Spending a lot of time in airplanes and airports recently, there’s been little evidence of reduced crowds or any paranoia about a pandemic. Boarding a plane last night, there was one woman wearing a mask around her neck, but as it wasn’t over her face, it wasn’t clear what her purpose was. Maybe she only wore it in flight when the air recirculates? In O’Hare another night (they all blend together), when someone nearby me sneezed, covering it appropriately, and worried out loud about her allergies scaring others, another bystander loudly commented in a nice voice, “regular sneezing isn’t a problem, only coughing.” In general, facing the regular delays and indignities of air travel these days, people seem more relaxed and easygoing; it’s been quite some time since I’ve seen any major display of pique or a temper tantrum by a passenger in an airport, which is a nice thing.
Kearney and I have been thinking about writing up our counting exercise for a medical journal in one of the “patient perspective” columns and these airport experiences (as well as recent professional encounters) have me thinking about the big things-little things conundrum: in medical care as in so many endeavors, it’s essential to get the “big things” right. The big things include the skill of the surgical team, quality of diagnosis, appropriate medications, etc. While those are all necessary, the conundrum is that they are not (always) sufficient. Assuming that the big things are going well (a big assumption), it’s the “little things” that affect the quality of the experience and leave lasting impressions. The O'Hare baggage handlers for the commuter flights have a new and terrible way of loading carry-on suitcases on carts, so they're packed in a way that makes them extraordinarily difficult to get off and increases the congestion in the jetways, etc. The good will that passengers (so far at least) bring to these messes really reduces the stress of it all.
In the medical setting, we were all very focused on the good imaging, diagnosis and skilled removal of the brain tumor. (Duh.) What influenced most our experience of the hospital recovery in the end, though? Whether we could read the name tags of the bedside care staff, whether each made eye contact and how they spoke with us, the difficulty of decoding the discharge instructions, etc. It’s like my email in-box. The thing that matters the most is that I keep the main projects going at a high level of quality. Yet it’s not enough to keep the projects going, it’s also critical to maintain the communication with those involved with and affected by the projects, respond to inquiries and acknowledge suggestions. That takes emotional energy, which sometimes ebbs after working hard on the projects. And that all takes place before lifting one finger to maintain the people connections in life outside of work. These are a high priority in our value system, emphasized by our recent life experiences, and they demand their share of the short supply of energy as well.
As applied to the piece Kearney and I are thinking about, it seems somehow unfair that the overall impression of a complex medical procedure can revolve around such small matters and ones not always under the control of, say, the brain surgeon. His bedside manner made an enormous difference in this entire process, as did, of course, his skill. Yet in the end, in our memories, the kindness of the man delivering the food holds a disproportionately large place, as does the counterexample of the nurses treating me like an object while pursuing their own objectives by and around me. All that we know about decision-making and social psychology explains these effects, but never quite reconcile them comfortably.
Where does the energy come from to take one more breath and go the last half percent to cover the little stuff well, too? That’s the central dilemma and it’s a hard one. I see manifestations of this problem at play all the time in the work I do with work groups, where an administrator might be doing a stellar job of managing the big picture, yet not respond to greetings in the hallway and thus be taken as rude, or not otherwise communicate well about matters handled, so the word on the street becomes negative or individual impressions harden into opposition. It’s so hard to convey to such leader the unfortunate truism that ignorance breeds pessimism: in the absence of facts, people make things up, and what they make up is usually worse than what’s actually happening. It’s a real-world application of the sinister attribution bias: When the “little” communication doesn’t flow smoothly and regularly, when there’s no feedback, people tend to attribute sinister motives to others. The conclusion is that bad things are happening, it is shared with others who concur and the negativity can spiral down and out in ever-larger circles.
If we can only find a good opening and nice way to frame the big stuff-little stuff conundrum, our counting exercise illuminates it nicely. The punctuation, of course, is the form letter we got back from the hospital CEO saying “thanks for writing,” after receipt of our letter and report and the complete silence of all the physicians we copied on it.
This weekend brings a grading binge as it’s the end of the semester. The last sessions of each of the classes I teach are coming up Monday and Tuesday and then there’s yet another airplane trip in this continuing travel-every-week segment of my life. I’ve had actual thoughts about things that might get written, but not put one one word on paper. It will be nice when I’ve paid my dues for the unfortunately poor scheduling choices I made and actually light in one place for an extended period of time. That is yet a few weeks away, so here’s a deep breath and one more foot in front of the other for yet another stretch.