The scope of things

An Endoscopic Symphony

While reading Ken Blanchard’s “The One Minute Manager Builds High Performing Teams,” I experienced a direct download from God...

We doctors simply don’t get it.

We believe that by virtue of our years of medical training, and one and a quarter yards of stain-resistant white poly/cotton blend and three buttons, that we are now the leader of the endo team, your unit, the patients, perhaps the entire free world. We come to your endosuite with an attitude of leadership, wreak havoc in our campaign of “shock and awe,” and then depart on rounds, leaving you to climb from the debris in our wake. Sort of like Iraq.

We doctors have been misinformed, you see, that as we ascend the rungs from medical student to intern to resident that we are gaining command of all we survey. When we assume the attending’s long white mantle of responsibility, we believe we are in charge.

In Blanchard’s illuminating parable, a guy who is a team leader goes to the “One-Minute Manager” to learn how to be a better leader in group situations. He learns that there are four stages of all team development as he sits in on several teams and observes how they operate. He discovers how the director of the squad assesses the teams’ stage, then motivates and helps it to mature. However, our guy is a guest, and observes. He is not a part of the team, nor is he their leader. He is a visitor. News Flash: We doctors are guests too; we are not the leader of your endoscopy team, we are but visitors to your unit.

Imagine how you’d feel if a guest in your home rummaged through your refrigerator contents, then spoke disparagingly about your cleaning skills while munching on your food. That visitor, unless closely related by marriage, would likely not be invited back. We have expectations about guest behavior.

Doctors are the bosses in their offices, and they’re in charge of their patients’ ultimate medical management, but the doctor is not your leader. Imagine that your endosuite is a symphony orchestra. The gastroenterologist is not the conductor of your endoscopic symphony, although they often think they are.

In our endoscopic symphony, your unit director or charge directs the flow of patients and conducts its many members. The staff are the orchestra members, intent on their own instruments and music. And the doctors, well, we’re the guest artists, the out-of-town soloists. Our duty is to make music with the orchestra, and then leave. The unit functions autonomously without us. The symphony sounds great without us, perhaps better when we’re there. But we aren’t in charge of the orchestra. We leave, and the team plays on, awaiting the arrival of the next featured guest artist.

If the featured player tries to snatch the baton from the conductor, chaos ensues. An egoist guest artist can cause the conductor to lose the beat, the instruments topple out of tune, and the music is lost. And that blending of music, that combination of beauty and synchronization, that is our patients’ endoscopic care. The orchestra’s efforts enhance the performance of the guest artist. And it sounds much better if we all play together in the harmony of endoscopy.

Not in charge. What a concept. And what a relief. Doctors are forever responsible in our professions, and frankly, it’s a relief to not be in charge of your endoscopy unit as well. When I speak to doctors on how to cope with the stress of medical practice, that much is clear. We would happily shift some of the weighty mantle of responsibility, be responsible only for playing our part in our own patient’s well-being, and then pack up our instruments and leave you in peace to await the arrival of the next soloist.

What can you do to promote beautiful music in your endosuite? How do you get your gastros to stop trying to lead your orchestra, to assume care for their patient but not disrupt your team? Well, assuming your docs don’t get their own download from God (that’s how my assistant Barbara describes an idea that springs fully formed into your skull, just like a program that downloads from the ‘net), you post this article where your docs dictate. For the more tentative, perhaps you clip it, slip downstairs to the doctors’ lounge, and slide it into a few mailboxes. Leave a copy of Blanchard’s book lying around. They’ll thank you for it. Eventually.

No symphony needs two conductors. Dual leadership would lead to cacophony that is not in the best interests of our patients. We need to let the conductor do her work. Let the instruments play their portion of the score, and play our own parts well. Once the docs understand that we aren’t conducting, we can focus on our patients needs, and then move on to our next gig with light heart. We can make beautiful music, together.

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