CHOOSE

Choose

By

Leonard
Zwelling

     Aloha! We (the BW, beautiful wife and I) are leaving Maui after our annual
visit to paradise. Wailea on the west coast of this gorgeous island gets our
vote as our favorite place for R and R. This year, both of us desperately
needed some R and R. Last year at this time I never would have dreamed I would
be 3 months into an ad interim assignment as Legacy’s Chief Medical Officer
and, of course, there have been a great many challenges facing each and every
one of the Division Heads at Anderson. We needed some rest. And we got it.

     But along with enjoying too many Bikini
Blondes (that’s a beer), chasing too many lost golf balls and never viewing enough
magnificent sunsets, the BW and I also did what we did last
year in Hawaii. We binge-watched House of Cards on Netflix. This was Season 2.

     For those of you unacquainted with Frank
Underwood and his wife Clare, they are the centerpieces (Kevin Spacey and Robin
Wright) of a taut political drama with its tongue firmly in its cheek. Frank
was the majority whip in the House before managing to manipulate himself into
the Vice Presidency. That was last year. This year his manipulations have risen
to a higher level as befits his new office as he simultaneously spins the
President, the First Lady, the Speaker of the House, the President’s Chief of
Staff, his own replacement as House majority whip (the person responsible for
garnering votes), as well as a spare billionaire or two. It’s all good guilty
fun except that having worked on the Hill, I notice that it bears a striking
resemblance to the behavior I actually observed at my former haunt.

     Frank and his wife are lying, thieving,
murderous and venal and thus the best theatrical couple since Thane and Lady
MacBeth. There is absolutely nothing that Frank won’t do to gain additional
power, but his greatest trick is making everyone else doubt himself or herself and
make bad choices. He has no trouble choosing as he manipulates others into a
co-dependent relationship with him where his needs are simply more power. He’s
in it to win it and never doubts himself for a minute. And that’s our topic for
today. Choosing.

     I don’t know about you, but I am constantly
appalled at the inability of putative leaders to make choices. I am well aware
that in academic medicine there is so much backbiting because there is so
little at stake, but that does not mean there is nothing at stake. Choices are
important, in academic medicine and in politics.

     President Obama has to be exhibit one in
hand wringing without deciding. Even George W. was a better decider. Tomahawk
missiles into Syria? Yes, I mean, not yet. Implement the ACA, well sort of. You
get my drift. This is not a decisive man and he is in a position where deciding
is his primary job descriptor.

     President DePinho has no such problems. He
has decided to convert MD Anderson into a drug development company with a
capital generating side business called patient care. We may not like it, but
at least he decided.

     From the recent issue of the Cancer Letter,
it appears that NCI is cutting back on its support for clinical trials so that
the genomic sequencing of human tumors can be paid for. This is another
decision you and I may disagree with, but it is a decision.

     What I am finding more common, however, is
the inability of anyone without a big title (or even with one) to decide on
anything. (Does every phone call you make to a help line wind up with you
speaking with a supervisor who is no more helpful than the person you waited 30
minutes to speak with who was useless or answering from India or both)?

The President in House of Cards is a
brooding, angst-ridden punching bag (those who watch will get the allusion).
Frank and Clare make decisions and live with the consequences no matter how
vile the circumstances. They decide.

     Making choices and decisions is what adults
do. They will make good ones and bad ones. Among these deciding adults are
doctors and I have usually found that most doctors are more than able to make
decisions and most of the time they make good ones, if the insurance companies,
administrators and federal regulators will let them. But more and more, the
trust that was the underpinnings of the doctor-patient relationship and was the
key to good clinical decision making and more important good clinical outcomes
is being taken away by regulatory bodies, concerns about legal action, and fear
that permeates the population of potential patients brought on by the after
effects of television commercials for ambulance-chasing lawyers to bogus and unsubstantiated
medical information masquerading as “fact” because it is on the internet.

     My hypothesis is that the reason choosing
is so hard is that the consequences of a bad choice are perceived to be so dire ranging from
fines, to prison to societal ostracism. This fear is also the basis for the
Y-linked syndrome of the inability of men to say I’m lost, I’m wrong and I’m
sorry. God forbid!

     Let’s choose to choose and let everyone
else choose, too. Then we can all be held responsible and accountable as well
as free to seek advice or not to. Analysis paralysis is killing America and the
current leadership below the level of the President at Anderson also seems
strangely reticent to actually decide anything other than to give themselves
raises and promote those loyal to them regardless of accomplishment or ability.

     Choose to choose. It’s OK to be wrong. It’s
not OK to just stand there.

     As I have said before, you have to stand
for something or you will fall for anything.

Today’s
(4/9/14) Houston Chronicle had an op-ed by my friend Lovell Jones and me. Here’s the link: 

http://www.chron.com/default/article/Jones-Zwelling-Time-to-end-prejudice-and-treat-5386882.php