Wisdom in Business and Medicine

Jeff Brown, MD

Today we plunge into the breach to try to make more of the tenuous bonds between medicine and business via some notable quotes.

One of the reasons that PMD exists is to help bridge the gap between medicine and business both in our personal and professional lives. We must acknowledge that they are inseparable, though they also are quite different in orientation and methodology. Each sphere tries to go about its business uncomfortably ignoring the other, especially because we don't speak the same language. But we annoyingly find that we are perpetually pushed together and are forced to make some sort of accommodation.

So today we plunge into the breach to try to make more of the tenuous bonds between these two areas of our endeavor via some notable quotes.

For starters, how about Starbucks CEO Howard Schultz's dictum that "detail makes retail"? And it’s true in medicine; of course, the focus usually being upon details. And so we are off to the races.

"The only place where success comes before work is in the dictionary,” Donald Kimball said. Its corollary is "Luck is the dividend of sweat," from Ray Kroc (yes, the man who turned McDonald’s into a success). In most respects, doctors are pretty lucky, and thanks be to sweat for it.

"Most of the trouble with business … is not the product of evil intentions but the difficulty of carrying out the best intentions." So said Henry Ford II — arguable about business, perhaps, but the statement certainly highlights the occurrence of medical errors in the unexpected consequences that we sometimes call "complications." To the point where Dr. George Annas once wrote "If you want to control your own death, stay out of hospitals."

On a happier note, Frederick Ecker, chairman of Metropolitan Life, said, "No one has yet invented a pastime that's as much fun, or keeps you as young, as a good job." Even in this age of dysfunctional medical delivery structures, obstructing paperwork and managed care, let's stipulate that medical practice certainly has, can and should attain this ideal.

"There is only one truth and many opinions,” said Stanford economic professor Mordecai Kutz. “Therefore, most people are wrong most of the time." At least in medicine we have a scientific modality to make the honest claim that we are relentlessly, if erratically, moving toward the Truth. That partially explains why in the meantime, until we arrive at the "Truth," 10 docs will have 11 opinions on so many cases.

"Every successful enterprise requires three men — a dreamer, a businessman and a son of a bitch," according to Peter McArthur. Steve Jobs was the all-in-one version, but we see how this works in medicine as well. It's just how human beings roll.

Look at hospitals: the Great Interface between business and medicine that every doctor has experience with. And on top of the usual business issues, "Running a hospital is like running an opera,” claimed Einar Areklett. “You have a lot of divas to deal with." Ouch and touché.

"Wisdom cometh with age" is an old saw that doctors and business folks generally agree upon. And we both also strive to "...add life to your years, not (just) add years to your life." That's why we try to "...die as young as possible while living as long as you can." There must be something to these because so many people have said them, quoting the ever-popular "Anonymous." Husband/wife writing team, Joan and Erik Erikson, added "Lots of old people don't get wise, but you don't get wise unless you age."

Medically, "two of the worst pieces of advice an older person can receive are 1) 'what do you expect at your age?' and 2) 'take it easy.'" And "despite all of our (advances), the death rate has remained constant at 1 per person" — Califano.

While we are focusing just upon medicine, how about "illnesses intensify at the moment of diagnosis"? It's ironic that a doctor has to have a diagnosis, a name, to do the most for the patient, but the imposition of that name often descends emotionally upon the patient's shoulders like an Iron Mask.

New York Times

More optimistically, "the ultimate value of illness is that it teaches us the value of being alive" — Arthur Frank, Ph.D. And we have to accept that it is "impossible … not become biologically narcissistic," wrote Ann Taylor Fleming in the . Although, we all have patients who appear to be immune to this human concern and just will not take care of themselves.

So we look back to our profession where sometimes "the real work of medicine starts when the drugs no longer work," said Paul J. Edelson, MD, director of Medical History and Epidemiology at Cornell University Medical College. Thus, it sometimes seems that "The American ideal of a doctor is a nurse, " according to one registered nurse. No matter where you fall on that subject, we can agree that all too often "A medical degree is a passport to an unknown country" — Anonymous.

Saturday Night Live

Let's end with C. Everett Koop, the former Surgeon General, who said, "I expect everything all of the time;" which was a version of the famous plaint Gilda Radner's repeated weekly on : "It's always something!"

Especially when it comes to business and medicine.