which are in stark contrast to the curves and shapes of the surrounding mountains and clouds. Such straight lines do not occur in nature—even trees are not so rigid.

What if Chaco and the Very Large Array serve the same purpose?

What if Chaco was an effort to better understand the universe and what was in it? The Very Large Array gathers data from invisible radio waves; Chaco collected data from visible waves from the sun, moon, and stars.

If people excavate the Very Large Array a thousand years from now, what will they think? Will they look upon the Very Large Array with the same wonder that we feel when we look upon Chaco?

I have noted before that death is the great equalizer. It puts everything in perspective.

In a thousand years, who will know your name? That thing you’re worried about now: Will it matter in a thousand years? Your creations—children, music, writings, meals, home improvements, tweets, laws, relationships—what impact will they have in a thousand years?

To be clear, I am not saying that what we do now has no importance or value.

There are things we do now that have huge significance and meaning. Sure, that kind act you do today won’t enter the annals of history. However, that same kind act will make the world an easier place for someone who is suffering now. Maybe the melody of that song you wrote will fall silent once you die, though it brings joy now to someone who delights in music. What you do now may not last forever, but that shouldn’t stop you from doing those things. What you do matters.

And maybe the remnants of something you create will still be around a thousand years from now. If that is the case, consider how your creations can inspire and humble the people of the future. The mysteries that you want to understand now may still be mysteries hundreds of years from now.

Someone said this a thousand years ago, and someone else will say this a thousand years from now. This is a reminder for us all today.

Categories
Medicine Observations Reflection

Dr. Handsy.

Note: I’ve felt pretty bummed out for the past two weeks, much of it related to the behaviors and opinions of the US federal government. Epictetus commented that

We are only enraged at the foolish because we make idols of those things which such people take from us.

which, yeah, is all fine and good, but I have yet to achieve a level of wisdom where I do not permit others to steal my peace. I find it hard to write when I’m unsettled.

A female friend, who is not a physician, recently asked me, “Do you find that, in your position, men treat you differently? Meaning, do they show you the same kind of respect that they show their male colleagues?”

The group of medical directors were seated around the table. The meeting was supposed to go on for six hours. While I was not the only female in the room, I was the only female medical director in that cohort.

Around hour two, the medical director seated to my right, a man with whom I had no relationship, made an emphatic statement to the group. While doing so, he leaned over and grasped my bare right arm with both hands. One hand gripped my bicep; the other hand wrapped around my forearm.

In my surprise, my eyebrows furrowed and I turned to look at him. Before I could ask him to let go, though, he had already released my arm and his palms were flat against the tabletop. The large gemstone on his left ring finger reflected the fluorescent lights overhead.

I smirked to myself. Did that just happen? Should I say something now? Maybe he won’t do that again. That was weird.

Around hour four, he used the back of his left hand to deliver a brisk tap to my right tricep.

“Hey, what does [acronym] mean?” he whispered as the group continued its discussion.

With urgency I pulled my arm into my lap. After murmuring my answer, I scooted my chair away from him.

It’s too late again for me to say something. Boo.

Around hour five, he rested his bejeweled left hand onto my right forearm while finishing his gallant comment, “… as Dr. Yang said earlier.”

Another man had already begun to speak as I yanked my arm away. Glancing at Dr. Handsy, I summoned forth the Ice Queen and hissed, “Please stop touching me.”

Oh, the look that Dr. Handsy shot at me! It was as if I had kicked his pet dog or spit in his beverage.

I smiled at my friend. “Do they show me the same kind of respect? Many do, but not all.”

Categories
Nonfiction Observations Seattle

White Glove Treatment.

In addition to five-star accommodations and world-class spa appointments in Portland and Seattle, each [Lamborghini] owner and their guests will be treated to private meals along the Pacific Coastline and the Puget Sound. Expect white glove treatment at every encounter, and curated excursions exclusive to Giro and the region. – GIRO 2017 PNW

The first Lamborghini I saw pulling out of the driveway of the parking garage in downtown Seattle was either yellow or orange. Its engine rumbled for all to hear even though it was in low gear. I stopped walking when I reached the driveway, waiting for the sleek and shiny car to pull into the street.

A few moments passed and another Lamborghini pulled out of the parking garage into the driveway. This one, another bright color, didn’t even stop before it turned left into the street.

The pedestrian waiting on the other side of the driveway was dressed for work: Short-sleeved summer blouse, pencil skirt, dark flats, and bangles on her left wrist. She shifted her weight to her right hip and looked into the garage.

A third Lamborghini zoomed out of the parking garage and swerved left into the street. There were now three or four pedestrians on the other side of the driveway waiting to cross the entrance of the parking garage.

In the street were two women, probably no older than 25, who were wearing white polo shirts and denim shorts. With some anxiety they looked down the street, watching for oncoming traffic. They waved their hands at the garage, beckoning more cars to come forth. They ignored the pedestrians on the sidewalk.

The fourth Lamborghini had a mirrored surface. The morning sunlight gleamed off of its sides. The driver was an older man who was losing his hair. In the passenger seat was an older woman with bright yellow hair and sunglasses that covered half of her russet face. This mirrored car coasted out of the driveway without pausing.

“Oh, come on,” I muttered. The Woman Dressed for Work on the other side of the driveway rolled her eyes and heaved a sigh that was seen, not heard.

More Lamborghinis poured out of the parking garage, parting the Red Sea of pedestrians. The traffic light farther up the street was still red, though, so the parade of Lamborghinis was slowing to a halt in a single queue.

Yet another Lamborghini was approaching the exit of the parking garage. Empowered by annoyance and self-righteousness, I walked forward. Would the Lamborghini let me, a mere pedestrian, have the right of way?

The pedestrians on the other side of the driveway followed suit. The fancy car lurched to a halt as we foot commuters walked in front of it. We all heard the loud, idling engines of more Lamborghinis in the garage waiting for us to pass. Even though some pedestrians slowed their gait, everyone looked straight ahead.

Good manners go a long way. Status alone doesn’t earn white glove treatment and respect.

Categories
Observations Reflection

It’s Okay to Get Angry.

It was my first job as a physician. I was 32 years old.

In that job I functioned as a psychiatric consultant. Thus, while I had clinical expertise, I didn’t have formal authority at any of the places I worked.

I can’t remember now what exactly happened: Someone said or did something that vexed me. It made me worry about how staff might (mis)treat patients. But who was I? I didn’t work for that agency; I was only there two days a week.

“I don’t feel like I can say anything,” I sighed to my boss.

My boss took a sip from his drink and leaned forward on the table.

“Maria, it’s okay get angry,” he said. “Sometimes you need to let people know that you’re angry.”

When we’re young, we often don’t believe that we can contain our anger. And, in some ways, that’s true: We don’t contain our anger because it is unfamiliar to us. There are different flavors of anger: Sometimes it simmers just beneath the surface of our skin while the flames roar in our ears. Sometimes it explodes and tears, words, and fists fly from of our bodies. When we’re young, these flavors are novel and strange: What is happening? What am I supposed to do with this? It’s empowering and overwhelming and frightening all at the same time.

We also don’t believe that we can contain our anger because we often don’t know how. It’s a skills deficit. Our anger propels us to do different things because anger is uncomfortable. We say (or scream) things. We break things. We cry. We bury it within us. We focus the energy of anger into other things. We avoid it.

As we age, we get to know our anger because it keeps coming around. There’s no way to avoid it, though that doesn’t stop us from trying. Most of us recognize the different flavors over time; we even learn what flavor we prefer.

Many of us also learn that our anger won’t destroy us. The sharp edges of anger cause us pain, yes, but we know that the edges will become dull and the pain will recede. That never happens as fast as we wish; we grumble with annoyance and impatience as the days, weeks, months—maybe even years—pass. The anger burns, but its flames do not kill us.

We also learn that when we share our anger with others, whether we intend to or not, we often make ourselves vulnerable. Those who must work or live with us learn what our buttons are and how we react when they press them. Sometimes our distress makes them laugh at us. Indeed, there are people who will use the vulnerability within our anger against us. Many others, particularly those who care about us, learn more about who we are and appreciate us more, despite our anger.

Not only does our anger let other people know who we are, but it also tells us who we are, too. Sometimes we don’t like what we learn about ourselves when we’re angry. Other times, our anger reminds us and reaffirms what we value.

And sometimes you need to let people know that you’re angry so they learn what matters to you.