"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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