AKSE's Peter Principle

AKSE's Nominating Committee issued its recommendations which become the coming year's reality.  Bylaws require the President to turn over every three years but now somehow it is no longer orthodox bylaws with the president returning as Executive VP and the president elect serving as head of the nominating committee. Maybe not even kosher bylaws, as my recollection is that the nominating committee members cannot themselves become officers. Each officer is a continuation from before, irrespective of achievements attained during their tenures.  A form of institutional incest which can be counted upon to beget recessive genes.  So for a number of years now the number of people advanced to the executive committee hovers at about zero.  Having been on the board during some of this time, I can attest to being very much underwhelmed by things like creativity and a marketplace for ideas upon which successful institutions like a synagogue depend.  The role of the religious VP seems to be to assign Torah readings when the Cantor is away.  I am hard pressed for anything that I might regard as a lasting achievement or innovation since the Rabbi's first year aboard.   Education has also become a recycling center with no innovations other than my AKSE Academy which is probably down to its final year.  We have no ways and means.  Membership reports are accountings of who has come and gone, truly devoid of anything innovative that might make the congregation attractive to anyone who is not already here.  The building people do not even have sensitivity for what the building is used for to have the right books in the pews in the right numbers before the worshippers arrive.  Our publicity has become more consistent. I cannot honestly conclude that it has been more purposeful.

Several decades back, a fellow named Lawrence Peter issued a best seller called The Peter Principle.  He observed that in many institutions people would get promoted through the ranks until they could no longer add to their own functions in a meaningful way and would then spend the rest of their time doing nothing particularly important, though becoming sufficiently entrenched in position to make it difficult to replace them with fresher minds.

As AKSE goes into what appears to be its twilight years, failure to refresh membership has its mirror in failure to refresh its leadership pool or to expand beyond comfort zones.  And Rabbi's, no matter how personable, do not alter the destiny of leadership generated attrition.

Reading Charts

Pet Peeve Time

My medical professors and senior residents trained me well.  I may not have liked it at the time, but they were insistent that I review old records when a patient was assigned to me.  Records were kept on paper with tabs for the various types of entries.  They would come up in a big basket, often with multiple volumes, and have the approximate appearance of a telephone directory from  a large city.  On the front of each admission would be a transcribed discharge summary which provided mostly useful information but occasionally became the source for propagated misinformation from one hospitalization to the next.  The specialists tended to go beyond discharge summaries,  needing to look at trends in lab data over time so I got very proficient at reviewing where the CBC's and creatinines had been the last few years.  Serial radiologic studies were more difficult to assess so a trip to the X-Ray File Room would be part of the chart review much of the time.

Computerization of records has made the review much easier.  Instead of having to go through each lab section of each admission, trends are now tabulated across admissions.  All the summaries are presented serially, all the X-Rays are presented in sequence, both images and reports.  This seems like a snap for those of us who once had to hunt for what we need but at least know what we need.  The amount of time spent doing these reviews probably has not changed much but the amount learned about the patient in that time has expanded enormously.  It helps, though, to know what you are looking for, a skill better developed by having to very selectively seeking out prior data from amid a multivolume record.

Many of my residents never acquired that skill.  They process through a new patient without ever looking at primary data from the past.  Summaries get propagated forward, misinformation with the correct diagnoses as a bundle.  But review of trends invariably comes from the consultants.  While this type of review is labor intensive, it is not that labor intensive.  And what might they be doing instead?  And why go through all the trouble of doing this if the patient will be handed off to somebody else in a day or two?  There is really no ownership of the patients, maybe not even stewardship.

So for now I have a useful but skill but one of diminishing interest.  I know how to use a stethoscope and slide rule too.

Facades of Purim

Purim can be an enigmatic time.  There is certainly a measure of revelry.  We wear costumes.  I thought about coming as Zaitar the Eunuch with  a necklace of my Prader Orchidometer and a packet of Androgel but our home was observing shiva for my mother-in-law so a more somber approach prevailed for me this year.  While we wear masks, we get drunk which can unmask thoughts, as many of us in the Jewish community learned from Hollywood icon Mel Gibson a few years back.

It's a holiday for kids.  At some shuls, including one I once attended, there was a program for children with a highly abridged Megillah and a small group of retirees who met in another room to hear the story of Purim in its entirety.  At my congregation we are mixed together which is as I think it should be.  It can be too easy to set aside some of the essence of the festival if it allowed to compete with other seasonal hedonism of Mardi Gras and St. Patrick's Day.  But since we wear costume, sometimes the serious elements stay hidden.

This year, my congregation and another sponsored a Carnival for the children of each shul.  The kids would march, sing Purim songs, hear a story and play games while the parents spend money.  After all, Matanos L'Evyonim or giving gifts to the poor is part of the holiday.  From our congregation's financial reports as presented at Board Meetings, nobody could be needier.  Moreover, little unmasks thoughts as effectively as asking people for money, another of the ironies of Purim.

Finally our mind emerges from the clothing facade when we feel outrage.  Our politicians capitalize on this routinely with the curtain on the voting booth shielding what we really think but the election returns revealing it.  And we have anger on Purim, most of it figurative with our groggers obliterating the name of Haman.  We also have a certain amount of real irritation.  At the Purim carnival where the kids sing their songs, the words they were to sing were transliterated.  The principals of the the two schools divided on this issue, probably unmasking what the principles of the two schools really are.  While one is a formal USCJ Framework for Excellence school, their educational director assessed that their children had not acquired sufficient Hebrew skills to learn a few words of Hebrew lettering.  Our principal takes great pride in the ability of our students to do that.  The Framework for Excellence in congregational recruiting literature may turn out to be one more mask, creating a surface illusion but misrepresenting what lies beneath.

So those are the Purim costumes.  The great sage Reb Geraldine noted that "what you see is what you get."  But maybe not, at least on Purim.

Interactive

I've given myself a respite from my own shul this winter.  I've not been absent entirely but absent enough to see if anyone takes attendance.  In all likelihood nobody misses me.  This winter brought my monthly day trip, Rosh Chodesh across town, a chance to sample an attempt at transdenominationalism across town, my periodic platelet donation, one weekend as Ba-al Shacharit at my own place and next shabbos I return as Torah reader.  While I cannot say whether anyone missed me, I can say that I found the absence welcome.  Nobody there seems obligated to respond to me, whether I comment on our service or on the experience someplace else.  Judaism in my mind is ultimately about the exchange of ideas, some welcome, some not.  Our sages were constantly engaged in dialog and current students thousands of years later learn by chevruta. I tap into my own sources, primarily yutorah.org, where no interaction is expected.  The lack of interaction where I do expect it creates a negative.  I run my medical teaching in an interactive way, whether with patients or residents or students.  I ask them questions, pose something perhaps provocative in the way of science or they query me.  At Mercy Philadelphia Hospital ideas create energy.  On Sermo somebody posts a comment and dozens of comments from people I am never likely to meet ensue.  On Facebook an article from The Forward will generate a dozen responses.  Some of my FB Friends post items of interest to them that will have been read by thousands with remarks from dozens.  This doesn't seem to happen at AKSE, or if it does I am isolated from it.  Trying to generate an AKSE Academy generates less enthusiasm each year, including from me.  The Rabbi for all intents and purposes never makes comments that generate discussion or even incite people to send cards and letters.  The President might but he controls discussion.

In a setting where mode of worship can never be regarded as inviting to large segments of the community, some form of compensation needs to be implemented to attract attendance.  Embracing/Engaging/Enriching, the logo, can providing there is really a commitment to innovation and advancement.  It just hasn't been there.  I'm not sure too many people recognize its absence.

Suggestions to make a shul more interactive would be welcome.

Exit Ramps

Steering onto the exit ramps of public Judaism and of medicine.  Both have a fair amount of traffic.  Both have created an attachment for me over a very long time in some form.  Yet each has become more of a private calling than a public expression.  There is a superb lecture on character as a prerequisite for leadership positions in Judaism.

http://www.yutorah.org/lectures/lecture.cfm/789822/Rabbi_Yona_Reiss/The_Importance_of_Character_in_Torah_Leadership_Positions

Rabbi Reiss cites sources that require effective Rabbis and other communal leaders to have both personal character and the willingness to irritate their constituency for the right cause.  I have found no shortage of people willing to make decisions that generate leadership induced attrition.  And at times people who do this conduct themselves in a way that is beyond reproach, but too often not.  And too often what is promoted as the right but unpopular cause is both faulty and unpopular.  There are limits to what people will accept, giving many a wannbe Jewish leader the Pyrrhic victory of a noble purpose but no talent to implement his vision.

Medicine takes a parallel approach.  No shortage of distinguished accomplished charismatic medical school alumni who engage in dastardly conduct.  Attrition may be a little harder in this forum where people depend on this type of activity for their livelihood but underparticipation seems rampant.  Clinicians have very little incentive to fully engage themselves in the pageant of medicine, opting instead their own niche, whether that be their individual practice or their lab.  Medical societies lose their purpose.  The American College of Physicians moves toward noctor parity as a surrogate for their own physician participation.  People still see patients and run their practices, but they are on the exit ramp just the same.

Sad

Hard to pinpoint why I have felt sad for the last two days in the absence of any precipitating event.  I do not feel angry, irritable or particularly irrational.  While my professional schedule seems full, it does not come across as overwhelming.  There are just a lot of things I think I would like to do or ought to do but lack any activation energy or inclination to do them.  Sure, the patients will get seen, the email will get looked at, my medical license will get renewed on time and I will have my upcoming Torah reading reasonably polished in the two weeks remaining.  It's the stuff that doesn't have deadlines which languishes.  There is a new NEJM article that I should read but nothing will happen if I don't.  I'd like to have my kitchen and bedroom more functional than they are, but no woe will befall me if they stay cluttered.  And my harmonica, which I purchased with great enthusiasm a year or so ago, rarely comes out of its case.

Two days of notable symptoms is hardly justification for getting myself of SSRI's.  Maybe if I accomplished a couple of the wanna do's but don't hafta projects, the accomplishment would reverse my mood a little.  More likely watchful waiting will do the same.

Clean Up

Before leaving for vacation in December, I devoted a few minutes each day to moving papers off my desk.  Copies of consults went to a canvas bag.  Stuff that needed to be signed got signed.  Some papers got tacked onto my bulletin board.  And there were things that I knew I should not discard but had no intention of reading again.  These went into a corner.  The effort to tidy revealed some useful stuff like writing pads, post-it notes, file folders and blank billing cards.  These went in another corner.  Pens went in a drawer or a cup and prescriptions went into a drawer.  Having been back at my desk a month past my return, the laminate surface had again become invisible.  With a half hour of early morning quiet this week, I again sorted papers, finding and separating a few of special importance which went into a folder on the window sill.  Things to sign will get signed within a few days.  The canvas bag still has room for more copies of consults.  And billing cards got filled out to try to keep the disapproving comments from the management from having its usual validity.

As much as I enjoy having a desk and an office with a door tucked into a generally untraveled corner, I do not particularly like working at my desk.  Never did.  Not since first grade when the left over Halloween candy got stuck in the cubby created for books and papers beneath the desktop, only to be purged in all its stickiness in April.  Junior High went well.  There was no desk or any kind of personal space other than a hall locker.  The most successful people would have no turf but journey from classroom to gym to library to another classroom to the bus home.  We did not have backpacks.  Some of us had briefcases but more of us had two rubber straps with clasps to minimize the risk of our portable books and loose leaf notebooks scattering.  Unorganized was not a handicap in that setting but became one in college where the dorm had a desk that I did not like to sit at to study, as did my apartment in medical school.  Residency returned me to lack of formally designated workspace for the last time, which may be why many people, myself among them, thrive as residents.  I had one main book, not that many papers, and journals that came in the mail unsolicited.  Somebody else filled out forms or wrote prescriptions.  I traveled light.

But now I accumulate paper once again and it has to be sorted and purged from time to time.  It's a low priority in my mind, though not necessarily in management's mind.  I like being with the patients and with the residents in the exam rooms and on the wards and sometimes in the conference room.  I can work effectively wherever the computer terminal and charts are, roaming from one patient unit to another as the need arises, without a good sense of professional headquarters.  Like the rolling stone, no moss or paper gathers.