• A note to his younger colleagues…

    I have a full morning of holding a little girl’s hand while she rollerskates planned, so I hadn’t anticipated posting this holiday. But my morning email contained a note and a link that I wanted to share with you.

    Harlan Krumholz is a cardiologist, and director of the Robert Wood Johnson Clinical Scholars Program at Yale University (full disclosure – I was an RWJCS at UW from 2001-2003). He has just written a piece entitled, “A Note to My Younger Colleagues… Be Brave“. I wish I could repost the entire thing, but it’s ungated and you should go read it. Here’s a nice part:

    A friend and role model, Victor Montori, who is a faculty member at Mayo Clinic, responded eloquently to a young research fellow who was advised, at an early stage in his training, to avoid a controversy in which he questioned the logic of a prominent study. Montori crystallized the issue in the following e-mail, which he has given me permission to share:

    I have struggled with this issue for years. Turns out that this is a common struggle for those who find themselves unable to stay silent in the face of waste, error, low integrity, or abuse.

    If you find yourself with some time (not a lot), let me recommend Letters to a Young Contrarian by Hitchens. His argument that clarity emerges from conflict is compelling. And for conflict to emerge, ie for clarity to emerge, someone has to take a position. The question you ask is whether this should be you, now, and at this stage of your career.

    The threat that if you express your thoughts that this very expression will negatively dispose you to funding and advancement suggests to me that you are receiving advice from folks who choose their battles ‘wisely.’ I think one needs to be mindful and respectful and go to battle when important and necessary. Yet, around here, though, people who ask that you choose your battles are indeed expressing fear of conflict. They are often more invested in themselves and their advancement than on the quest for clarity. While I understand their behavior, my personal choice is not to admire it or seek to emulate it.

    If you learn by critical analysis and thinking, if you share the results of this thinking with passion and honesty, you will find fertile ground for growth. This may not happen with certain people or in certain places but will happen. You will also attract to your side people who feel strongly about honesty and integrity in science—people worth being around not only because they enjoy the work and do so with passion, honesty, and integrity, but because they will hold you and your work to the same measures of accountability. And guess what? That can only make your work and the world you are trying to change better.

    Will your path toward growth be more difficult? Perhaps. Would you have it any other way?

    If you take the path toward clarity, I guarantee that you will occasionally find people who will disparage you. They may seek to undermine you, find ways to marginalize you, and try to incriminate you. They may come from directions that surprise you. Powerful ideas often attract attacks that focus more on individuals than ideas. If you raise inconvenient truths or voice uncomfortable opinions, particularly if they threaten someone’s comfortable status quo, then you will discover much about the character of those with whom you disagree. But always take the high road, engage in dialogue about ideas and evidence, and be motivated by the opportunity to best serve patients and the public. You will not regret it.

    Many times, I have been asked by academic colleagues if I worry that stating opinions here and elsewhere might anger someone. I’ve worked with many groups that are so afraid of any negative publicity at all that they fear to say anything of value. But in today’s world, there is just no way to talk about health care reform, or health care policy in general, without someone getting upset. No matter how polite you are, no matter how careful you are, you can’t please all of the people all of the time. That’s OK.

    I think the last part of Montori’s email speaks to the philosophy of this blog. I have long believed that if I come from a place of data, evidence, and research, and I bring it to you openly and with passion, that people will respond well. There will always be the inevitable nasty comment, and I may lose out on some “chance” because I didn’t say nothing at all. In the end, though,I think doing this has been far more rewarding and far more productive than whatever potential opportunities have been lost along the way.

    Once, early in my career, I was effectively silenced by someone with far more power than I. It really upset me, and I asked many people with far more experience than I had, what I should do. Almost to a person, they told me to keep my head down and shut up. They said that I’d hurt my long-term prospects more than I’d gain in the short term. I listened. I also spent the next few months of work in a depression. I don’t know if that was the right advice or not. It’s possible that I would not have succeeded as I have if I’d gone to war as a brand new junior faculty.

    But I can tell you that’s the last time I’m going to let that happen. Next time, I’ll say what I think is right. I’ll do it as politely as possible, of course, but I believe that things might have worked out the same, or even better, if I had not let a fear of conflict choose for me.

    Someday, if a junior faculty asks me the same question, I’ll answer differently. I’ll give them the advice Harlan Krumholz and Victor Montori do above. If they are motivated to serve patients and the public, if they are citing ideas and evidence, and if they are taking the high road in their approach, I’ll advise them not to shrink from the fight.

    And I’ll stand right there beside them and defend them.

    @aaronecarroll

    Share
    Comments closed
     
    • A very important post.

      I strongly suspect that anyone who has worked or trained in a major health center has seen this kind of suppression of dissent and/or truth. I know that years ago, when I was still in training, I witnessed an organized national attack by what could only be called the “powers that be” on the research of a young staff member where I was training. From the perspective of thirty more years evolution of the field, his position was so clearly absolutely correct and their position so clearly absolutely wrong that it is laughable, but at the time it effectively ended the career of what up till then had been a talented and industrious young researcher eager to make contributions to the knowledge base. He continued work as a skilled clinician and eventually an administrator, but never published significant research again.

      The history of health care is the history of a struggle between the established vendors of what “everyone knows” and individuals who have discovered that “it just ain’t so.” From Semmelweis to Wennberg, the establishment has always fought back, often viscously.

      This struggle has always had high stakes for people’s health and well being. The difference now is that the high stakes today include trillions of dollars being fought over by stakeholders and the public, with the potential to eventually make health care so expensive that it becomes a luxury product fully available only to the wealthy. The stakes for bravery have never been higher. Fight on, Dr. Carroll.