Stepford Docs On The Bayou: Not The MD Anderson Way
Leonard Zwelling

What so struck me in 1984 when I came to MD Anderson was the enormous tolerance the institution had for people with—how do I put this—different ideas about cancer, its treatment and how to interact with other people. The place was a mélange of people from all over the world who were outspoken, opinionated and full of life in a place where death lurked on every hospital floor. No one was discouraged. The mission was both clear and believed to be attainable—the eradication of cancer. It was a place trying to put itself out of business and I had never seen anything like it. It was fabulous. This was particularly true for me who had an out-sized personality, a huge ego, and convictions about my abilities, misplaced as they were. My, my, how things have changed.

It’s a very different MD Anderson now.

The first hint of this goes back several years when the leadership called in consultants to help us all, “get along better.” The consultants did psychological testing on the leadership team members and found that most of the successful leaders were Meyers-Briggs INTJs. That was all except the president. He was an ENTJ as he needed to shake a lot of hands at parties and drum up money. It was my first glimpse into an MD Anderson where the standard deviation around behavior narrowed a great deal and a more regimented sort of faculty member and leader was encouraged. All of a sudden, that rough and tumble place I had come to love was a bit less tolerant and far more regulated. How intolerant? My own Meyers-Briggs personality type had shifted from the one assigned to me in business school. My E had become an I. I had to conform to fit in or I would be gone. So I morphed into an INTJ.

This was a good thing for my job was, in a way, to regiment that which was previously uncontrollable. Clinical research compliance. It was, how should I say this again, non-compliant in the past. Dr. LeMaistre and Irv Krakoff had gone a long way toward taming the tiger that was Developmental Therapeutics, but I guess I had to take it the rest of the way.

I was appointed to create order in a somewhat chaotic clinical trials system that was in vapor lock due to piles of unread contracts, unapproved protocols, and unreviewed adverse event reports. In fact, what I was trying to do was change the way clinical research was being done at a place famous for a certain flair for creativity in the performance of human subject research.

I made some progress, but the leadership of the institution made even more. Through a series of changes and placements of key people in high-ranking positions, discipline came to MD Anderson. But something was lost as well. There was a bit less innovation that came with the greater coloring within the lines.

Today, there is another iteration of the same phenomenon.

Now it’s all about professional behavior and the lack of tolerance for people who, again, how do I put this, stray a bit from the Solomonic.

People are being penalized for yelling at nurses when that yelling is to demand higher quality of care than was being delivered. There is a push to the creation of an MD Anderson persona—calm, cool, collected, polite. In short—nice. And, by the way, there’s “One MD Anderson.” Faculty are now no better than anyone else who works there. Everyone has to be nice.

Well, just say for me that I don’t care if my doctor is nice although most of my many caregivers are perfectly polite. In my doctor I want smart, engaged, caring and well-trained. Nice is less important. Especially among the surgeons. I’m asleep when I need their talents. And remember, no patient ever came to MD Anderson to see a member of the nursing staff. Sorry, Charlie. Faculty still rule. And should!

I am just sending up a flare that this niceness thing can be taken too far and at some point it limits creativity and innovation. Those pushing the envelopes in science and clinical care are often those whose personalities push the envelope as well. If MD Anderson still wants to eradicate cancer, it should return to the days of greater tolerance and base “professionalism” more on talent than on comportment.

Everyone does not need to be the same, like Stepford Docs. Some of the people who have become my best friends were among those falling several standard deviations outside the mean of behavior and who drove me crazy as a vice president. They are and were the brightest people I have ever known!

And they are why patients come to MD Anderson, not the nurses, administrators (like vice presidents), lawyers or clerks. Make no mistake about that.

Leonard Zwelling