Many years ago, as a hospital medical director, I attended a meeting we had with one of our payers.   I remained quiet throughout most of the meeting, and when the time was right, I spoke.  I process slowly, but I process well.

When I spoke, the mood in the room was tense.  I summarized the payer’s points, asking whether I was correct.  I wasn’t, so I continued summarizing until they agreed that I had understood them.  The tension went out of the room like air out of a balloon.  I don’t remember who “won,” but I learned something that day.

During my tenure as medical director, I received many complaints about the hospital and doctors, and I handled them the same way.  Rather than defending, I summarized the complainant’s points, discovering that I could hear tension go out of a telephone conversation, too.  People were amazed that somebody was listening to them.  Sometimes, that’s all people want.  Try it with your spouse some time.


I was asked to debate climate change.  I try to do things that will make a difference, and my debating climate change is not going to change policy.  Debating requires good public speaking skills, which I have, but only when I teach.  I doubt I will teach anybody anything in a debate.  Debating also requires fast processing skills, which I do not have.  That is why I am a writer.

Debates also have other problems, too.  They have winners and losers, and winning and losing have become toxic.  The desire to win has overshadowed the desire to look for new solutions.  Steve Jobs was deeply flawed, but he had the ability to move people to find solutions to problems that they thought impossible to solve.  We need that sort of approach in medicine.  Debates don’t offer it.

In medicine, we would have done well to have first studied the efficacy of  CABG, CEA, angioplasty, stents and EC-IC bypass.  Had we, millions of people would have been helped or not harmed.  Of the five, only EC-IC bypass was properly studied, and we found it didn’t help.  The scientific method is more helpful than the often screaming debates I heard, sometimes directed at me in the case of CEA.

In the past 15 years, national discourse on many topics, at one time bipartisan, disappeared. There are several reasons, but it is a fact that many issues that are scientifically based, and should be treated that way, have become politicized. Such polarization is toxic, and it can be transmitted.  I caught it.

The idea of seek first to understand, then to be understood, Covey’s Fifth Step, is one of the most powerful.  It goes with “if you want to influence people, you must first allow yourself to be influenced.”

I’ve also been guilty of misuse of the language, using such words as “most”, rather than “many”; adjectives and adverbs I chose might have been better.  Words matter.  I am deeply concerned about Internet anonymity and the loss of critical thinking skills; lessening of emphasis on science and math education might be the cause.  Apple outsourced to China in part because we didn’t have the engineers here.  We have far too much name calling, prejudice–not just in the racial or religious sense–but politically.  For those like me, who process very slowly, this fast-paced prejudice puts me at an disadvantage, for if I process, often the conversation is over without my participation, and if I don’t process, I risk saying something I later regret.

I’m often glad I’m pushing 65.  It isn’t always fun, and with each passing year, like the great tight end Jerry Rice, I have to work harder and harder to do the things I have done all my life, knowing at some point, I will have to hang those things up.

But I am glad I won’t be alive in a world that will be people rich and resource poor.  Wilderness will disappear.  Quiet is disappearing, too, along with our great heritage of dark skies.  I do not want to live in a crowded world, where I can no longer find solitude in the wilderness and feel more comfortable there than with a lot of people.  The first thing I notice in Europe and Asia is the pushing and shoving.   The second thing I notice is the smoking.  The third thing is the relative lack of obesity, the fourth the number of solar panels in a latitude 20 degrees further north than the one I live in.  Europe has wonderful public transportation, polyglots, downtowns that work, and good use of the available space, which is not a lot.

There are many softer words in our language; we would do well to use them more often, in hope that maybe others will catch on.  We need to discuss medical care in this society, not debate it.  I don’t know what the right system will be, but many of us think it needs to be changed.  The irony is that not all of us are doctors or payers, but all of us are patients at one time or another.  That gives us something in common.  How should patients be treated?  How do we pay for it?  How do we do what is necessary and avoid what is not?  How do we die, when it is time?  When and how do we deny care, because we simply can’t afford it?

It is easy to criticize.  It is far more difficult, but far more rewarding, to first ask “Let me see if I can summarize what you said, for it is very important I do so correctly.  Please correct me if I make any mistakes.”

I hope I am not mistaken when I say that hopefully we still have time.  But not much.

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