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The Divided Self No More
The ABIM Foundation convened a group of health care stakeholders in Madison, Wisconsin to learn more about how they think and act about the “wise and effective management of limited health care resources,” as stated in the Physician Charter.
When we convened this group of stakeholders in Madison, we didn’t know what exactly to expect. There was a lively, respectful and valuable conversation among the 25-plus participants. They spoke about the respective roles of stakeholders, often returning to the need to educate all stakeholders about the nature of the cost of health care and the need for a common view among all around how to address the issue.
What impressed me was the dedication and focus of all those present, including practicing physicians; patient advocates; employers; a congresswoman and leaders from hospitals, health systems, group practices and health plans. They all wanted to do what was right for their organization and community.
To me, attendees faced the same struggle with which most of us working in health care wrestle – the misalignment of personal values with the realities of work and organizational imperatives to survive in a competitive environment. While their values lead them toward doing what is right for their community and each individual in that community, organizational survival and economic imperatives often lead to a divided self. Although many in the room had experienced economic success, they appeared troubled about the prospect of going it alone. In their world – as elsewhere – competition trumped collaboration. Attendees did not find joy or pride in that fact.
In The Courage to Teach: Exploring the Inner Landscape of a Teacher’s Life, author Parker Palmer writes about this kind of divided self and the need for individuals to separate themselves from organizational realities. “Inwardly, we experience one imperative for our lives, but outwardly we respond to quite another.” When our day job aligns with our deepest values, we don’t have a divided self. If only we were all that lucky. According to Palmer, leaders are those whose courageous actions separate with organization demands and better align with their personal values and objective of their work.
The irony of this is that Parker Palmer lives in Madison. I wish we would have invited him to this meeting. Perhaps he could have instilled in us all the courage to be such leaders.
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