Thursday, April 13, 2017

"We treat ears here!"

Let’s take a look at some of the ways power is perceived and deployed.

Useful for this purpose is the model of the photographer: framing determines composition. The more narrow the frame, the more intense the image, and the reverse is also true: the wider the frame, the more interesting and more distant the image(s).

Medical science, one of the most dominant of intellectual models of perception, given the cultural and political importance of the practitioners. Everyone, at some time, will experience a specific pain, injury or infection. And, when the doctor “examines” the symptoms, s/he will focus on the most significant, the most obviously treatable and the most painful. Unless there is a legal requirement that they report a “cause” because they suspect foul play, they are almost totally disinterested in the “source” or the history of how that symptom came to be.

 As one ENT (Ear, Nose and Throat) specialist put it, when asked if a young female patient might be suffering allergies, given a history of ear aches and even “tubes” implants, “We treat ears here!” He simply would not even entertain the question, simply because it was “outside” his speciality. The family doctor’s referral to an allergist at Sick Children’s Hospital and resulting examination demonstrated unequivocally a long list of allergies.
The ENT’s “framing”  was confined to the ear canal, and all of its component parts. Even the family doctor had not mentioned allergies, prior to his referral to the ENT specialist; it took the mother to raise the question, and who knows how long the issue would have festered had the question not been asked when it was.

Management of the ear aches, thus, could not be restricted to the skills and the procedures available to the ENT practitioner. Nor should it have been. And the allergy hypothesis is only a single circle outside the range of perception and knowledge and practice of the ENT doctor. Even then, there was no discussion of whether or not anyone smoked in the home and whether or not that might have impacted the young girl’s earaches. (With deep remorse and regret, I smoked a pipe for all of the first eleven years of her life, only confining my smoking to an open-windowed study, following the allergy diagnosis! Some forty years later, I still question whether my smoking negatively impacted her growth and development.)

There is, admittedly, a degree of “focus” and intensity in the ENT’s approach. If successful, it produces measureable results. The ear aches dissipate or disappear. However, without the allergy diagnosis and ensuing treatment, a unique serum prepared by a respected allergist, who knows how long the ear aches would have persisted.

Let’s take a few steps back, with out “camera lens” and move the discussion to an issue in a school or another institution, where people are expected to resolve disputes. Of course, the immediate ‘intervention’ is designed and executed to bring whatever drama is occurring to a stop. And then, presumably, the next step is to work toward prevention of a similar incident. And here is where the issue gets murky. Of course, ‘he hit me first, no he bad-mouthed me first’ (or something similar) will confront the responsible authority. And if the incident generates blood, a broken bone, a concussion, or an unconscious body, then that symptom will require immediate attention.

However, school principals and teachers, unlike doctors and paramedics, are not “instant emergency responder”. They are there for the long haul, the whole year, or perhaps the whole decade. And the offending students will be there for an extended period. Right away we can see the short-term benefit and ‘down side’ of the medical intervention. It will not and can not provide the needed investigation into the motives, background, biography, family history and parenting style in which the student has been living (and mimicking or modelling) for several years. Nor will it provide much insight into preventive strategies that might help the student shift his or her “modus operandi” from pugilism to negotiation and compromise.

So far, we have looked only at single presenting symptoms and incidents. However, no matter who is responsible for “administration” or management or leadership in situations outside the doctor’s office does not have the luxury of relying on a single, pin-point (or scalpel) intervention as the solution to the problem. In fact, the medical model is not only counter-intuitive; it could prove to be completely or partially ineffective, as was the surgery by the ENT.

Complex circumstances invariably underlie most human conflicts, especially at the point when “outside” professionals are brought into the situation. Domestic violence, for example, does not start with the last “blow” when the cops and the paramedics are called and must intervene. And even after their investigation is completed, and their report written, there will be important details left off simply  because of a myriad of motives. Some might not disclose all of the intimate details of the relationship, while magnifying others they know will be socially and culturally acceptable and put the “witness” in a ‘proper’ light (often victim) representing the self-perceived image they have developed through their biography. Those having to make decisions about culpability, therefore have limited evidence on which to base decisions; hence, no fault divorce.

Yet, there are numerous situations in which ‘no fault’ does not and cannot apply.

 However, from an institutional perspective, adoption of the medical model, (reducing an incident to a single presenting symptom, and disciplining that symptom) will never resolve a much more complex human conflict drama. And here is where the medical model intersects with the institutional/law enforcement/ school administration/social welfare realities, often to disastrous results.

The interests of the “authority” in such circumstances, too often, take priority to the long-term resolution of the conflict. Like the ENT specialist, they too often want a minimal intervention to have a maximal impact. And, of course, their band-aid soon washes off, gets dirty, or simply falls off, ad the situation that originated the conflict returns, as it surely will. Only by then, someone else will have to “administer” the management/leadership/intervention.

Millions, if not billions, of dollars are poured down the drain by corporate leaders who subscribe to the minimalist diagnosis/minimalist intervention expecting maximal results, with little impact. Reduction of any conflict to a single “symptom” is like reducing a cancerous tumor to a scalpel, without investigating and intervening in the biographic details, the social cultural environment in which the patient lives and the need for significant changes outside of chemotherapy and radiation and surgery, and more recently, outside genetically-based therapies.

Or course, a more detailed research of the circumstances, the history and the environment will take time, and especially viewed in the short run, the preferred and exclusive purview, will cost money. And yet, rationalizing the scarcity of fiscal resources only supports a minimalist view of the “problem” and a ‘band-aid’ application that does not, cannot effect the kind of change that would expose the institution and their representatives for their complicity in the problem and thereby have the potential to lead to resolutions that would make all participants proud and committed to their sustainability.

One management text coming from M.I.T.,The Learning Organization, outlines the need to ask the question “why” a minimum of five (5) times whenever a conflict arises in an organization. The first four will provide only a superficial diagnosis of the problem, and the resulting intervention will be marginally effective. How often would the medical model, except in case referred to a “case management discussion” come under the “5-why” microscope? Probably not the majority.

There is a risk that this argument will be seen to be a condemnation of the medical profession. It is not so intended, only to demonstrate that it is often limited in both evidence and resources, including time and dollars. Of course, the preferred patients, friends and family of the medical profession are given more “preferred” treatment, given the human connections.

Individual responsibility, individual courage to ask the right/tough and often unwelcome questions are more and more required, and worker representatives, legal counsel and ethics professionals are often not available in situations in which they might impact seemingly minor decisions, that will ultimately have major impact.

It is not only the medical symptoms that require attention, by the patient first, then by the family and then by the medical fraternity. There is also a plethora of political, psychological, social, cultural and biographical details of every person’s life that need (and hopefully demand) a seat at the table when important decisions are being made.

 This is especially true when executives make “personnel” decisions. If people really are the most important resource in any organization, (and who is willing to risk challenging that premise?) whether for profit or not for profit, then mere single-issue decisions, without encompassing as complete a picture of the context as is available will continue to demonstrate the decision-maker’s need for immediate control, and for immediate resolution.

Some of the primary rationalizations for such a decision-making process include:

·      The relative insignificance of the issue at hand

·      The stuffed schedule of the decision-maker

·      The inexperience of the decision-maker and his/her need to impress superiors

·      The shortest and least unsettling “chess move” that will, at least on the surface, disturb the fewest people

·      Conformity with other decisions on the same file that were reductionistic and over-simplified in their design and execution

·      The organizational culture that is described as “efficient” and “uncomplicated” rather than “person-centric” and “patient centric”

·      The lack of formal and informal training and/or apprenticeship of the decision-maker

·      The cultural framing of personnel issues with a primary cost-saving/cutting demand on the decision-maker

·      The decision-maker’s fear of, aversion to, resistance to and abhorrence of any form of conflict and the emotional toll these conflicts take.

     Yet, none of the rationalizations justifies the kind of “single-issue focus of the ENT’s “We treat ears here!” that neither acquitted that practitioner nor will acquit any of his imitators. A microscope may be a useful and even optimal instrument for examining specimens; it is not an appropriate instrument or lens through which to diagnose an organizational issue of conflict.

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