SHM Annual Meeting 2011: SEAL’d and Delivered

What’s that you say?

Let me explain.  I partake in a yearly ritual at each SHM annual meeting.  The rite is two pronged: one involves business, the other pleasure.  The former involves the creation of my group’s yearly weekend call schedule—that I assiduously grind out on the flights in and out of the host city.  This year was a first time flub, as the requests (from new hires) were not in on time, and subsequently, an empty Excel spreadsheet is waiting for data on my hard drive.  That is the next blog post.

The second is a book indulgence, usually in the guilty pleasure vein, that normally would not be on my (ever growing) must read roll.  My usual canon encompasses nothing exciting—typically non-fictional history, biographies, and political works.  Ho hum.

This year’s choice was one I was really looking forward too however, because both the reviewers gave it high praise, and yes, I am a huge fan.  Go figure.  Mom could never figure that one out.

However, uncharacteristically and a first, I made a course correction 48 hours prior to departure.  It was not the Osama Bin Laden raid that altered my plans, but the good timing of the author to release his book simultaneous to the assault.  I read a quote from a review that immediately got my attention:

[…] Only 21 originals from Class 237 would ultimately graduate. I believe that we had more men quit at that moment than at any other time in all of BUD/S training.

What kind of man makes it through Hell Week? That’s hard to say. But I do know—generally—who won’t make it. There are a dozen types that fail: the weight-lifting meatheads who think that the size of their biceps is an indication of their strength, the kids covered in tattoos announcing to the world how tough they are, the preening leaders who don’t want to get dirty, and the look-at-me former athletes who have always been told they are stars but have never have been pushed beyond the envelope of their talent to the core of their character. In short, those who fail are the ones who focus on show. The vicious beauty of Hell Week is that you either survive or fail, you endure or you quit, you do—or you do not.

Some men who seemed impossibly weak at the beginning of SEAL training—men who puked on runs and had trouble with pull-ups—made it. Some men who were skinny and short and whose teeth chattered just looking at the ocean also made it. Some men who were visibly afraid, sometimes to the point of shaking, made it too.

Almost all the men who survived possessed one common quality. Even in great pain, faced with the test of their lives, they had the ability to step outside of their own pain, put aside their own fear and ask: How can I help the guy next to me? They had more than the “fist” of courage and physical strength. They also had a heart large enough to think about others, to dedicate themselves to a higher purpose.

SEAL Trident

Why am I writing about this you ask?  Three reasons:

1. Awe.  The book’s author is a Duke graduate, White House fellow, and Rhodes Scholar, and at the age of 26—an old man by SEAL standards—entered the military to train.  He was precocious as a youth and read prodigiously on many subjects, including all the classics and then some.  His family gave him little academic support.  He travelled abroad and engaged in aid work at an age when most of us were still sleeping late and acting irresponsibly.  He did more at age twenty-one than most of us have completed in a lifetime.  He served his country honorably and is now performing charitable services for injured combat veterans.
2. I am a sucker for military books, and this stems from my dad, a voracious reader who came of age post WWII.  To this day, his fascination and romanticism for the armed services has never wavered, and frankly, I do not think there is book he has not read on the subject.  Through him, I discovered Band of Brothers long before the HBO series, and even now, I have not read a greater book on leadership and courage.  The focal subject, Dick Winters, is the most inspiring individual I have ever encountered in any literary genre.  Let me repeat that.  He is the most inspiring individual I have ever come across in literature.  The name of this blog is The Hospitalist Leader. Get it.
3. Challenging conventional wisdom and dogma is more than a guilty pleasure.  I read to learn; accepting assertions, proclamations, and claims of truth at face value always leaves me wanting.  Need some examples?

• You have diverticulitis?  Don’t eat seeds!
• Americans are astute.  Give them the information, and they vote wisely.
• The uninsured overuse the ER.
• If hospital Medicare reimbursement rates go down, commercial payers will have to make up the difference.  PS—send this one to your CFO 🙂

SEALS and Rangers are tough, and believe me, when you read how they train, you will not question that claim.  A ten-mile run is desert, and if two mile swims in 50 degree water get you hot and bothered, maybe medicine is not your calling.

However, like the excerpt above, leadership and toughness do not reside in the physical domain; you quickly realize humility and love is the SEAL coin of the realm.  An ordinary soldier kills bad people; SEAL’s save the innocent child first, then pursue the bad guys.  SEAL leadership means loving your men and human kind, and the term “warrior” means something very different to this breed of combatant (you are never a soldier or fighter, but a warrior, in mind and body, heart and soul).  This revelation is humbling.  It is a cliché and worn phrase, “I am not worthy” that is, but in this instance, nothing is further from truth.  My passion for questioning conventional wisdom (or lack thereof in this instance) led me astray and into the abyss; let’s just say SEALS 1, Flansbaum 0.  I am being generous.

You want to be a hospitalist leader.  Walk a mile (or maybe a tenth of a mile) in a SEAL’s shoes, and maybe, just maybe, you will learn a few lessons on what commitment and honor mean.  These men are different.  The lessons they teach are grander than the collective weight of graduate school degrees, leadership academies, and added certifications.  Doctors are ordinary.  These are great men.  I have a profound and humble respect for their service and most recent mission in Pakistan.

I chasten to think what these individuals could do if called upon to repair our broken health care system.  Our country would be a better place, and our hospitals a helluva lot safer.  As far as HCAHPS: 99th percentile.  Dont even give it a second thought.