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In my new position I am required to ask doctors, who work for a university health care system (that includes hospitals), to fill out evaluations on students working to become doctors. In the most recent eight week period (which ended three weeks ago) this amounted to 307 evaluations sent to 117 different doctors; some sent as many as nine weeks ago. I have followed this (so far) with 654 reminders and I am still missing over 100 evaluations; (107). Overall, this is more than 1 in 3 evaluations so far unreturned.

From the other side I have students expressing frustration over the apparent double standard within a system that requires prompt responses from them yet allows doctors they finished working with 8 or 9 weeks ago to continue their boycott of evaluations. The most vocal complaint I have heard from students is that the lack of timely feedback makes it more difficult for them to focus on areas needing improvement.

Though I suppose I am complaining and I definitely would like to see improvement, I believe this to be the norm; typical prioritization for busy and harried professionals. So with that in mind I would like to think my written thought is less frustration and more seeking understanding so we may improve the process.

I understand it often is a matter of perceived priorities and I know that some of the doctors who are guilty of this heedless procrastination are literally making life-altering and life-saving decisions on a daily basis. But I am also quite certain that they are not doing so every moment of every day. When will a 10 minute block of time to fill out an evaluation become a priority? When the Clerkship Director asks? Or the Faculty Director? Or the Dean? Or the University President? If any of these apply, then why not when I ask?

I believe that for a physician to accept a position in a teaching hospital or health care system is to accept a responsibility to the future of medicine. I understand that in a given moment an evaluation may appear to be a small thing, but it speaks to a much larger mindset, and it has a much greater influence on morale and energy and outlook than what it may appear to, in a given moment.

Finally, and certainly of least importance, I am told I should not take this consistent lack of response personally. And I do not take it home with me or lose sleep over it; (at least not much). I consider it a particularly challenging (and at times a particularly frustrating) aspect of the job, but then I have also always been energized by a difficult challenge. When I see more expedient responses from a Director's request though, it is difficult to not realize that there is less respect for my position, and I am in my position because I am me; and being human, “me” is personal. How can it not be? Still, I agree it is the least important aspect of this plea for more expedient evaluations.

I truly am extremely energized by all of the organizational aspects of this new position, but most particularly I am personally challenged by the not-uncommon and contradictory disregard I see for a responsibility that I am confident every physician in our system takes seriously. I am not going away. I will continue to send reminders, (however many it takes), and I am sure that I will continue to be challenged. I have a great deal of respect for doctors and their profession. They are (from my perspective) performing miracles; but when they are doing so in a teaching environment, (like it or not) that involves filling out student evaluations. Please.

And Thank You.

I originally wrote the above as a template for a slightly more personalized “impassioned and heartfelt plea regarding student evaluations” that I intended to share with the Director, in the active hope that we could then share this with 117 physicians and that my perspective might help us to improve. But when I verbally presented a condensed version of this thought, (focusing mostly on the stats), I received a lukewarm (at best) reaction. After this discussion the Director sent out her standard “ATTENTION NEEDED” email to the 15 or 20 seriously delinquent doctors, and this missive will accomplish what is intended and it will keep me in my place and we will do it all over again in another eight weeks.

The paragraph above reflects my immediate reaction which (because of its immediacy) I am sure is an overreaction. Perhaps the Director will think things through and determine that my perspective and my thoughts are valid and worth sharing. I do believe that our doctors take their responsibility for the future of medicine very seriously, and I am pleased to be in a position to support this endeavor. And yes, I am in my position because I am me, and I do struggle with what I perceive as (perhaps not exactly a lack of respect, but certainly) a recognition and active acknowledgement of my place vs. their place. In this circumstance, in this moment, it feels like we have simply maintained. Whether, (from our varying perspectives), we see it as thinking things through, or prioritizing, or (because I am new to this position) giving it some more time, or avoiding confrontation, or making excuses, or protecting fragile egos, regarding student evaluations it feels like we are merely staying afloat. Long live the Status Quo!

I am confident we will improve. I believe we could (and should) work to improve more quickly.

The other aspect of this circumstance I want to examine is the apparent contradiction between responsibilities taken seriously and tasks not completed. The most obvious (to me) explanation is that some physicians need urgency to act. I could analogize my requests and reminders to the common cold, and the Director's requests to pneumonia, and the doctor's resulting response to their efforts to avoid further complications, and by doing so it lessens the personal sting for me, but it does not optimize student learning. It is apparently difficult for some to see the urgency in evaluation because by the time they are asked for this formal feedback, they have moved on to new students and they have nobody in their face demanding attention.

Assessment and evaluation is a critical piece of every effective teaching-learning model utilized at every level of education. After dealing with an urgency some physicians hand patients off for continued care and follow-up. This is not an option in teaching. The process is not complete without the evaluation, and the physician cannot hand the evaluation off to someone else. The urgency can be found in the future of medicine, and this (teaching – evaluation process) mirrors the earlier contradiction between responsibilities taken seriously and tasks not completed in that “now” is far more urgent than the future. So how do we instill a sense of urgency into our actions for the future, as represented (in this circumstance) by student evaluations? This question reaches far beyond this circumstance.

Phrasing the question as applicable to our current challenges worldwide, with the past on our backs and the present slapping us silly, how do we instill a sense of urgency into our actions for the future?

As a clerkship coordinator unable to obtain a few student evaluations from a few heedless procrastinators without the intervention of a Director, when I consider worldwide challenges, I am discouraged; and more than a bit overwhelmed.

Unless we find a way to disarm the nostalgic yearning for days gone by and to demobilize the crippling bureaucracy and the polarizing politics that dominate today, tomorrow will simply become a more dysfunctional extension of today.

In my personal circumstance, we will improve because I will continue to pound the drum and (though faint right now) it will ultimately become a part of the rhythm and flow of our small community.

In the worldwide circumstance, even though my drum is not the only drum, those with the wealth and power either cannot or will not hear the drums. Regardless, we must continue to pound the drums until they too become a part of the rhythm and flow of our larger community.

But this week, I am the one that feels beaten. This week I am sad. This week I am discouraged. This week I am disappointed. This week I am seeking understanding, and I am asking for understanding.

Please.

And Thank You.

I live in the Land of No-Ever.

How to describe it?

It is not necessarily a where, but at times it is. It is more often a when, and on occasion it is a why. It is not an ever, nor is it a never; unless I am on the cusp of How-When or Why-How. How in No-Ever is brief and rare. An extended moment of How overlapping Why and/or When often results in a fleeting simultaneity of ever and never. This synchronicity is hard to describe, and harder to catch, but you know it when it hits you. This paradoxical concurrence may be coincidence, but I like to imagine it as more. This Whatever feels the closest I will come to a definitive Whatever.

In the Land of No-Ever, hard work is its own reward. At first it has to be, but eventually it becomes itself.

In the Land of No-Ever the intangible becomes far more important than the tangible. To survive in the Land of No-Ever, the imponderable must be pondered, the imperceptible must be perceived, the insensible must be made sense of, the indeterminate must be determined, and the inappreciable must be appreciated.

In the Land of No-Ever, there is only uncertainty. Outside the Land of No-Ever, though there are still many moments of uncertainty, there are also many moments of Whatever; many more for some than for others.

Some inhabitants of the Land of No-Ever pretend so hard that they are a Whoever from Whenever, that they actually create a Wherever for themselves outside of No-Ever; but still only a stone's throw away, and still with considerable uncertainty and relatively few moments of Whatever.

When those of us from inside the Land of No-Ever must transact with an individual or an entity (Whoever) from outside the Land of No-Ever, (be it Wherever or Whenever), we are required to spend considerable effort explaining and justifying. From inside the Land of No-Ever we are frequently expected to apologize and to ask forgiveness from whenever for following whoever's instructions from wherever. And not infrequently, from inside the Land of No-Ever, we must admit to wrongdoing for not following instructions ungiven.

In all the Lands, unrealistic expectations are the norm. Inside the Land of No-Ever many, many unrealistic expectations have become unrealistic requirements. Outside the Land of No-Ever excuses are reasons. Inside the Land of No-Ever reasons are inexcusable.

Those from outside the Land of No-Ever never come to visit; even though they have a multitude of easily accessible and readily available maps and compasses and guidebooks that are full of color photographs depicting the gray reality of the Land of No-Ever.

Inside the Land of No-Ever, we have a plethora of maps and compasses and how-to guides and directions to help us find our way out of the Land of No-Ever, but because they were provided to us by those from outside the Land of No-Ever, they do not work.

From inside the Land of No-Ever it feels like everybody lives outside the Land of No-Ever.

From outside the Land of No-Ever there is no such thing as the Land of No-Ever because there is no Land.

From outside the Land of No-Ever, those of us from inside the Land of No-Ever are seen (in the best light) as unexpected guests, or visiting relatives over-staying their welcome. In other lights we have been slaves, we are prisoners, we are the homeless, we are the underprivileged, we are the outsider, the newcomer, the disparate and the unimportant, we are an unnecessary burden or a necessary evil, but we are most definitely not autonomous inhabitants of an autonomous Land.

From inside the Land of No-Ever, we tend to go along with the assessment above.

From outside the Land of No-Ever, nobody lives in the Land of No-Ever.

I live in the Land of No-Ever.

This week I was asked to escort a group of new students from one hospital complex, across the street to another hospital complex. I dutifully led them down the hall, took a right, took a right, took a left, down two flights of stairs, took a right, long hallway, took a left, long hallway, took a right, down one flight of stairs, took a right, another right, out the main entrance, around the circle drive, long sidewalk, took a right, across the street, took a right, long sidewalk, around the circle drive, in the main entrance, took a left, long hallway, took a right, waited for the elevator, got in the elevator, took the elevator to the fourth floor, preceptor waiting, handed them off.

Somewhere between a long sidewalk and a circle drive I asked if anyone knew a more efficient way from one hospital to the other. One student quickly responded, “you mean the tunnel?”

In my mind I started screaming at myself, “There's a Tunnel? A Tunnel!! There's a gosh-darned tunnel and I’m on a scenic route slogging my way through traffic and 100 degree heat!?

I made light of it. In the elevator, I apologized for being a fool. How could I not know about the tunnel? One or two others on the elevator, not with our group, were openly amused. Openly! Amused! Visualizing this Pied Piper March of Fools.

Dummy! Dummy.Dummy.Dummy! I'm an idiot! Story of my life! I never know about the tunnels. But worse, I never think to ask. Or if I do, it's only after I have made a fool of myself. In hindsight though I realize that I am not a fool for not knowing. I am a fool for not asking. But then again, what is that proverb about wise men following the laughter of fools? Is it truly just to know to go a different way? Or are these wise men looking for new ideas and new ways of thinking?

Yea, though I walk through the Valley of the Shadow of Fools
I shall fear no folly, for thou art fools with me.
Thy nod and thy laugh, they comfort me.
We preparest a stable disparity in the presence of mass obedience.
They disjoint our heads with feckless toil, yet my thoughts runneth over.

Surely I shall follow the Way of the Fool all the days of my life,
And I will seek the House of Happiness forever.

And therein lies a question begging to be answered. They followed me! Why do you follow a fool? If thou art fools with me, who then is the bigger fool? Is it the leader who does not ask? Or is it the follower who knows but does not tell? Or perhaps it is the blind follower who does not know and does not ask?

Some might argue that until it is determined with certainty that you are following a fool, it is better to wait. There could be another tunnel. There could be a new idea or a new way of thinking. There could at least be new and/or different scenery. The leader is a leader for a reason, right? It's not possible someone could become a leader without first knowing about the tunnels; is it?

Ultimately I believe it is incumbent upon the leader to ask. However, I do not believe that excuses a follower who knows, from commenting on their Way, which may prompt the leader to explore options. Of course, not knowing the leader, a follower may fear reprisal, or anger. A considerate follower may also be reluctant to embarrass the leader by pointing out that the leader is a fool.

I can take some solace (and partial credit) from the fact that I eventually asked. Too late for this time, but I will know for next time. I am grateful that I will (likely) have a next time. Additionally, I wonder, if I would not have asked, would anyone who knew about the tunnel have ultimately said anything? And did anyone else in the group not know about the tunnel? If so, no one spoke up – for fear of being associated with a fool? Or for the possibilities presented within new and different?

Yes, it is good to ask if there is a tunnel. And a conscientious, caring leader should locate the tunnels and then consider the advantages and disadvantages of the expediency of tunnel vision vs exploration and discovery. Wisdom requires a considered willingness to leap. A fool frequently leaps without looking. The bureaucrat and the traditionalist live in their maze of tunnels.

So I suppose that if enough people have had enough, they might be willing to follow a leaping fool who is not looking, but who is also not in the tunnels. We have realized that there is no sunshine in the tunnels. There is no leaping in the tunnels. There is no possibility of discovery in the tunnels. There is no wisdom in the tunnels. And in the tunnels there is considerable fear and consternation. In the tunnels the only possibility for joy is in finding new tunnels; or in building more tunnels.

The tunnels are important and necessary, but we have realized that to seek wisdom, we must leave the tunnels. We must also come to realize that there are no all-knowing sages or gurus and there are no wholly enlightened thinkers, in the tunnels or outside the tunnels. In the tunnels there are bureaucrats and there are traditionalists. Outside the tunnels there are fools and there are those seeking wisdom. Outside the tunnels, those seeking wisdom remain fools because wisdom requires a considered willingness to leap. By definition, a leap requires some uncertainty, and only a fool would leap not knowing where, when or how they might land. It is worth repeating: outside the tunnels those seeking wisdom are fools still. This is why bureaucrats and traditionalists stay in the warmth and security of their darkened tunnels. Today it feels like we are following a tribe of traditionalists who support and advance a horde of bureaucrats who worship a pack of fools. We would be better following those outside the tunnels who still know the value of the tunnels, but are not afraid to ask for help, and who find joy in leaping. We would be better following those (fools) seeking wisdom.

This week I was asked to escort a group of new students from one hospital complex, across the street to another hospital complex. In the process I was exposed as a fool. But along the way I asked for help. Along the way I searched for wisdom. And in glimpsing wisdom, (still just beyond my reach), I learned something of value. I learned that there was an available tunnel for when expediency was a priority. I was reminded to ask lots of questions. I was reminded that we are all fools. I learned the difference between a heedless fool and a thoughtful fool. And I experienced the joy in leaping.

I ended last week's post with the question, “But what then?” To that end…

I believe we are not only closing the knowledge gap between us and the powerful, but many of us have come to realize that the gap was not much of a gap to begin with. I believe those of us who have come to this realization are naturally paying more attention. Instead of “What then?” I believe it is past time to ask, “What now?” We must advance this timetable in the active hope that past time is not too late.

So, what now?

How do we open the prison gates? Stop bickering? End intolerance? Embrace our individual strengths? Move past the past? Eliminate the ever-widening wealth gap? How do we save the world?

It appears to me that before we are able to work together to save the world we must first resolve at least some, maybe most, and perhaps all of the underlying issues…
…underlying issues as outlined above and last week.
…other underlying issues that I have overlooked and/or neglected to address.
…any underlying issues that divide and/or maintain hostility and/or fortify resistance.

Below are some ideas to address some of these underlying issues.

A universal basic income has been suggested. But we struggle over how to fund such a sweeping initiative.

• The concept of reparations is still being discussed.
• Education.
• Perhaps an expedited, widespread, focused education on argumentation that differentiates political rhetoric from fact and politicians from experts would help us to move forward more efficiently.
• And perhaps some additional expedited, widespread, focused education on the unbiased reality of Western European and American history would help us to attribute context and see things as they are.

Of course without the understanding that could come from selective focused education we will be unable to progress to sweeping change or even consider doling out long overdue justice.

Thus, without a large majority of individuals willing (and eager) to understand facts and reality as opposed to relying on tradition and believing rhetoric and myth, we will be unable to save the world.

I am discouraged. It appears that to save the world, (which by the way includes us – Humanity), we need to wait for tradition and rhetoric and myth to die off. But I am afraid, (truly afraid), that by then it will be beyond too late. We are a species. Humanity has killed off 200 species; today. Instead of an attritional background rate of 6 per month, we are responsible for killing off 6,000 species per month. Tradition and myth embrace reckoning. As a species Humanity’s day of reckoning is coming. Wouldn't it be preferable to kill off tradition and myth, and save Humanity?

We cannot wait for the old guard to die off unless we are willing to die off with them. It is past time to bring down the powerful and to subvert the status quo.

I am back where I began. What now? If the answer is to be rid of the old guard, how exactly do we pull the plug on tradition and myth?

It would be difficult to outlaw rhetoric.

It would be impossible to outlaw fear.

It would be, (it is), contentious to legislate specific learning.

It is difficult to trust someone who is not afraid to say “I don't know.”

It requires little to no effort to trust someone who says “I have all the answers; follow me.”

It is impossible for one individual, (or even for one faction driven even in part by belief, creed or opinion), to have all the answers.

It is a fact that any individual who claims (or gives the impression) that they have all or most of the answers, is a liar. (The same is true of a faction connected by common belief, creed or opinion.)

It is difficult for a liar to backtrack or admit mistakes.

So in the face of these overwhelming and divisive constraints, again, how exactly do we pull the plug on tradition and myth?

Perhaps we need to attack it directly. I go back to the earlier question:

Wouldn't it be preferable to kill off tradition and myth, and save Humanity?

If presented as a choice:

• Tradition and Myth, or
• Life

I realize that the old guard would continue to fight for tradition and myth but if we simplify,

Tradition and Myth must die or Humanity (as a Species) WILL die,

Perhaps more fence-sitters and bystanders and comfort-zoners would become more attentive and more actively hopeful.

And then perhaps as a second wave attack, supporting the initial full-frontal assault, we could go after rhetoric:

1. Rhetoric will be the Death of Humanity.
2. Those who advance the purposes of rhetoric will be the Death of Humanity.
3. Politicians will be the Death of Humanity.

Synonyms for rhetoric include:

• Hyperbole
• Bombast
• Balderdash
• Grandiloquence
• Magniloquence
• Pomposity
• Rant
• Verbosity
• Big Talk
• Hot Air

Rhetoric supporting Tradition perpetuating Myth defining Humanity will result in the Death of our species.

When we discount rhetoric we weaken tradition.

When we weaken tradition we muzzle myth.

When we muzzle myth we redefine Humanity.

If we redefine Humanity according to reality, we postpone Death.

And isn't that the point?

Choose!

1. Rhetoric, or
2. Facts.

Choose!

1. Experts, or
2. Politicians.

Choose!

1. Tradition and Myth, or
2. Humanity.

Choose!

1. The Future, or
2. The Past.

Choose!

1. Extinction, or
2. Survival.

Choose!

1. Life, or
2. Death.

I Choose Humanity.

I Choose Life.

Isn't that the point?

Am I a bigot if I am intolerant of a bigot? By definition, yes. A bigot is “a person who is utterly intolerant of any differing creed, belief or opinion.” Intolerance is defined as “an unwillingness or refusal to tolerate or respect…” So perhaps the linchpin here is respect or disrespect. if I respectfully and with sincerity, (yet firmly and rationally) disagree and disapprove of what a person or group says or stands for, I am not practicing bigoted behavior. And if I then make an uncontrived good faith effort to understand why they believe or think as they do, I am more likely to tolerate their insensitivity and respect their right to express their opinion. If their opinion is presented to arouse sentiment, to elevate emotion or (worst case scenario) to incite violence, to be intolerant will only enflame that passion, whereas understanding and respectful tolerance has a better chance of defusing volatility and calming a situation and even an entrenched mindset; especially if the reasonable course of thought extends to seeking common ground. But to be clear: violence must not and cannot be tolerated. Violence is not a belief, creed or opinion, and violence is not worthy of respect. Violence is an injurious and forceful action that can be engendered by a belief, creed or opinion, and is often triggered by emotion. If that line is crossed, there may be no choice but to judiciously fight fire with fire as prescribed by the reactive realization of sound law enforcement principles.

All well thought, but the reality is I am Human, they are full of hate and simplicity, and intolerance begets intolerance. I believe though that most bigoted people or bigoted factions who work along that spectrum from “arouse sentiment” to “elevate emotions” to “incite violence” do so because they are afraid. And though most will not admit to being afraid, when I understand that to be their underlying motivation, I can have more empathy; (but they're still ignorant).

Why is it so damned difficult to tolerate intolerance?

I will come at it from another angle.

You may believe that I am in some way inferior---a lesser being---and though I disagree, I have to respect your right to believe that, and, you have to respect my right to disagree. Regardless, you need me and I need you. We have no choice but to work together. You cannot do it without me and I don't want to do it without you. Energies spent on divisiveness are so much better spent on saving the world. And just because you want to widen this divide between us by loudly and viciously disagreeing with everything I say, your sanctimonious double-edged intolerance does not change the fact that the world needs saving. And to do that, you need me.

It is past time to (both literally and figuratively) open the prison gates so as a nation (and ultimately as a world) we can operate at full capacity.

It is past time to stop the childish bickering and blaming and embarrassing pissing contests.

It is past time to realize that intolerance (even of intolerance) is a step backward.

It is past time to stop practicing colorblindness and embrace the positivity of our individual ethnic and cultural strengths to contribute to the universal progress that is necessary for saving the world.

It is past time to realize that our nation was founded and built on the backs of an underclass identified and labeled by the color of their skin.

And it is past time to realize that today, (though the labels have become more politically correct and the underclass has become somewhat more diverse and inclusive), our nation continues to operate on this caste system in order for the powerful to maintain status quo.

It is past time to bring down the powerful and to subvert the status quo.

I am actively hopeful that past time is not synonymous with too late.

I can hear the old guard struggling for breath; fighting to live. Though today they appear to have revitalized their outmoded thoughts and ways, I believe they are not long for this world. And nearing the end of their life of simplicity and ignorance, I see them desperately working to prop up their crumbling, collapsing walls by sowing fear and fertilizing nescience.

The old guard is afraid of change. Their younger (and frequently poorer) followers, (more accustomed to change), are afraid of ubiquitous integrity. For the old guard to maintain power requires an illusion of preeminence. For their younger (and frequently poorer) followers to follow requires a belief that reality is not real and “we” are more deserving. To maintain superiority requires metaphorical (and sometimes physical) barriers; boundaries that create a delusion of safety and security; a stronghold that keeps “them” out; all delusional because the fear is misdirected. Their fortifications will not protect them from themselves. The question becomes will the offspring of the powerful work to maintain the illusion, and if so, are they savvy enough to pull it off? Or are the younger and (frequently) poorer followers paying more attention, closing the knowledge gap and becoming less easy to fool?

I can hear the old guard struggling for breath; fighting to live.

Is it their last gasp?

Let's actively hope so…

But what then?