Random Thoughts from a Restless Mind

Dr. Darrell White's Personal Blog

Cape Cod

Archive for February, 2011

Sunday Musings 2/27/11

1) Inspiration. Loved the “Women of the 2010 Games” video. Gotta say, though, that I have yet to NOT have goosebumps watching “Nasty Girls”, the original. Want to inspire young women? Show them what grit and determination looks like?

Still can’t do better than Nicole and “Nasty Girls”.

2) Christie. “When I run out of fights to have, I’ll stop fighting.” I DO like that, the following notwithstanding.

3) Us. So much of our worlds is made out to be “us vs. them.” By its very construct, at its most basic such a thing is designed to create a winner only if a loser is simultaneously spawned (more on that in a bit). Please don’t get me wrong–at times it really is “us vs. them” or “you vs. them,” no matter who “them” happens to be at that moment. Sometimes the conflict really does come to you, or come to us, and in those moments the only way to persevere is to engage, verse.

For some the act of engagement, the state of conflict is a natural and very comfortable location. A corollary: I once worked with a colleague who was a terrific crisis manager; he turned every decision point into a crisis because that’s what made him comfortable. But just as that form of management tends to burn a group, or indeed an individual, from the middle out, so, too, does a constant state of “us vs. them” become a self-defeating proposition.

While ruminating on this, in the middle of an “us vs. them” conflict that I did not choose, I kind of tripped over the opposite. The affirmative version. “Us WITH us”. The continual internal effort to build upon the positive, to plan for the best. To offer within the group the assumption of goodwill on the part of “us”. Indeed, to assume, until proven otherwise, goodwill on the part of “them”.

To build on the power of what it is that makes “us” good, whoever your “us” happens to be.

4) Non-Zero. Do you know people who seemingly can only feel good about themselves if someone else has fallen? Folks who cut others down in an effort to build themselves up? Everything, every encounter big or small, is a little Zero-Sum game. There can only be a winner if someone loses.

Have you ever listened to them talk? Their words are like little knives, meant to produce tiny injuries as they convey information. Many times these injuries are purposeful; other times they constitute collateral damage. What is notable is that the only effort that is apparent is the effort to wound, never an effort to protect or cushion or even prevent unintended injury. No opportunity is too small, and the effort to prevent injury seemingly too great, to miss the chance to inflict damage. You never know when that damage might helpfully/hopefully weaken someone to whom you might some day be compared.

Content and tone are inextricably mated. How you communicate expresses not only your thought but also your intent. Kindness, or not even that but neutrality, puts the content squarely in focus. Central. Untarnished. Funny, but speech meant to communicate and harm is often preceded by some qualifier such as “no offense” or “bless your heart”, as if that somehow makes the speaker blameless for any damage downstream.

The sad thing about this whole gig is that the person who seeks to elevate himself by bringing another down, seeks the win by creating the loss, achieves nothing of the kind. At best…at the very best, the situation created results in a loss for the other, but no more than a draw for the instigator. Which, if you’re keeping score, is actually NOT a Zero-Sum game at all, is it? Nor is it a Non-Zero Sum game, one in which both sides win, or one wins to the other’s neutral “draw”.

Nope, tearing another down in the vain hope that such a thing will boost you up, get one in the “win” column, is actually the third type of game, the Negative-Sum game. NOBODY wins.

Who would want to play THAT game? Who wants to be THAT person?

I’ll see you next week…

Posted by bingo at February 27, 2011 7:03 AM

Sunday Musings 2/20/11

Sunday musings…

1)Sharp. “He had an ear sharp enough to hear a gnat shrug.” How good is that?

2) Census. 100% of the human population of the moon has been American. How good is that?

3) Rest day. Today is a rest day for me. Three days. Three “Girls”. Three PR’s.

I’m tired.

4) Direction. Is it easier to turn away FROM something, or is it easier to turn TOWARDS something? Is leaving viewed through the windshield or the rear–view mirror?

I’m pretty sure you could call this splitting hairs, gilding the Lily as it were, but I got to thinking about this after reading an article about Jake Plummer and his quite sudden retirement from the NFL at age 32. Walked away from some $5 million, and walked to a rather quiet life in northern Idaho. Even before I read the article I was sort of thinking about this after encouraging a patient to visit a Crossfit box owned by a young woman who left rockstar status in her corporate job to open up an Affiliate.

Does it matter? Man, I dunno, but it’s bugging me a little bit. What takes more balls, to walk away from the known (be it good or be it bad), or to walk toward what might be a very good unknown? The “devil you know” and all that.

No answers here, I’m afraid.

5) Gratitude. Someone posted on Facebook something about always wanting more. NEEDING more. Always striving for more. The sense I got from the post, and indeed the theme that ran throughout the comments, was that to NOT be ever–striving for more, to not EVER be satisfied, was to somehow settle. Settle for less. This was pretty much universally agreed to be a bad thing.

But where does happiness fit in here? If one never has enough, if one can never even be content, how is it that one can ever be happy? Frankly, I spent most of the day looking for the vocabulary to explain this. It’s just another version of the “want versus need” issue, complicated by a misunderstanding of the concept “ambition”.

I am ambitious. I have aspirations. Some of them are grand (reform organized youth sports, save the city of Cleveland), and some of them are quite trivial (own a home in Park city again, buy a watch). The difference, though, is that I’m really quite happy with what I have, who I am, where I am, and what I’ve done right now. I am thankful, openly and consciously thankful, for each one of those things.

Wpuld I like more? Why, yes thank you. I’ve HAD more and it was really quite lovely. The only thing better than enough is more, eh? But there’s the rub: the man who knows when enough is enough will always have enough. We could say that one who is thankful for enough is living a life of gratitude. That certainly does not rule out ambition or aspiration, but it does leave a great big open door to happiness. People who are thankful for what they have, even those who constantly strive for more, tend to be quite happy.

I’m really quite happy. You?

I’ll see you next week…

Posted by bingo at February 20, 2011 6:35 AM

Sunday Musings 2/13/11

Sunday musings…

1) Vacation. I’m not really very good at taking a vacation. To be more exact, I’m not really very good at BEING on vacation. Once upon a time I actually took many weeks of vacation every year; I wasn’t very good at being on vacation then, either.

It’s not that I don’t enjoy being on vacation, it’s more that it simply takes me too long to realize that I’m actually on vacation. To relax. To be okay with doing exactly… nothing.

I am now day one back from yet another week of failure.

2) Courage. I read the letter from GruntDoc’s blog posted above. The soldier who sacrificed himself so that his comrade might live demonstrated HEROISM, the practical application of courage with a significant aspect of selflessness thrown in. Not too many people have an opportunity to actually do this. What is extraordinary, at least to me, is how frequently this occurs when folks are given the chance. I am awestruck and humbled every time I read one of these stories.

Courage doesn’t always need to be attached to heroism, however. Courage is also the willful refusal to give in to one’s fears. It matters not what others think of any particular fear; fear is intensely personal, as real as any object we might touch. Overcoming that fear, finally screwing up enough courage to move through, then past that fear, is significant and monumental. Always.

I was there last night when “Lovely Daughter” overcame one of her terrible fears. It doesn’t really matter what it was. I was there to witness a little tiny glory, the glory that comes when one finds the courage to win the battle agains fear.

3) The Valley. “… when you start hurting you’re not even CLOSE to the bottom of the valley, and if you don’t panic at the first agonies there’s much, much more of yourself to give.”–Sebastian Junger.

I’m having trouble pushing through the pain. In almost any physical endeavor, but most definitely in Crossfit, it’s necessary to go to a pretty dark place to get the full benefit of the enterprise. I’m having trouble going there recently. I’m not really sure why, to tell the truth. There’s really nothing all that different about today, or yesterday, or last month in comparison with three, four, or six months ago. Nothing different, except for the fact that I’m opening the door to that dark place, but I’m not walking through.

I’ll go there again, of that I am sure. The payback, the benefit, is simply too great to continue to turn back. Perhaps it is the solitude within which I have always traveled when passing through that dark place, or perhaps it is simply the duration of the solitude.

Something is missing, something not exactly like, but something seems like courage.

4) Sonhood. in a few moments I’ll be leaving the warmth and comfort chez bingo, off to attend yet another wake for the parent of a friends. I have reached that stage in life where my friends and acquaintances are losing parents.

That’s not all that’s lost, of course. When we lose a parent, especially when we lose that second parent, we also lose a significant part of who and what we all are. For me it will be losing the role of “Sonhood”. At some time I, you, we will all cease to be someone’s child. The age at which it occurs matters, of course, but in the end when you’ve lost your parents you have become an orphan.

Frankly, my own personal “sonhood” was much easier and much simpler when I was younger. Right up until about the age of 35 it really didn’t take all that much thought or effort. Some rebel, cut the cord, whatever, in their teen years, or even before. I managed to put off whatever rebellion I had in me until around the age of 35. And yet, despite the fact that being the son has actually been a greater challenge as an adult, I revel in the fact that I am still someone’s child.

I guess that’s the point of this, eh? It’s not Father’s Day or Mother’s Day, but it COULD be. Hard or easy, with or without the necessity of thought or planning, in most cases “Sonhood” (or “daughterhood”) is really one of those good things we have, those good things we are.

I’m sad for my friend and his loss, and I’m also a little sad that it sometimes takes something like this to remind me of my “sonhood”, to not take for granted that I am still someone’s child, to remind me to actively engage in being a son.

I’ll see you next week…

RFP, Arnold Kling et al

Consider this an official “Request For Proposals” from Arnold Kling to design a health care plan. And just so Dr. Kling doesn’t think I’m picking on him, what the heck, let’s hear from Tyler Cowan and René Herszinger, to0. While I’m at it, I have a certain health care policy rock star brother-in-law, Jim, and I’d love to hear what he has to say about it. Let’s toss in that blogger Maggie Whatever-Her-Name-Is, and why not invite one of the smartest guys I’ve ever actually chatted with, guy named Barry Cooper in Louisville. I’m ready to appoint each and every one of you, and anyone else who’d like to take a shot, as uncontested Health Czar for a large group of people. This is a Request For Proposals to design a health care plan from scratch.

Let’s see who’s got game.

This isn’t something I just made up; this is actually a real group and a real possibility, although it’s highly unlikely that the real players have either the imagination or the balls to really do something new. Nonetheless, it’s very cool to apply imagination and balls to this question. The group consists of 250,000 individuals, 95% men, between the ages of 20 and 60. The average age is 45. Once they become part of this group they essentially remain so for their entire working career. They have a single labor representation, and while they work for a number of different companies there are four major employers. Health insurance has been part of their negotiated contracts for decades.

You have carte blanche to design a health care program for this group. You are not bound by any ERISA regulations, and you will “participate” in any financial savings you might create. Let’s say that it will be a 10 year trial, and in year one you have the average amount of money actually spent on healthcare over the past three years for this group. Each year the funds available to you will increase by only the CPI, inflation in the general economy and no more.  In years one through five any money that you do not spend is yours to keep. Remember, the members of this group do not come in and out, and any investments you make in the early years that reap savings in latter years will come to you and not another provider or payer. In years five through 10 you will share any savings with the employers, the payers.

As part of this proposal you must not only try to save money, to provide health care in a more cost–and efficient manner, but you must also achieve superior health. In years one and two the health outcomes of your 250,000 members must be no worse then the aggregate outcomes across the United States for individuals in a similar demographic. However, in years three through 10 you must demonstrate superior health outcomes for your group, each year better than the last. In other words, you must design a program that will not only save money but will also produce superior health.

That’s it. No other rules. You may use economic incentives with the members, both positive and negative. You may put together what ever type of provider group, physicians and physician extenders, hospitals and clinics that you wish. Pay the healthcare providers any way you’d like (probably ought to be sharing the lion’s share of any savings with this group, if you wish to be successful). You only have to do two, simple things: make these 250,000 men healthier, and spend less money doing so.

Wadda ya think, Dr. Kling? You in?

I don’t want to sound like I’m picking on Dr. Kling because it was actually his short manuscript, “A Crisis of Abuncance” that really got me to thinking about the barriers we have erected in our healthcare system to actually providing healthcare, providing for the creation of health. The best example of what you CAN do, as well as what happens now when you DO do, is the Mayo Clinic program designed to take care of patients with kidney failure. Given free reign to design a program that would accomplish exactly what I am asking for with my 250,000 member group, the Mayo Clinic did just that. By creating a team that was given free reign to utilize best practices, the Mayo Clinic designed a program for kidney care that resulted in fewer mortalities, fewer complications, and greater health, all with a lower price tag.

So why, you might ask, do we not know more about this program? Why is this not the gold standard for ALL medical care, let alone chronic kidney disease care in the United States? The sorry fact is that the Mayo Clinic actually LOST money on this program despite the fact that their patients had BETTER health by doing less and doing it better, thereby resulting in the need for LESS work still, The Mayo Clinic essentially cut off its nose to spite its face. Not willing (and reasonably so) to lose money, and unwilling to practice medicine any way less than what they have shown to be best practices, the Mayo Clinic has now declined to care for Medicare patients in some of its satellite locations.

But you guys don’t have to worry about that. I’ll let you keep the cash! So, what do you say, folks? Ask your friends. Everyone can play. We might even catch the attention of the real, live people who are presently negotiating new labor contracts for this very group. Here’s a chance to start saving the American healthcare system. This is a formal Request For Proposals.

The lines are now open…

You are currently browsing the Random Thoughts from a Restless Mind blog archives for February, 2011.