I just finished a remarkably good book. After concluding, a passage continued to replay in my head. I went back to find the page, and reread it a second, and then a third time. Not my habit, I knew the knowledge contained within needed passing on.
The wisdom emanates from a 1968 conversation between Henry Kissinger, and then RAND researcher, Daniel Ellsberg. Kissinger discussed with Ellsberg the trappings of power. Given his experience as an Under Secretary of Defense during the Vietnam War several years before, Ellsberg had advice to give—and Kissinger got it in spades.
Despite Ellsberg’s association with the Pentagon Papers later on— a teensy kerfuffle you might have heard of, at the time, he had a friendship with Kissinger and guest lectured in some of his Harvard courses.
While the conversation is pure realpolitik, and the advice a bromide to prepare for the political arena, you can apply the lesson to hospital leadership and power. Easily.
Though we all can be unsympathetic to those who steer any enterprise, particularly those ill-suited for the role, one cannot help but feel a bit of the isolation these individuals might experience–particularly behind closed doors in their offices, in possession of private data or information. The Sword of Damocles comes to mind.
Regardless, read it, soak it in, and pass it forward:
“Henry, there’s something I would like to tell you, for what it’s worth, something I wish I had been told years ago. You’ve been a consultant for a long time, and you’ve dealt a great deal with top secret information. But you’re about to receive a whole slew of special clearances, maybe fifteen or twenty of them, that are higher than top secret.
“I’ve had a number of these myself, and I’ve known other people who have just acquired them, and I have a pretty good sense of what the effects of receiving these clearances are on a person who didn’t previously know they even existed. And the effects of reading the information that they will make available to you.
“First, you’ll be exhilarated by some of this new information, and by having it all — so much! incredible! — suddenly available to you. But second, almost as fast, you will feel like a fool for having studied, written, talked about these subjects, criticized and analyzed decisions made by presidents for years without having known of the existence of all this information, which presidents and others had and you didn’t, and which must have influenced their decisions in ways you couldn’t even guess. In particular, you’ll feel foolish for having literally rubbed shoulders for over a decade with some officials and consultants who did have access to all this information you didn’t know about and didn’t know they had, and you’ll be stunned that they kept that secret from you so well.
“You will feel like a fool, and that will last for about two weeks. Then, after you’ve started reading all this daily intelligence input and become used to using what amounts to whole libraries of hidden information, which is much more closely held than mere top secret data, you will forget there ever was a time when you didn’t have it, and you’ll be aware only of the fact that you have it now and most others don’t….and that all those other people are fools.
“Over a longer period of time — not too long, but a matter of two or three years — you’ll eventually become aware of the limitations of this information. There is a great deal that it doesn’t tell you, it’s often inaccurate, and it can lead you astray just as much as the New York Times can. But that takes a while to learn.
“In the meantime it will have become very hard for you to learn from anybody who doesn’t have these clearances. Because you’ll be thinking as you listen to them: ‘What would this man be telling me if he knew what I know? Would he be giving me the same advice, or would it totally change his predictions and recommendations?’ And that mental exercise is so torturous that after a while you give it up and just stop listening. I’ve seen this with my superiors, my colleagues….and with myself.
“You will deal with a person who doesn’t have those clearances only from the point of view of what you want him to believe and what impression you want him to go away with, since you’ll have to lie carefully to him about what you know. In effect, you will have to manipulate him. You’ll give up trying to assess what he has to say. The danger is, you’ll become something like a moron. You’ll become incapable of learning from most people in the world, no matter how much experience they may have in their particular areas that may be much greater than yours.”
….Kissinger hadn’t interrupted this long warning. As I’ve said, he could be a good listener, and he listened soberly. He seemed to understand that it was heartfelt, and he didn’t take it as patronizing, as I’d feared. But I knew it was too soon for him to appreciate fully what I was saying. He didn’t have the clearances yet.
Pretty remarkable, huh?
Bradley Flansbaum, DO, MPH, MHM works for Geisinger Health System in Danville, PA in both the divisions of hospital medicine and population health. He began working as a hospitalist in 1996, at the inception of the hospital medicine movement. He is a founding member of the Society of Hospital Medicine and served as a board member and officer. He speaks nationally in promoting hospital medicine and has presented at many statewide meetings and conferences. He is also actively involved in house staff education.
Currently, he serves on the SHM Public Policy Committee and has an interest in payment policy, healthcare market competition, health disparities, cost-effectiveness analysis, and pain and palliative care. He is SHM’s delegate for the AMA House of Delegates.
Dr. Flansbaum received his undergraduate degree from Union College in Schenectady, NY and attended medical school at the New York College of Osteopathic Medicine. He completed his residency and chief residency in Internal Medicine at Long Island Jewish Medical Center in New York. He received his M.P.H. in Health Policy and Management at Columbia University.
He is a political junky, and loves to cook, stay fit, read non-fiction, listen to many genres of music, and is a resident of Danville, PA.