Comment on Bob Wachter’s “Letter From London”

Wachter's World is a somewhat irregularly posted, always thoughful, sometimes provocative blog that Bob Wachter, Chief of Hospital Medicine at UCSF maintains.Reading it is a great pleasure for me as Bob's posts elicit both reflection and responsive comment. I commonly wait until I can use my computer to read his posts, rather than read on my blackberry or iPad as I do with so many others. For me, the pleasure of consideration and reflection is enhanced by Bob's fine job of eliciting dialogue–which he clearly seeks to accomplish and engage. Writing a responsive comment on a Bob Wachter post brings me pleasure.

Unfortunately, for the last several months his site hasn't accepted my comments. Let me be clear, Bob does moderate comments to his site, but his site hasn't allowed me to enter a comment to the site for moderation. He and his technical team are aware of a problem and have been working on it. Given that I've tried three different browsers on two different Windows7 computers, I don't think it's on my end, yet it persists. Today, I wrote a comment evoked by Bob's recent post, Letter from London" and since I can't post on his site, I thought I'd post it here with this explanation. Though many fewer will see it here than if it had been part of his site's comments–the text below, somewhat satiatiates the urge to usefully comment on Bob's post.

Slightly more than two years ago @KentBottles and I had a conversation in multiple parts about trust and the physician relationship with patients and the public more generally. Somewhat later the June 2009 issue of HBR in Rethinking Trust provoked consideration of the question more broadly. Given the greater political malaise and active diminishing of trust through various political antics, including perhaps some of those mentioned by the commentator @Cory on Wachter's original post, it seems most useful to focus on the profession and local efforts at raising trust.

So I ask, "Is improving patient safety a good way to do that, Bob–raise trust between physicians/clinicians and patients?" For Bob's post tells us he is off to London for a sabbatical, June-December 2011.

Don't get me wrong, I'm in awe (and envious!) of Bob's planned sabbatical with Charles Vincent who I've followed since meeting at the AEMJ Sponsored Consensus Conference in 2000 and Vincent's subsequent published contribution.

Bob's blog posting as always looks to the substantive as does his planned sabbatical. Yet I wonder if that's enough. Today's NY Times Magazine in "The President and the Passions" makes the case:

 "The lesson to be drawn is that the art of politics must be the art of engaging the passions, first by exciting them, then by moderating and directing them to a worthy end, one that reason may reveal but cannot achieve."


So too do Solomon & Flores in Building Trust which @KentBottles introduced me to. They make the case that it's less what goes on in the exchange and more about how engaged, interested and compassionate the exchange with another is conducted.

Thus, if I were to submit my contribution to that decade past consensus conference AEMJ issue today, I think I'd likely add a fourth area of comment: communication, particularly the use of social media in expanding connections between providers and patients and thereby hopefully rebuilding trust among them.

It's not just the science we bring to bear and how we explain it; it's also how we show the patient that they are safe and their concerns and interests are valued.

A feature the decade younger me hadn't yet grasped.

Thank you, Bob, for sharing your thoughts and experiences through your blog postings and your encouragement of the subsequent commentary and dialogue. Oh, and I look forward to the correction of the technical difficulty that prevents me from commenting on your site.

"The problem with communication is the illusion it has occurred." –G.B. Shaw

Trust and the Serendipity Engine: Twitter

In this wonderful, 10 minute video done at the NYC Web 2.0 Conference in mid-November 2009, Chris Brogan opines on the value of Twitter, especially search on Twitter. He tells of his experience with discovering the Roger Smith Hotel, just down the way from the Four Seasons which is losing business to the Roger Smith. Why? Because colleagues responded to his twittered question about where to stay and then so did a live communicating voice (through Twitter) from the Roger Smith.

However, don't be distracted by the forgoing narrative as it's the deeper message that Brogan speaks to a commercial world using the web for commercial business that resonated for me. I've written about Brogan before, elsewhere, and urge you to read that post and Brogan's Trust Manifesto, for it is the loss of trust that so many clinicians experience–perhaps not so much with their patients–in working with all of the components of the health care system that support clinicians in the care of their patients. Brogan in this video, once again speaks to building trust, using the contemporary tool of relationship development: Twitter.

Brogan recommends using your @replies much more than most users do to this point. 80% of his tweets are replies–he suggests that users reply to others 12 times for every one original tweet and addresses many other aspects of using Twitter.

He goes on to raise a series of questions:

How do we share?
How do we extend experiences and relationships?
How do we collaborate?
How do we make new distribution?
How do we develop relationships that yield?

"The difference between an audience and a community is which way we turn the chairs."

Brogan closes with this quote from Ralph Waldo Emerson, "Do not go wherever the road may lead, but go where there is no road and leave a trail."

I'm proud to have done that in my work in Emergency Medicine; I'm just warming up for the next act.