No accommodation
The inflexible characters in medicine
When I was a medical student, we were warned on our Ob Gyn rotation that there would be no grade changes. Whatever grade you got, you got. No negotiating.
Apparently, our predecessors had abused the privilege. University of Chicago students were never happy with a high pass (B grade). They always wanted honors (A). Many who didn’t get it, wanted to discuss why. The faculty who ran the clerkship were overwhelmed, the story goes, and had to take drastic action. Your grade was your grade.
At the end of the rotation, the clerkship administrator passed out our final report card. We sat around a conference table, in the older part of the hospital, and she slid us our evaluation face down. There was a series of quotes. For instance, “Vinay didn’t seem so enthusiastic retracting for hours on end.” Or “Vinay did not know that 75% of the cardiac output goes to the gravid uterus” and a final grade. I was shocked to see that I did better than anticipated.
A friend of mine, who ended up specializing in neurosurgery, seemed indifferent to the process. Yet, I could see concern spreading over his face, as he read his evaluation. At last, he spoke up.
“Listen, I know your policy is no grade changes, but I have to say there is a mistake here. This isn’t my grade,” he began.
“—I knew someone would say something,” the administrator replied, “We made it very clear— your grade is final.”
“Can I just read you one quote: ‘<Tim> was pleasant and knowledgeable on this rotation, but unfortunately, I could only evaluate him for 1 of 7 days, as he was absent due to a broken arm.’ — I hope you can see that I do not have a broken arm, but he does!” He pointed down the table.
Indeed, our classmate— similar height and hair color had a broken arm.
“Sorry, no grade changes…” the administrator replied curtly.
***
There is a type of person who likes to enforce rules even when they make no sense, are illogical, or even detrimental. Years later, I applied for a temporary medical license in DC for a one month rotation. After filling out interminable online forms, the final prompt asked me to book an appointment, in-person for fingerprinting. I did for the soonest the software allowed: the following Monday.
When I arrived, the clerk broke the bad news. He couldn’t fingerprint me because I didn’t have a file open. Files only open when the online form prints— often a week or so after submission. Once a file is open, then they can fingerprint you, and later add that report to the file.
“Why don’t you just open the file now, put the fingerprint report first, and then add the form when it prints?” I asked
“Sorry it doesn’t work that way,” he replied
***
I have always wondered what happens to make someone so inflexible. Who was born wanting to enforce idiotic and capricious rules? I would kill myself if I had a job that was so rigid that I could not open the file and put the fingerprints in prior to the online form being printed. A career obeying the arbitrary rules of the DMV would break my spirit. It is no life worth living.
Recently, a colleague of mine needed a favor from an administrator. The favor required flexibility and thinking of the bigger picture. Nominally, it involved a little bit of rule bending. If I were in charge of the request, I would grant it in a second.
“She will never do it,” he told me resignedly
“Why is that?” I asked, “You don’t know that. Just try asking.”
“She still wears an n95 mask and another mask covering that!” he exclaimed.
“Oh, well, just give up then”
***
No accommodation— fixating on rigid rules— making the process the enemy of progress— it is an unfortunate personality trait, and something no good doctor can retain.
Good doctors know that you can never be inflexible. Rules are meant to promote good outcomes, not hinder them. As the saying goes, “rules are for the obedience of fools and the guidance of wise men.”
Its amazing how many rules we fill our lives with that simply don’t make things better, but slow us down and deprive us of flexibility and choice. These drag us down. The people who enforce them are often petty tyrants— disappointed with their lot in life and clinging to the small bits that give them power and purpose. The whole business strikes me as sad.
People who insist on enforcing inflexible rules should realize how easily they are replaced by AI. If you refuse to engage your brain, you deserve to lose your job to something without one.
Back in the day, Continental Airlines was notorious, among my colleagues and many other people, as the worst airline in America. I'm sure there were other candidates in other companies, industries and regions, but for me as a young man Continental was the touchstone for abominable airline service.
Then at some point in the 1990s the company was purchased, I think by an investment group. A new CEO was installed, a former Boeing executive named Gordon Bethune. I remember reading a profile of Mr Bethune in BusinessWeek, where he outlined his plan to shake up a very sick corporate culture. One of the aspects of his program I vividly remember was his decision to exchange customer service rules for guidelines, basically empowering the flight crews and desk agents to make decisions about service issues on the spot, according to broad policy principles. Under Bethune, Continental went from being regarded as one of the worst airlines in the country to one of the best regarded, if not the best.
I'm sure Mr Bethune made a lot of other changes at Continental, but giving his customer-facing staff more flexibility in handling problems must have been one of his most effective measures, especially compared to the rigid, bovine obstinacy encountered at most other airlines. I must say I experienced it myself, as I was a frequent, and satisfied, Continental customer in the late 1990s.
A quarter century later, I distinctly recall that BusinessWeek article, and the importance, in many situations, of defining guidelines rather than rules.