Monday, October 20, 2008

Leadership and Servitude 2/20/09

I was planning to write next about my first week as an Attending in the hospital, but I will have to procrastinate on that issue a bit. Today I participated in a workshop on health for the underserved and homeless as part of the STFM-NE/FMEC Conference. I listened as many health professionals and students presented and discussed their commitment to the most marginalized people in our society. We used the forum to troubleshoot practical problems but also to envision the kind of health care system that would support justice for patients, citizens, and providers. We brainstormed how medical education and residency training could incorporate experiences with the underserved and homeless as a way to actually attract more students back to Family Medicine.

It was an inspirational, but challenging day. I left feeling hopeful, but also somewhat ashamed of what little I've done in my own life to further the cause. I'm a Family Doctor, I work at a Health Center, and I went to residency in a medically underserved setting. But there is a homeless woman I pass every day (twice!) on my way in and out of the gym and have never even looked her in the eye, much less spoken to her. The truth is that I don't really want to spend one of my precious evenings out in the stinging cold giving out sandwiches. I don't want to move to Eastern Kentucky and struggle to run a health center. I want to serve the underserved, but I don't want to be inconvenienced or uncomfortable.

So I left feeling vaguely energized, yet ambivalent. And then when I came home I found this on an emailed blog from Mimi Haddad: "When you consider your own achievements, how many people come to mind whom you might acknowledge as integral to the success of your own work? Few of us accomplish any worthwhile goal without the sacrificial work of others. While the church today (and the world as a whole) seems preoccupied with leadership and the achievements of leaders (with endless books and seminars on how to become a better leader), it leaves me wondering whether anyone might purchase a book or attend a conference on “Becoming a Servant.”

Her argument is biblical, but it could also be ethical, moral, and practical. One of the problems I see in medicine, why some of the most altruistic people don't want to go into it, is that we so deify "leadership." We want to see community service in a student or doctor's resume, but it often seems focused on that person's accomplishment rather than the community or persons being served. The truth is that even Family Physicians are way more "doctor-centered" than "patient-centered." Can you imagine having a brainstorming session among providers and policymakers in which it was assumed there were no money or legal barriers and then designed a system that was actually the best we could do for all patients?? We certainly wouldn't come up with anything resembling the insurance and employer-based insurance system and patchwork safety net delivery system we have now.

I am among those who argue that we don't market and promote Family Medicine close to enough, but I need to remind myself that promotion of FM should only go so far as it benefits the patient, the community, the system. And how do we support our own work without becoming self-serving? It can often seem that we are at best indentured servants, and, at worst, slaves to the system. How do we find the balance of leadership and service and servitude? What do each of us sacrifice to serve our communities, and where is it not our role? How do we each find the service that energizes us and give ourselves permission to pull back when our obligations drain our enthusiasm or make us cynical?

I thought at first of changing my "service" page to be ahead of my "leadership" page on this blog, but that move would be a superficial response at best. Neither categorization of activity is good or bad in and of itself; it is my motivation in those activities that is meaningful. So far it has been the relationships with the students and residents that have energized me, as well as some of the patient encounters I've had, regardless of how transient. They haven't all been comfortable, of course, and give me hope that I will learn to talk to the homeless woman eventually. And that I'll find the servant role that does work best for my talents and challenges me as much as this conference.

By the way, the woman whose shoulder I injected brought her daughter for a visit yesterday. She thinks I cured not only her arm numbness but her ankle swelling as well. Perhaps a large part of being a servant leader is recognizing my place in the world: yes, even the placebo effect is sometimes a better doctor than I am.

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