Swimming Up the Bayou Is
Like Swimming Up the Amazon With the Piranha: The Common Cultures of an Abusive
Internet Giant, a Major Cancer Center, and the Largest Federally-Qualified
Health Clinic in Houston


Leonard Zwelling


         In a much talked about article on the front page of last
Sunday’s NY Times (August 16, link
above, top), Jodi Kantor and David Streitfeld reported on the working
conditions of white collar employees at Amazon in Seattle. My youngest son was
one of those employees and corroborated the horror stories depicted in the
article of long hours, abusive working conditions, internecine spying and the
mindset of the pre-Berlin Wall falling-Soviet Union. The Gulag in Seattle is the
front door as turnover at Amazon is quite brisk. It’s amazing that a company
that has shown no profit yet is as popular as it is and has fooled the country
as it has. But how is that different than Making Cancer History?

         It’s not.

         It is not just the accounting at MD Anderson that is suspect
as I recently blogged about. How they treat people is, too. Like Amazon.

         The Anderson brain drain over the past 5 or so years has
been staggering as world-class physicians and scientists have been ousted from
key positions or have chosen to leave rather than deal with the combination of
autocracy and idiocy that is currently running the number one place for cancer
care in the country.

who says it is number one? A popular magazine that you can buy at CVS? So what?

         Joe Nocera wrote an op-ed on Saturday, August 22 in the NY Times (link, above, bottom) about the
Amazon culture. He makes several key points that resonated with me, a former MD
Anderson employee. (And by the by, these conditions were also true at the place
of my subsequent employ from which I was fired, Legacy Community Health).

1. The leaders of Amazon, MD Anderson and Legacy don’t
give a damned about what anyone else thinks. Absolutely true! They have the
vision and they have the knowledge. They also have no doubt. I cannot comment
on what Jeff Bezos knows or doesn’t know but I do know that the leader of MD
Anderson is not an oncologist and the leader of the largest federally-qualified
health clinic in Houston is not a physician. This would be scary to me if I
held stock in either company, but unlike Amazon, MD Anderson and Legacy are not
publicly traded companies.

2. All three entities treat people badly. It is just the
way it is. Amazon had warehouse workers laboring in awful heat without air
conditioning and handled the problem with ambulances at the ready to get the
workers back in the game. MD Anderson’s tactics with some of its finest
caregivers including major leaders of clinical divisions, some of whom have
discovered cures for cancer, is abominable. Yet on it goes. The CEO of Legacy
held the physicians working in its clinics in contempt as complainers. I heard
these plaints with my own ears many times from more than a few executives at
the clinic. Note, it’s a clinic. Most of its revenues are generated by those
doctors held in such low regard by their bosses.

3. Turnover is part of business, yet turnover is
incredibly costly. Again, I cannot comment on the Amazon organizational chart,
but the Christmas trees at the other two organizations had constantly shifting
ornaments which changed branches at the pleasure of the leaders. That’s no way
to run a company.

4. I have also been through several strategic planning
processes at both of the places at which I was employed. They were all lengthy,
all costly in time and money, all filled with consultants, and all came to
nothing as the leaders took the plans, and tore them up or shelved them if they
ever read them at all. At Legacy I was told by the CEO that two of the executives
could have written the plan themselves. This was a plan that was arrived at by many teams of employees over
a year of work. The clinic never implemented the plan while I was there. The plan was
based on efficiency and quality—neither term was ever defined.

5. One would hope, that in organizations pledged to the
alleviation of suffering, that action would extend beyond the way the patients were treated to include the treatment of those who worked there. I was not even sure
the patients got the best the doctors had to offer because at both MD Anderson
and Legacy patient volumes were the criteria of physician performance not the
quality of the care delivered which was never adequately defined or measured.

6. All the CEOs “don’t recognize their ______ (type the
company name in here)” written about in the press. I am sure they don’t. Given
the complete dissociation of the CEOs from the actual business of the companies
they lead, of course they don’t recognize the company.

7. I have no idea if Amazon has a functional board, but I
know neither MD Anderson nor Legacy does. How do I know? MD Anderson has no
local board overseeing what the executives do at all. It is overseen by the UT
Board of Regents in Austin. The board’s members know next to nothing about
cancer or medicine unless they have been patients. Serious illness in yourself
or a relative should not be a qualification for a seat on an oversight board. I
was on the Legacy board before I joined the company as an employee. All the
deepest secrets of the clinics were kept from the board. Its members were
unpaid and felt they were “doing good.” This includes me and I was both a
physician and MBA and should have been able to figure out what was going on but
two of the highest ranking executives at Legacy are ex-Enron felons and they
know how to deceive people very well. They have had practice. Their pictures
are prominently displayed in The Smartest
Guys in the Room
, the book about the Enron scandal. I came to know, like,
and then distrust them. I am not sure they learned a whole lot in jail.

leaders of these business entities, some overseeing billions of dollars, really
do not care about their employees or the patients in the case of the latter two
entities. In that way the two health care entities are just like Jeff Bezos and Amazon.

am sure glad my son doesn’t work at Amazon any more and if he goes back, I hope
he is greeted by a new CEO, with a new idea of culture. Darwinism is great for
nature, besides, it isn’t optional in the forest. It is less good for people.

set the culture of the organizations they run. For good or for evil. It’s a
choice. Choose wisely CEOs and all you perspective employees as well.

Leonard Zwelling