"The power of the Web is to return our Modern society to the small village interactions from which we all evolved" ~ Unknown
As a CSA Delegate, I recently represented the Society as a part of the Specialty Delegation to the California Medical Association (CMA). The CMA’s annual meeting in Sacramento was held at the same time as the ASA’s annual meeting in DC. While the ASA’s annual meeting is important and many CSA representatives would attend, I was rather thrilled to have the "Cowtown" assignment.
I truly believe most politics are local. I was looking forward to state debate on topics like MediCal and State Health Care Exchanges. National politics in my mind are a necessary evil; I believe that states are often best left to their own local political solutions. Consequently, I truly believe in the work of the CSA and the CMA.
As an anesthesiologist, I feel I'm a physician first, and I take interest in all the issues physicians deal with, so I found the thought of mingling with other physicians from other specialties in California intriguing. Being fairly well read on health policy, I was ready to leave my Silicon Valley private-practice anesthesia bubble. Bring on the diverse health care policy debate, the diffuse visions of health care reform, and the strong voices on how primary care and specialists are paid. I was ready for all of it.
By and large the CMA meeting fulfilled my expectations. I had some wonderful conversations with physicians across specialties, and across the state on interesting and profound health care topics. Unfortunately there was too little of this type of talk and invigorating engagement. Why was that?
The delegates’ schedules were dominated by the formal governance of the CMA: Caucuses, mini-committees, reference committees, House of Delegates, and more mini-committees. Seemingly endless speeches, speakers, redundant statements, rules of order and parliamentary process filled these sessions.
The structured communication felt so unproductive throughout the multi-day meeting, that by day two, it was apparent a parallel meeting started to break out: side conversations, eye rolls, head nods, and impromptu meetings in bars and restaurants where delegates talked and laughed over the core issues of health care. While secondary to the intended purpose of the CMA annual meeting, this subsidiary meeting was filled with the emotional and really important stuff that represents the heart of medicine.
Our flaw, and maybe a critical flaw in organized medicine, is that we often see medicine from an administrative standpoint, as the flow of facts and information (we are scientists after all). But the core of American medicine is caring relationships between patients, between physicians, and between patients and physicians; and these emotional conversations move much faster than the speed of organized medicine’s governance.
I will share one of the many examples of emotional connections from this meeting. Over Saturday dinner a group got to talking about one resolution that seemed to rub a lot of delegates the wrong way. This resolution would have had MediCal patients pay a nominal co-pay for every physician visit. A family practice physician and an orthopedist were particularly vocal, debating the merits and drawbacks of both sides the resolution. Personal perspectives were presented and real-world benefits and consequences impacting families using MediCal were considered. The issue was discussed in monetary, political, practical, philosophical and emotional terms. There was certainly strong disagreement amongst this diverse physician group, but overall there was genuine concern for both eradication of waste and elimination of patient barriers within the system.
These conversations—these emotional connections where our commonality as physicians, the problems and concerns we all face were identified and pondered—were apparent in small conversations and settings, yet lacking in the big meeting rooms with speakers at a microphone. Not enough small conversations were to be had because of time constraints of the larger meeting, but all of the delegates from the CMA’s annual meeting can continue the talk beyond this meeting, in our places of practice—connecting ourselves and our patients without procedural rules and process.
While I may sound ambivalent about the CMA’s annual meeting, I do give enormous credit to the organization for getting the physicians from across California together and for getting them talking. I also credit the CMA enormously for effectively representing California physicians to the public and through legislation. Beyond that though, we need more small talk and fewer speeches.
A pox on the crushing bureaucracy of communication and progress. Let’s take advantage of the age of instant communication we live in, increase the pre-meeting online conversations as much as possible to include caucuses and committee meetings) and post-meeting administration (to include voting on the issues that were discussed in person), and just let the larger reference committees and the House of Delegates convene at the actual meeting. That would leave more time for the meeting to network, learn, connect and focus on the issues physicians in California really care about.
How would I modify the meeting if it were up to me?
Let's get the factual communications out of the way. One month before the meeting, post resolutions and HOD business online, alerting every member to comment on them; we can debate online if given enough time. First day, Friday, of the CMA HOD, just host social events and dinner, so delegates can leave work to get to the meeting. Second day, Saturday, would be for CME and inspiring speeches—future of American medicine kind of stuff. Saturday night, include functions for conversations—on the issues that delegates find most compelling. Sunday morning, the last day, have the reference committees hear about resolutions that have drawn the most debate both online and at the meeting. Then Sunday afternoon, have the House of Delegates convene for business. Let's us get back to work on Monday, and open up votes on the issues online for one week. That's it: online time for resolutions you care about, meet, chat and get some CME, back to work, and a week to vote on resolutions you really care about.
We live in a technology-rich environment, yet we resort to flurries of paper and protracted debates of rules of order. More will get done, we will have a better time and more engagement will flourish. It's time to focus on what is really missing in medicine: small conversations. Organized medicine 2.0 should be ready to have a small conversation with physicians. Let's post, email and tweet about that and be free to converse as village friends again.
Dr. Harrison Chow is a member of the Committee on Professional and Public Communications for the CSA, and was a delegate as part of the Specialty Delegation at the 2012 California Medical Association House of Delegate meeting.