"The buck stops here!"

I came across an interesting article the other day that asked the question, "Are we seeing a culture of corruption or a deficit of accountability?"  The article focused on corporate ethics and government ethics in the European Union, but I think the same question could be asked in corporate America too.  There have been a number of very high profile cases of breaches in corporate ethics (for example, the scandals with Enron, World.com, and the fraudulent actions by a number of bankers connected with the London Interbank Offered Rate, or LIBOR immediately come to mind) that are now taught in business schools around the country.  Similarly, there is very little confidence or trust in government these days, even outside the European Union.  The point of the article, I think, was this - are we really seeing an epidemic of corruption, fraud, and unethical business and government officials, or alternatively are leaders - in business and in politics - not taking ownership, responsibility, and personal accountability for the decisions that they make? 


President Harry Truman used to have a wooden sign on his desk in the Oval Office that said, "The Buck Stops Here!"  As the story goes, one of President Truman's friends (the U.S. Marshal for the Western District of Missouri at the time) was visiting the Federal Reformatory in El Reno, Oklahoma and saw the sign on the desk of the Warden.  He asked if a sign could be made - it was - and President Truman placed the sign on his desk in October, 1945.  President Truman referenced the sign on a number of occasions.  According to the Truman Library, he referenced the sign during an address at the National War College, stating emphatically, "You know, it's easy for the Monday morning quarterback to say what the coach should have done, after the game is over.  But when the decision is up before you - and on my desk I have a motto which says The Buck Stops Here - the decision has to be made." 


President Truman also referenced the sign again during his Farewell Address in January, 1953, saying "The President - whoever he is - has to decide.  He can't pass the buck to anybody.  No one else can do the deciding for him.  That's his job."  In other words, leaders have a responsibility to make the hard decisions - they need to have the personal accountability to make those decisions and defend them, when necessary.  Just as important, leaders need to base their decisions on personal morals and ethics. 


I have referenced General Dwight D. Eisenhower's letter on D-Day in a previous post (see "Ike's Back-up").  One of the things that General Eisenhower learned - it was something that was drilled to every cadet - while at West Point was that there are only four possible answers to a question from an upperclassmen - "Yes, sir", "No, sir", "No excuse sir", and "Sir I do not understand."  In other words, if the unit fails, it is the leader's responsibility.  There is no excuse for passing the blame on to someone else.  "The buck stops here."


So, I agree that there are definitely leaders out there in politics, business, and probably even health care that make unethical (or at the very least, "questionably ethical") decisions.  However, I would say that more common, our leaders are not taking personal responsibility for their actions and we are not holding them accountable.  We need more of "The Buck Stops Here" mentality and less passing blame (or as the saying goes, "Passing the buck"). 

A "foolish and wicked practice"

I recently joined a book club about American Presidents.  Our first meeting later this week will discuss a wonderful biography by Joseph J. Ellis about our first President of the United States, George Washington ("His Excellency George Washington").  As I was reading about President Washington, I came across something that he once said, "The foolish and wicked practice of profane cursing and swearing is a vice so mean and low that every person of sense and character detests and despites it."  He is absolutely correct (well, of course he is right, he is the "Father of Our Country").

There is really no excuse for swearing and cursing.  I think leaders who swear or curse in public do themselves a great disservice.  Even if they are trying to make a point, these leaders end up setting such a poor example that the point is long lost.  I have learned over time (and in many ways, I am still learning) that swearing and cursing is just not appropriate.  I have learned, perhaps through the wisdom of experience and maturity (i.e. "older age") that profanity is just not a tool to be used to get my point across.  It's a lesson that I have learned the hard way. 

I remember once, probably at least 20 years ago, when I was talking to my son - he was probably five years old or so at the time.  I don't remember exactly the context, but I may have been reading him a bedtime story or something like that.  I told him, "You are a really good boy."  He replied, "You are a really good Daddy.  You haven't said 'Goddamitt in a really long time."  From the mouths of babes...

Inevitably, as I was looking through one of several stacks of papers at home ("tsundoku"), I came across a couple of interesting clinical papers that I apparently had once found interesting enough to save.  I suspect that this would not be a surprise to anyone, but there is probably one time (and only one time) when swearing might be okay.  Two studies - "Swearing as a response to pain" by Richard Stephens, John Atkins, and Andrew Kingston and a follow-up by the same group, "Swearing as a response to pain - effect of daily swearing frequency") - suggest that swearing increases our tolerance to pain.  In the first study, these investigators used a fairly well known, objective measure of pain tolerance - placing your hands into a bucket of ice and measuring the amount of time that you can stand it before pulling your hands out.  Swearing increased the duration of time that subjects could hold their hands in the bucket of ice and decreased the subjective perception of pain.  The investigators suggested that swearing induced a "flight or fight" response (notably, swearing also increased subjects' heart rates) that essentially inhibited the link between fear of pain and pain perception.  Interestingly enough, swearing increased the tolerance of pain to a similar degree in both male and female subjects; however, the increase in heart rate and the decrease in the subjective perception of pain were more pronounced in females compared to males.  The investigators hypothesized that males swear more than females (though they did not provide evidence to support), so in the follow-up study, they showed that swearing on a regular basis (determined by self-report) basically eliminated any benefit to swearing on subsequent pain tolerance.

So, to summarize.  Leaders should follow George Washington's advice and not swear or curse in the workplace.  If George Washington isn't enough for you, try this one.  Leaders should stop swearing so that the next time that they step on a nail, touch a hot stove, or hit a hammer against their finger while trying to hammer a nail, the use of profanity can decrease the pain!

What do you really want?

I came across a great Harvard Business Review blog post yesterday by Lori Goler, Brynn Harrington, and Adam Grant, called "The 3 Things Employees Really Want: Career, Community, Cause."  The article starts with a very brief discussion of Maslow's Hierarchy of Needs, something that I have talked about before in a previous post (see "What can we learn about leadership from a movie?").  The premise of Maslow's Hierarchy is that we are all driven by a hierarchy of needs, starting with the basics first (physiological needs, such as food and water, shelter, and sleep), followed by love and belongingness, self-esteem and prestige, and lastly self-actualization.  We can only seek to fulfill the higher levels of need only after we fulfill the ones below - in other words, if we are not addressing our basic physiological needs, we will not be able to fulfill the need for friendship, intimacy, and the sense of connection (i.e., the "love and belongingness" level of the pyramid).  Most psychological experts now agree that, while Maslow's Hierarchy is a good model, it is probably outdated and in need of modification, particularly with respect to how we motivate workers in the modern information/knowledge and service economies that are so prevalent today.


Goler, Harrington, and Grant suggest that in today's environment, organizations that focus on three things - career, community, and cause - will be the ones who are most successful (for example, according to one study companies listed in the "100 Best Companies to Work For in America" typically generate higher stock returns, on the order of 2.3% to 3.8% higher compared to their peers, in every year from 1984 to 2011).  The authors surveyed hundreds of thousands of employees in a twice yearly Facebook workforce survey and consistently identified career, community, and cause as the main motivators for employees:


Career focuses on the work itself.  It's more than just having a job - today's workers want to be able to use their strengths and skills to do something useful and productive, they want the autonomy to do so, and they want to be challenged to learn and develop their skills further.


Community focuses on the work environment.  Employees in today's knowledge and service economies want to be feel valued, respected, and cared about.  When they do a good job, employees want to be recognized.  Conversely, when they do a bad job, they want feedback so that they can improve and do better next time.  Employees want to feel like they are part of a team.


Cause focuses on a sense of purpose.  Employees want to feel connected to the organization's mission, vision, and values.  More importantly, they want that mission and vision to do some good in the world. 


Contrary to the popular belief that there are generational differences in workforce motivators, Goler, Harrington, and Grant found that there really were no significant differences between Baby Boomers, Gen Xers, and Millennials.  As a matter of fact, regardless of how they analyzed their results (whether stratified by geographical location, type of industry, age/seniority, gender, or level of performance), the three most important drivers of workforce satisfaction - and by extension, workforce motivation - were career, community, and cause.


Organizations have to get this right.  The three authors also identified a meta-analysis that showed that when organizations do not fulfill the so-called "psychological contract"with their employees, the consequences can be catastrophic.  Breaking that contract leads to feelings of mistrust and even betrayal, which ultimately leads to poor performance, turnover, and in the long run, higher costs and lower profits/margins. 


In the end, we all want to trust that the people we work for have our best interests at heart.  We all want the organizations that we work for to serve a higher purpose.  And we all want to have a meaningful impact on this world.

Today, I was a doofus...maybe I should use a checklist?

There's nothing like a three day weekend to recharge your batteries (especially when it's a three day weekend at the beach!)!  So, in other words, I was feeling pretty relaxed this morning when I drove in to work.  Not a care in the world.  Ready to take on every challenge with verve and vigor.  Bring it on!

Well...as the saying goes, easy come, easy go.  Somehow, I managed to lock the keys in my car.  As a matter of fact, I didn't even realize it until I got up to my office and reached in to my pants pocket to grab my keys and unlock my door.  Uh-oh.  Where are my keys?  I looked in my other pants pocket.  Nope.  I looked in both of my coat pockets.  Not there either.  How about in my backpack?  Nope.  Not there.  Hmmm.  Could I have left my keys in the car door?  I doubt it, but I better go look.  Just in case.  Oh.  There they are.  Still in the ignition.  Wow, how did I do that?

I know what you are thinking.  And you are right.  I am a doofus.  You are also probably saying to yourself (I know most of my co-workers told me this), "Most cars don't let you do that."  Well - this one did!

As I started to retrace my steps and conduct my own mini-After Action Review, it suddenly all made sense.  I broke up my normal routine this morning.  I usually walk our dogs first thing in the morning before leaving for work.  When I am out, I grab the newspaper, take it out of its plastic bag, and throw it in my backpack (with all of my other papers - remember, I have a pathological condition known by the Japanese term, "Tsundoku").  Well this morning, my normal routine was all different.  The dogs were still at the kennel (we got in too late last night to pick them up).  No dogs = no early morning walk = no newspaper.  Today I drove down the driveway, stopped to pick up the newspaper, and threw it in my front seat.  I also had some other things that I had placed in the front seat that I wanted to take to work.  When I got in to work this morning, instead of grabbing my keys, closing the driver side front door, and opening up the driver side back door to grab my stuff, I must have grabbed the things out of the front seat, closed the driver side front door, opened the driver side back door, and grabbed my stuff.  I always hit the door lock before I close the front door, which I did this morning.  All the doors locked.  I grabbed my stuff, closed the back door, and off I went.  No car keys.

It's amazing to me that I do something almost exactly the same way every single morning to the point where I don't even stop to think about what I am doing.  My routine is so routine, that I use very little brain power to go through the exact same sequence of steps every single day of the work week, year in and year out.  I think I've probably followed this exact same sequence of steps at least a couple of thousand times, if not more.  Change my routine just a tiny bit and everything falls apart!  I made, what Patient Safety professionals would call a "slip" (according to the Center for Patient Safety, a slip is defined as "a failure of schematic behavior or a lapse in concentration", usually in the face of a competing priority, distraction, or fatigue).  I made a classic slip.  You may or may not have done the same thing - for example, have you ever placed something in the refrigerator that clearly doesn't belong there?  That's a slip.  The Agency for Healthcare Research and Quality recommends, based on a wealth of experience and proven track record in the aviation industry and in health care, the use of checklists to prevent these kinds of mistakes. 

Think about it for a minute.  Checklists have been shown to be the most effective for exactly the kinds of scenarios that I described with my daily morning routine - a sequence of steps that have been performed over and over and over hundreds, if not thousands of times.  Pilots run through a checklist before take-off.  They've probably performed the steps so many times that they really don't need a checklist, but they use them to prevent that one minor slip that could turn into a major catastrophe.  Similarly, operating room teams run through checklists before every surgery to make sure that they have the right patient, the right equipment, and the right planned procedure.  Physicians and nurses use checklists whenever they place central lines or change the central line dressing, in order to significantly reduce the risk of a central line infection.  Checklists may not be applicable in every situation, but they are very effective in preventing slips or lapses when performing distinct processes that have become routines.

My own personal lesson this morning reinforced the need for checklists when performing everyday routines!  And I was once again reminded of the fact that my wife is a saint (she did marry me, of course, but she also drove WAY out of her way this evening to bring me the spare set of keys).  The vacation is officially over, but the lessons keep coming.

"It's not about the coffee..."

I recently discovered (maybe the better word is "re-discovered" from my childhood) the convenience and ease of ordering books from the local public library!  I am sure that the stock price of Amazon will now likely fall, as I have been, or I would like to believe that I have been, their number one customer the last few years!  No more - it's just as easy to borrow a book from our library.  They even have some of the older books that have been on my "books to read" list for quite some time.  Two of these books were written by Howard Schultz, the former CEO (but still Executive Chairman) of the Starbucks Corporation.  The first, "Pour Your Heart Into It: How Starbucks Built a Company One Cup at a Time" tells how Schultz first got started in the coffee business and how he built Starbucks into the internationally recognized brand that it is today.  The second, "Onward: How Starbucks Fought for Its Life without Losing Its Soul" was written after Schultz had left Starbucks and how he returned to rescue the company during the economic recession in 2008.  They are both really good books, and I highly recommend both.  I added several comments, quotes, and stories from both to my commonplace book. 

The point that Howard Schultz makes, again and again, in both books is that Starbucks is more than just coffee.  In fact, I would suggest that in large measure, Starbucks became successful because it was "not about the coffee."  Schultz writes (this time, in "Pour Your Heart Into It"), "We never set out to build a brand.  Our goal was to build a great company, one that stood for something, one that valued the authenticity of its product and the passion of its people."  He explains further (in "Onward"), "Starbucks is not a coffee company that serves people.  It is a people company that serves coffee."

Think about it for a moment.  Before Starbucks ever became as ubiquitous as it is now (you can purchase the coffee online and at the grocery store, anyone and everyone with a Keurig can make you a cup, most airlines now serve Starbucks, many restaurants serve Starbucks - even our hospital serves Starbucks!), what impressed you the most about Starbucks?  Did you really go to your local Starbucks and spend the extra money (you could always purchase a much cheaper cup of coffee at your local McDonalds, the gas station, Dunkin Donuts, etc) for just the coffee?  I am the first to admit that the coffee is pretty darn good, and yes, nowadays I would rather pay a little extra to drink Starbucks as opposed to a cup of coffee from the local gas station.  But back then, when the only place you could go to get a Starbucks was at one of their coffee shops, was the coffee really worth the extra time, hassle, and money?  I would suggest no.  What probably impressed you most was the whole "Starbucks Experience."  It was walking into a shop that had the look and feel of a "mom and pop" store.  It was the music playing in the background.  It was the fact that the entire store smelled so good - you could breathe deep the aura of coffee.  It was the fact that the individuals working behind the counters were called something special and different ("Barista").  It was the fact that if you were a regular customer, the Barista would know your name and would be able to fix your favorite cup of coffee to your exact specifications without even asking.  It was the fact that when your coffee was ready, the Barista would call out your name, hand you the cup of coffee, and tell you to have a great day. 

Schultz talks (in both books) about wanting to create what he called a "third place" - a place that wasn't work and wasn't home, where you could go and relax.  Read the newspaper.  Gather with some friends.  Surf the Internet.  Drink a cup of coffee. 

A few years ago, my sister and her family happened to be visiting London (one of my nephews was finishing up a "study abroad" semester and the entire family had gone to pick him up and do some sightseeing) - I just happened to be speaking at a conference at the same time.  We had planned to spend an afternoon and evening together doing some sightseeing and going to dinner.  We set up a time and place to meet.  While riding in the London Underground (the subway system), my sister's family was trying to catch the next train at the last minute.  They were running late.  She pushed one of my nephews (he was in high school at the time) on the train and the doors closed before the rest of the family got on.  Off my nephew went. Separated from his family in a large city in a foreign country without cell phone or WiFi!  What did he do?  He got off at the next station, walked into a Starbucks (with free WiFi), and e-mailed his parents to tell them he was fine and arrange for a place to meet.  Apparently, Starbucks is more than just a "third place", it's a landmark and safe haven too!

I guess that what I am trying to say is that Starbucks, as Howard Schultz intended from the start, is not selling you a cup of coffee - they are selling you an experience.  There is a lesson to be learned here for sure.  Leadership is not just about managing people.  Leadership is creating and setting a vision that the rest of the team/organization/company can rally around in the pursuit of excellence and perfection.  Howard Schultz was a visionary leader.  He made a compelling case for what he wanted Starbucks, as an organization, to become.  He got others to buy into that vision.  And he built Starbucks into a world class organization that does a heck of a lot more than just sell coffee.

There are so many more lessons to be learned in these two books.  I will definitely have more to say about Howard Schultz and Starbucks in the future.  I would like to leave you with one last quote - it's one that I think sums up perfectly why Starbucks has been so successful (and how I think other organizations can find that same level of success).  He says, "Success is not sustainable if it is defined by how big you become or by growth for growth's sake.  Success is very shallow if it doesn't have emotional meaning."  Schultz signs off with the same word in every memo, every letter, every company blog post, every speech - and I will do so here.  "Onward."

Traditions

Today, February 14, 2018, is Valentine's Day.  It also happens to be Ash Wednesday, the first official day of Lent in many Christian traditions.  Ash Wednesday derives its name from the practice of placing ashes (in the shape of a cross) on the forehead of worshipers with the words, "Repent, and believe in the Gospel" or, by tradition, "Remember that you are dust, and to dust you shall return."  While you will find several symbolic references to ashes in both the Old and New Testaments, you will not find (at least I don't think you will find) any mention of placing ashes on the forehead in the shape of a cross anywhere in the Bible.  Placing ashes on the forehead is a beautiful tradition, but one that was started long after the time of Jesus.


Traditions are important - they help form who we are, both as individuals and as groups.  They are a unique part of our culture that collectively bridge the gap between the past and the present, as well as the present and the future.


It seems to me, that one of the ways that new individuals are introduced, oriented, and assimilated to the prevailing group culture is by having these individuals learn (and in many cases, memorize) specific tidbits of information.  I am thinking back to when I was in medical school - there was a time-honored tradition of rounding on Saturday mornings with a certain surgical attending physician (the rounds were known, affectionately as "Dog Rounds") in which the 3rd year medical student had to present each case to the surgical attending without using notes or the medical record.  Our hospital was a tertiary and quarternary surgical referral center, so the patients were fairly complicated and complex.  Most of them had medical and surgical histories that were quite long.  I didn't really understand the point of it then - frankly, I thought it was fairly silly.  After a particularly weak (not my best performance) presentation, the surgical attending "asked" me to come back to present to him later that afternoon, when I was truly ready.  I did - it went fine.  He pulled me aside afterwards and asked me why I thought he was making me present without using notes or any "cheat sheets" in front of me.  He told me that if I spent the time going through and learning the history - even if it was lengthy and complex - that I would be able to talk intelligently and concisely about the patient, even in an emergency situation when I may or may not have notes in front of me.  Okay, fair enough.  Makes sense.  But he also told me that if I spent the time really learning about the patient so well that I could recite the history by rote memory, then I would have invested the time in really, truly understanding the patient and his (in this case) problem.  If I cared enough to memorize the history, I would care enough about the patient and be a better physician.  In other words, traditions lead to culture, which leads to being a part of the group.


In the same way, I recently learned that the United States Naval Academy sends a book called "Reef Points" to al incoming freshmen before their so-called "Plebe Summer" (the summer before the start of their freshman year).  Plebes (that's what the freshmen are called) are required to basically memorize the entire book - they fail to do so at their own peril (not mortal peril, of course, but rather at the risk of getting an earful from one of the upperclass midshipmen).  I recently took a look at a copy of one of the older versions of "Reef Points" - there is a lot of really important information in there (Navy ranks, rules and regulations for students, etc.) as well as seemingly less important information (the history of the Navy, the history of the Naval Academy, etc.).  Again, why would the Academy require the Plebes to memorize all of this?  Traditions lead to culture, which leads to being a part of the group.


Winston Churchill once said, "A love of tradition has never weakened a nation, indeed it has strengthened nations in their hour of peril..."  We all have traditions - they serve a great purpose.  But one final word of caution - Mahendra Chaudhry, the former Prime Minister of Fiji, said, "To hide behind culture or tradition to justify anarchy is a gross insult to the very people whose culture or tradition may be paraded to glorify criminal conduct."  In other words, respect the traditions that respect everyone and forget those that do not. 

"It's lonely at the top"

As I think I have mentioned in the past in this blog, I really like to read.  I mostly read non-fiction, but I will occasionally pick up a work of fiction to enjoy too.  One of my all-time favorite series is the Aubrey-Maturin series by the English author, Patrick O'Brian.  There are 20 novels in this series, as well as one unfinished novel that O'Brian was working on before he died in 2000, set during the Napoleonic Wars and the "Golden Age of Sail."  The books focus on the friendship and adventures of Jack Aubrey, a Captain in the Royal British Navy, and Stephen Maturin, a half-Irish/half-Catalan physician, naturalist, and intelligence agent.  There was a movie based on a few of the books in 2003 ("Master and Commander: The Far Side of the World") starring Russell Crowe (in the role of Jack Aubrey) and Paul Bettany (in the role of Stephen Maturin). 

The series starts with the book, "Master and Commander" when Jack Aubrey receives his first command.  While thrilled with the opportunity of a promotion, he immediately begins to feel lonely, which leads to the developing friendship with Stephen Maturin that continues throughout the rest of the series.  Aubrey learns that being the one person responsible for an entire crew, a ship, and the mission - indeed, the one person who bears all of the authority and responsibility as the representative of the Royal Navy and of the country of England - can be personally intimidating and particularly lonely.  During Aubrey's first command, he is out in the middle of nowhere in the open sea - no one else is around.  There is no one that he can confide in, no one to ask questions about what to do next, no one to get advice from (eventually, Stephen Maturin plays that role).  The decisions that a sea captain made could mean the life or death of his crew, as well as the success or failure of the Navy and of England.  The decisions that a sea captain made could make or break his reputation - in some cases, Navy captains were tried and executed for making poor decisions that were not in keeping with the English way.  Being a captain, in other words, was lonely.

Leadership is like that - it can be lonely.  Remember that as a leader, you are always "on stage" - people are going to watch you closely to see if you are following all of the rules.  They are going to be watching you to see if you are enthusiastically embracing a particular initiative or project.  They are going to be watching you (and they will critique you) to see if you say "Hello" when you are walking down the hallway or getting on the elevator.  As a leader, everything that you do - every little action, every facial expression, every comment, may (and likely will) be heavily scrutinized.  Leadership is not about popularity.  As a leader, you are going to have to make decisions that many individuals in your organization are not going to like. 

Forbes magazine published an article "Do you feel lonely as a leader? Study says you are not alone" that reported on a survey of CEO's in corporate America - half of all the CEO's who were surveyed reported experiencing feelings of loneliness in their jobs.  More importantly, and perhaps more worrisome, more than 60 percent of those CEO's who reported feeling lonely said that it adversely impacted their job performance! 

There is a famous picture of President John F. Kennedy shortly after he took office -  the picture was taken by the photographer, George Tames, on February 10, 1961.  Tames called the picture, "The loneliest job in the world":



Kennedy was simply reading the newspaper while standing up in the Oval Office - something he often did due to his bad back.  However, the picture portends the loneliness and the great "weight of the world" that Kennedy would feel later in his Presidency during the Cuban Missile Crisis.  Moreover, the picture is an appropriate metaphor for the loneliness that many leaders, including the CEO's in the study mentioned above, feel every day.

So, what can a leader do, especially when he or she is feeling the so-called "loneliness of leadership"?  The Forbes article suggests that leaders should find a peer group, a group of advisors, or a mentor or coach.  All of these make a lot of sense.  We all can benefit from mentorship - I still rely on the same mentors that I have had throughout my career for advice and assistance.  We all can benefit from a peer group - individuals that we can trust and with whom we can bounce our ideas off of and get honest, sincere feedback.  Finally, we all can benefit from developing a group of advisors - individuals who not only are our direct reports, but also the individuals who we are developing to take our place - who we can talk through our decisions and get feedback on how we lead.  To these recommendations, I would also add that leadership doesn't have to be lonely.  As leaders, we should be getting out to talk with and learn from our front-line employees.  Working on the front-lines - empowering our teams - can be invigorating and rewarding.   

  

Before you think about leaving, make sure you are ready to go

Here I go again, talking about the New England Patriots.  You would think that after writing a blog called "The Patriot Way" and another called "The Patriot Way Redux" that I would get sick of writing about the team that everyone outside of the northeastern United States loves to hate!  Well, unfortunately (if you are tired of hearing about them) or fortunately (if you are tired of hearing about them but at least appreciate the lessons they can provide), they keep providing some really good lessons on leadership.  My comments have nothing at all to do with their recent loss in Super Bowl LII (though there are probably some good ones in there to discuss).  Rather, I want to focus on one particular individual in the Patriots organization - in this case, their current Offensive Coordinator, Josh McDaniels.


If you haven't heard, Josh McDaniels at least had a gentleman's agreement to be the next Head Coach of the Indianapolis Colts.  For at least the last two weeks up to the Super Bowl, rumors had been swirling that McDaniels was the leading candidate for the Colts' job.  Similarly, the Patriots' defensive coordinator, Matt Patricia, was rumored to be the leading candidate for the head coaching job for the Detroit Lions.  Nothing here is at all surprising - assistant coaches with successful teams often leave at this time of year to become head coaches for other teams.  Moreover, contracts are not typically signed until after the season is over (the season is not officially over for a team until they are done playing, so the Patriots' season didn't end until after the Super Bowl).  So far, so good.  Apparently, McDaniels had convinced some other assistant coaches to join his staff in Indianapolis, so the odds were looking pretty good that he was going to leave the Patriots at the end of their season.  As recently as yesterday, the Colts had announced that there would be a press conference to introduce their new Head Coach (and that the new Head Coach would be Josh McDaniels). 


Perhaps to everyone's surprise, McDaniels apparently told the Colts that he was no longer interested in the job (see breaking news article on ESPN.com here).  McDaniels had a change of heart and decided that he would like to stay in New England.  There has been a lot of speculation on why he made such an abrupt change in plans, anything and everything (for example, maybe he found out something that the rest of us know about the status of the Colts' quarterback Andrew Luck and his surgically repaired shoulder).  The information that has been released to the press suggests that (1) the Patriots' owner, Robert Kraft, conducted an aggressive, last minute retention campaign and "sweetened the deal" to such an extent, that McDaniels was more interested in staying and (2) McDaniels decided that he and his family would like to stay in New England.


The truth of the matter is that it doesn't really matter why McDaniels changed his mind.  He did.  It was his choice, and he had not signed a contract.  He alone will have to live with the consequences of his decision, whatever they may be in the short run and the long run.  I heard one commentator question whether or not any organization in the future could trust McDaniels until he signed a contract.  I also heard that other coaches would be less likely to agree to join his coaching staff in the future, at least until he had signed a contract. 


Regardless of his reasons, and regardless of the future consequences, there is a lesson here.  It doesn't matter where you are in your professional life - don't waste anyone's time going through the process of interviewing unless you are really in a position to leave your job for another one.  If you are not ready to make a move - whether it is for personal reasons or professional ones - you should not look at other positions.  I realize that there will be times when you aren't quite sure, and at times, the mere act of looking at another job convinces you that it is time to move on.  That's all fine.  But if there is no way that you would ever leave a position, you shouldn't waste your time or anyone else's.


If Josh McDaniels truly felt that his family loved living in New England, then he shouldn't have even bothered to look at another head coaching job.  I completely understand that family comes first - I won't argue with his rationale for staying with the Patriots, if that is truly the reason.  But if that truly was the reason, then why even bother to go look?  I would like to believe that, even with the world that we live in today, things like honesty and integrity still matter.  I wish Josh McDaniels all the luck in the world, and I truly hope that he finds happiness, joy, and meaning in his work.  To the Indianapolis Colts, I think you found out (albeit the hard way) that you can do better than Josh McDaniels.

"Do we need a National Women Physician's Day"?

Today, February 3, 2018, is National Women Physician's Day (NWPD) in the United States.  NWPD was first observed last year and commemorates the birthday of Elizabeth Blackwell, MD, the first woman in the United States to receive a medical degree. 


Elizabeth Blackwell was born in Bristol, England in 1821.  Her family moved to the United States (New York City at first, later Cincinnati, Ohio, where she spent her formative years) when she was eleven years of age, both for financial reasons and because her father wanted to help abolish slavery.  Dr. Blackwell was a relative late-comer to medicine, beginning her career as a teacher (a profession that was then considered more appropriate for a female).  In fact, the thought of practicing medicine initially seemed repulsive to her, as she suggested in her memoir (Pioneer Work in Opening the Medical Profession to Women, published in 1895), writing that she "...hated everything connected with the body, and could not bear the sight of a medical book...My favorite studies were history and metaphysics, and the very thought of dwelling on the physical structure of the body and its various ailments filled me with disgust."


Dr. Blackwell eventually turned to medicine when a close friend who was dying told her that she would have suffered far less if her physician had been a woman.  She would write, "My mind is fully made up.  I have not the slightest hesitation on the subject; the thorough study of medicine, I am quite resolved to go through with.  The horrors and disgusts I have no doubt of vanquishing.  I have overcome stronger distastes than any that now remain, and feel fully equal to the contest.  As to the opinion of people, I don't care on straw personally; though I take so much pains, as a matter of policy, to propitiate it, and shall always strive to do so; for I see continually how the highest good is eclipsed by the violent or disagreeable forms which contain it."


Dr. Blackwell convinced two physician friends to let her work with them for a year (an early example of "shadowing") and applied to all of the medical schools in New York and Philadelphia, as well as 12 more schools throughout the Northeast.  The faculty at New York's Geneva Medical College assumed that the all-male student body would never allow a female to join their ranks and decided to let them vote on whether to admit her to the college or not.  A number of the male students, largely as a joke, voted "yes" and she was accepted, graduating in 1849. 


Dr. Blackwell practiced medicine in London and Paris for the first few years and studied midwifery at the La Maternite, where she contracted "purulent ophthalmia" (i.e., ophthalmia neonatorum, or gonococcal conjunctivitis) from one of her patients.  She lost sight in one eye and returned to New York in 1851, giving up her dream of practicing as a surgeon.  She struggled to establish her practice, as there were few patients that wanted to come to a female physician and even fewer physician colleagues who would work with her.  She eventually opened her own dispensary, and her sister, Dr. Emily Blackwell joined her in 1856.  Together, they would establish the New York Infirmary for Women and Children in 1857.


Throughout her career, she was a passionate advocate and supporter of medical education for women.  She established the New York Infirmary in 1857, largely in response to the need to provide medical internships for women physicians, who were usually rejected at other hospitals around the country (merely because they were women).  Dr. Blackwell was a pioneer who paved the way for all women physicians - for that, it is right and appropriate that we recognize her today.


A few of my colleagues have asked me, "Why should we celebrate Women Physician's Day?"  I respond by first citing the statistics.  While the number of women physicians has increased significantly during my career, as of 2016 only 35% of physicians are women.  Unfortunately, a study published last year in JAMA Internal Medicine found that women physicians earn, on average, 8% less than their male counterparts.  One-third of women physicians report experiencing sexual harassment in their work environments, and a large percentage experience gender bias.  Just ask any woman physician whether she has been called "Honey" or been told "Nurse, I would like to speak to the doctor."  I also talked about a study in a previous post that found that women physicians were more likely to be introduced using their first name, even when presenting at professional conferences, as opposed to their male counterparts who are introduced as “Doctor”.  This is in spite of the fact that there are studies that suggest that women may actually be better physicians than men (see one of my previous posts, here). 


So back to my original question and the title of this post - "Do we need a National Women Physician's Day?"  In a world where we need to have a #MeToo movement, where Time magazine recognizes the women who stood up to sexual harassment and discrimination in the workplace in its annual "Man/Woman of the Year" issue, and where it is okay to sell T-shirts and campaign posters and bumper stickers during the 2016 Presidential Election saying things like "Trump that Bitch" or "Life's a Bitch - Don't vote for one", I would say absolutely, 100% yes!  Women make outstanding physicians too!  Certainly they deserve the same rights and privileges that male physicians receive - most of us would not argue that point.  But the fact remains that in most cases, we are falling short in this regard.  In addition to all of the statistics I cited above, the evidence also suggests that women physicians are at a much greater risk of burn-out than their male counterparts - when you recognize that the rate of burn-out in physicians is twice that of most other professions outside of health care, that is saying a lot!


So while we have so much more work to do, today I recognize and thank all of my women physician colleagues - today is your day.  Thank you for doing what you do.  And thank you, Dr. Elizabeth Blackwell, for making it all possible!