The Roles of Doctor and Patient Are Changing

November 11, 2019 By David Griesing Leave a Comment

On a train to New York City, I found myself sitting next to a doctor from Johns Hopkins. Mid-career. Confident. As it turned out, he was also from a family of doctors.

In his career, he said he’d alternated between research and seeing patients and I asked him if he was getting what he’d hoped out of it. He said he had at the beginning, when he could practice more the way his dad had, like taking the time he needed to treat his patients. But more recently, demands from the government and insurance providers were requiring him to spend more and more patient time gathering information and creating medical records about their visits.

It gave him “an awful choice,” he said. “I can either spend much of my patient time looking down at my pad or tablet and taking notes or I can look them in the eye. I went into medicine to establish healing relationships, it’s how I saw my dad practice, but now this beast has to be fed every day.”

“What beast,” I asked. “Because I’ve chosen to keep talking to my patients,” he responded, “I still have to record all their medical information before I forget what we talked about, so almost every night I spend between 9 p.m. and midnight ‘feeding the data beast’ because, of course, my wife and kids get to see me for an hour or so once I get home.” “The volume of it is grinding me down,” he continued, “but our insurance system requires it. What I looked forward to as a doctor every day is getting harder to come by.”

I’ve noticed this from the other side too. When I go to a specialist or for my regular check-ups I’m faced by my doctor as well as “a record keeper” with a touch screen. I’m always asked whether “I mind” having record keepers there and can always ask them to leave if I want to talk “one-on-one,” but it changes the entire dynamic in the room. Is this visit about me or my medical information?

It’s not whether electronic record keeping is working as intended, or is actually helping to manage medical costs that caught my eye this week. Instead, it’s how the generation and use of patient data is placing more obligations (with fairly profound ethical implications) on the so-called healing arts, and how far those obligations extend beyond data privacy and confidentiality. Among other things, it got me wondering whether even our best doctors and medical caregivers are treating us as collections of data points instead of “as whole patients” in the grind of it all.

For centuries, a doctor’s ethical obligations have been set forth in the Hippocratic Oath, with its standards being tailored to current understandings about health and healing. For example, to reflect our growing environmental awareness, a current version of the Oath widens the focus of care from the individual patient to the health of the community and the planet itself:

I swear to fulfill, to the best of my ability and judgment, this covenant:

I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow.

I will apply, for the benefit of the sick, all measures [that] are required, avoiding those twin traps of overtreatment and therapeutic nihilism.

I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon’s knife or the chemist’s drug.

I will not be ashamed to say “I know not,” nor will I fail to call in my colleagues when the skills of another are needed for a patient’s recovery.

I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know. Most especially must I tread with care in matters of life and death. If it is given me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God.

I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person’s family and economic stability.

My responsibility [also] includes these related problems, if I am to care adequately for the sick:

I will prevent disease whenever I can, for prevention is preferable to cure.

I will protect the environment which sustains us, in the knowledge that the continuing health of ourselves and our societies is dependent on a healthy planet.

I will remember that I remain a member of society, with special obligations to all my fellow human beings, those [who are] sound of mind and body as well as the infirm.

If I do not violate this oath, may I enjoy life and art, respected while I live and remembered with affection thereafter. May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help.

In the light of today’s Hippocratic Oath, it was easy to find several of its shadows.

Can our doctors provide “warmth, sympathy and understanding” while they are also filling in the blanks in their paperwork during the few minutes they are allotted to spend with us?

When it comes to my data, how is it being used, who is using it, and how exactly is “my privacy” being protected?

Is this data collection primarily designed to make “the business of medicine’” more cost effective and efficient, or does it also promote my health and healing?

What is my responsibility as a patient, not only as a collaborator in my medical outcomes but also regarding “the multiple lives” of the data I’m providing?

In these regards, some food for thought this week came in the form of a new Hippocratic Oath that has been proposed by West Coast doctor Jordan Shlain. I think you’ll agree that in some ways his proposed Oath makes our jobs as patients and our doctors’ (and other medical professionals’) jobs as healers even more fraught than they were already.

Here’s Dr. Shlain’s proposed Oath, with my initial impressions [in brackets] following each of its statements.

1. I shall endeavor to understand what matters to the patient and actively engage them in shared decision making. I do not ‘own’ the patient nor their data. I am a trusted custodian.

[Instead of doctors doing and patients receiving, the emphasis on joint decision-making shares the health and healing burden more equitably. Unanswered is whether patients should own their medical data.]

2. I shall focus on good patient care and experience to make my profits. If I can’t do well by doing good and prove it, I don’t belong in the field of the healing arts.

3. I shall be transparent and interoperable. I shall allow my outcomes to be peer-reviewed.

[Both 2 and 3 confront “the business of medicine” squarely in the Oath, acknowledging that care should be delivered with greater transparency around a doctor’s outcomes for patients, which the data now allows. As the business of medicine publically proves its worth, patients will become more like shoppers in a marketplace. What this new reality means in terms of accessibility or quality of care is, of course, uncertain.]

4. I shall enable my patients the opportunity to opt in and opt out of all data sharing with non-essential medical providers at every instance.

[Recognizing a patient’s interest in his/her data, information will need to be disclosed about essential and non-essential users of that data and about each patient’s ability to limit how it is shared.]

5. I shall endeavor to change the language I use to make healthcare more understandable; less Latin, less paternal language; I shall cease using acronyms.

6. I shall make all decisions as though the patient was in the room with me and I had to justify my decision to them.

7. I shall make technology, including artificial intelligence algorithms that assist clinicians in medical decision-making, peer-reviewable.

[As AI and augmented intelligence programs become more common in medicine, protecting proprietary business information should not inhibit validation of the tools a doctor is using to treat us by his or her professional peers.]

8. I believe that health is affected by social determinants. I shall incorporate them into my strategy.

[This one goes further into the community behind the patient. As Dr. Shlain argues: “Someone’s zip code can tell you more about their health than their genetic code.”]

9. I shall deputize everyone in my organization to surface any violations of this oath without penalty. I shall use open-source artificial intelligence as the transparency tool to monitor this oath.

[With doctors working until midnight to feed the data beast and stressed about market competition from other practice groups, their willingness to open themselves to these kinds of ethical challenges from within their organizations seems almost utopian, but at the same time, this part of the proposed Oath acknowledges that patient/consumers alone won’t be able to police this rapidly evolving profession.]

Increasing reliance on data collection and algorithm-driven automation is changing the medical profession into a business. It also changes our jobs as patients, Where once we were passive recipients of “the healing arts,” we are now being called upon to become more engaged consumers, with rights to more information about our care and additional options in the marketplace. Moreover, we should be as concerned about the uses of our medical information as we are about how our other personal data is being used (or misused) by Google, Facebook or governmental bodies like the police and IRS.

At the same time that doctors should be anticipating more changes to the Hippocratic Oath, the job of being a patient and the responsibilities that come with it are also becoming more burdensome. It’s not doctor “up here” (with all the responsibility) and patient “down there” (with almost none of it) any more. We’re confronting an uncertain future together now.

This post was adapted from my November 10, 2019 newsletter. When you subscribe, a new newsletter/post will be delivered to your inbox every Sunday morning.

The Next Crisis Will Be a Terrible Thing to Waste

September 30, 2019 By David Griesing Leave a Comment

(photo by Markus Spiske temporausch.com @pixels)

We are moving into less settled times both here and in the rest of the world. Several different storms are gathering along the waterfront today:

– in politics, with gridlock both breaking down and intensifying over impeachment and the future course for America, in the UK over its relationship with the rest of Europe and what it wants for itself, in the battles between populists and traditionalists elsewhere;

– in economics, with weakening global prosperity and the likelihood of a financial pullback that will affect almost all of us as the fundamentals weaken;

– in the environment, with increasing alarm over the current effects of global warming, the longer-term outlook for the health of the planet, and state actors’ halting efforts to respond to the challenge;

– in the world order, with a rising China, a demoralized and divided West, and a handful of nations around the edges that are both willing and able to take advantage of the uncertainty; and

– in the prevailing spirit, perhaps the most impressionistic of these storms but potentially the most powerful, as pessimism, alarm, hysteria, backlash and hostility get reduced into urgency in their boiling cauldron—a drive to do something, anything to move off the dime.

The silver lining is that chaos, confusion and uncertainty also provide opportunities. When you’re clear about the priorities behind your work, your chances to advance them are always greatest when the storms finally break as long as you’re ready to rebuild the storm-tossed world in the ways that you want. Now is the time for getting ready, because the chances to address our most pressing problems–and the rewards for us and others that can flow from that–may never be greater.

When the work we do helps us realize our priorities, it becomes more purposeful and satisfying.  As I argued here last week, in many of our jobs it is both possible and desirable to align our priorities with that job’s broader objectives. Improved health. Greater fairness. A more sustainable way to live.

In other words, it’s tying what you want yourself to almost every job’s higher purposes. Not only does the alignment reduce friction between you and those impacted by your work, it can also produce an esprit de corps with your bosses, co-workers, customers, suppliers and members of the broader community as they support your efforts. You’re experiencing the shared benefits of a productive community while taking home both the pride and satisfaction that comes with it.

Of course, another essential of “good work” is its future focus: anticipating circumstances that might enable you to take bigger-than-usual strides towards realizing common priorities. It is being aware of the obstacles and opportunities today so you are ready to act when the storms break and the lay-of-the-land shifts, weakening those obstacles and providing those with a vision of the future a path for realizing it. That’s because everyone who has weathered the storm wants to put the pieces back together and is unusually receptive to putting it all back together in some better way.

Realizing your particular work ethic in times of crisis has almost nothing to do with luck but everything to do with your mindset and plans. It’s having a vision of the better future that you want, keeping your eye on that goal line as the game degenerates into chaos, and, when everyone is finally able to listen, inviting your fellow survivors to help in rebuilding something that you’re convinced will be more durable and sustainable than all of you had before. At such times, aligning your personal priorities with a higher, common purpose will not only be satisfying for you, it can also make changes that seem impossible today, possible tomorrow.

My priorities (in search of this broader resonance) would include the following:

Thriving workers, families and communities.  Most of us have jobs as citizens of democratic countries with capitalist economies. We regularly make our preferences known by choosing leaders who share our priorities. As citizens during unsettled times, what kinds of change would we support and priorities would we pursue?

In large part because “thriving workers” are the foundation for other kinds of positive change (such as reducing income inequality, gaining affordable health-care and safeguarding the environment in our communities), I’ll be looking for leaders with the courage to say they are foregoing other “hot button” reforms to invest in retraining today’s workforce for a more automated world; to support trade buffers so that workers here don’t lose their jobs to cheap foreign labor when they’re compensated more fairly or work under safer conditions; and to support new public policies like bolstering the economic security of low-wage workers by supplementing their incomes through payroll deposits, thereby encouraging their continued work and improving their chances to start building wealth for their families and communities.

We don’t hear politicians making hard choices between costly alternatives.  Or willing to make the engines of capitalism more democratically-driven by ensuring that working men and women have a larger seat at the table with business owners. In the wake of the economic storm that’s coming, there will be many citizen-driven opportunities to support leaders who are eager to rebuild the future on the backs of thriving workers, while admitting that to realize that goal means putting many other goals on a back burner. It should also be a bi-partisan issue. As citizens, our focus and support can help them to accomplish this one important thing as the political process bottoms out and it struggles to identify new, common goals.

Environmental stewardship. As Alain de Botton argues persuasively (and often amusingly) in The Pleasures & Sorrows of Work it can be difficult to understand the wide-ranging impacts of your paying job given the global supply chains that feed it and the distribution networks that bring your “goods or services” to consumers. Difficult yes, but hardly impossible.  Among many other things, De Botton invites us to learn more about the consequences of our work, both for better and for worse. I’d argue that when we do, we’ll be able to see “how we can work better in the future” in a common light that includes “greater environmental stewardship.”

Is the product I’m selling or helping to sell, is the service I’m providing and the ways I’m providing it, improving the health of the planet or reducing it? Raising consciousness in the workplace about an issue like environmental stewardship provides opportunities for alignment with others–including bosses and even owners—who may share your concerns. The accelerating storm of today’s climate debate and the quest to find our way out of it will likely present many opportunities to change business practices (and even nudge them in groundbreaking directions) where we work.

Righting the balance between people and profits. Connecting your paid work to its wider-world impacts is not just limited to environmental stewardship. As global economies get roiled and we begin to look beyond these upheavals, we can be thinking now about how our jobs can provide greater benefits to us and our communities and not simply about how we can assist business owners in becoming profitable again. To ensure that you and I are not merely helping to restore the profit-dominated status quo after the next recession, we could be learning now how to connect our labor to “more of its fruits” than higher corporate dividends.

As I argued last March, administrators of a global education test are using that test to assess independent thinking, collaborative problem-solving and building better communities. On the theory that we “treasure what we measure,” students globally are now building these aptitudes in their classrooms because they will ultimately be tested on them.

By the same token, employers could assess (and reward) their employees–and be assessed themselves–for “aptitudes” beyond profit-making, including their success at tying company productivity to greater community benefits. For example, workers could push their companies to retain them (even with reduced hours) instead of firing them during economic downturns because policies like this maintain stable communities, or to take less profit from a product or service if it will keep a job here instead of losing it to a foreign worker. Moreover, employees who can demonstrate that they have strengthened the company-community bond would be rewarded for doing so.

The groundswell for this broader focus needs to come from forward-looking employees as well as executives and owners, and the time to be thinking about more community-oriented work assessments and broader exercises of corporate responsibility is now.

After we’ve weathered the next downturn, are looking for better ways forward and desiring greater corporate accountability for common problems—that’s when you can stand up with your new way to determine economic success.

That’s when you can argue that what’s good for the company needs to be good for the community too, and that the economic fallout might be reduced next time if the broader community were part of the equation from the start.

That’s when you can gain even more pride and satisfaction than is usually available when you help to solve common, work-related problems, because now you’re helping to humanize the foundations of democratic capitialism itself.

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We are far enough today from the economic recession that began in 2008 to gain at least a measure of historical perspective. Two new books are arguing that Barrack Obama was so eager to restore economic stability and the health of the American banking industry that he failed to “use” this crisis (as FDR had used the Depression) to seek fundamental—and to these authors—necessary changes to the country’s economic policies.

For example, in the course of re-building America’s way out of the last recession, they observe that Obama (like Clinton before him) never challenged the economic imbalance between the corporations and ordinary working people that had been a hallmark of the Democratic Party from the 1930s through the 1980s. When it came to punishing wrongdoing, Obama refused to insist that the bankers who had profited from the bubble they had created in the housing market be held accountable. When it came to economic initiatives like the Affordable Care Act, he favored market solutions over government policies and direct interventions (unlike the alphabet soup of initiatives during the Thirties or The Great Society programs of the Sixties).

According to Reed Hundt’s Crisis Wasted (out last April) and Matt Stoller’s Goliath: The 100 Year War Between Monopoly Power and Democracy (coming in mid-October), Obama sought to preserve the pro-business status quo rather than rectify the economic imbalance that disadvantaged workers, families and communities while benefiting the American business owners who held (and continue to hold) a disproportionate share of the country’s wealth.

I agree with them that a crisis is a terrible thing to waste, and that the last one was a string of opportunities neither taken nor pursued. None of us should be willing to waste the next one.

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I’m defining a “crisis” here as a ground-deep unsettling of prior certainties. A political/economic/environmental/moral crisis tends to prove that “the ways we used to do it” are no longer working and, for a brief window of attention and opportunity, regular people are willing to explore (and even support) both different and better ways forward. It’s why from the perspective of our work, we need to be ready with arguments, data, plans, hope and visions for the better world that each of us wants when that window finally opens.

We don’t need to agree on the changes. (The bold-faced objectives above just happen to be some of mine). But I’d argue that all of us need to be active parts of the conversation, even when it’s full of anxiety and has a fevered pitch. Because it’s when your work really can “change the world” and when the personal satisfactions and sense of purpose that come with it can be similarly transformative.

In 2016, a group of forward thinkers who were clustered around the University of Sussex in the UK created educational materials for anyone who is interested in seizing the opportunities of a world in flux. Those materials begin with powerful examples from history where:

– radical changes occurred in disruptive times that would not have been possible otherwise;

– to nearly everyone’s surprise, immediate changes were accepted by the public fairly rapidly; and

– longer-term improvements followed, with some expected and others exceeding expectations.

The Sussex materials also describe how, in a host of practical ways, change-agents can capitalize on the opportunities crisis presents and maintain forward momentum.

There is a broader discussion of their approach and a link to additional materials here. If you’re interested in readying yourself to take full advantage of the opportunities after our gathering storms break and the re-building begins, I think you’ll find their approach empowering.

Our work can always be aligned with deep motivations and high purposes, but the rewards are never more satisfying than when you’re helping to build a better world out of one that may be ending.

This post was adapted from my September 29, 2019 newsletter. When you subscribe, a new newsletter/post will be delivered to your inbox every Sunday morning.

Making Our Jobs as Big (or as Small) as Possible

September 24, 2019 By David Griesing Leave a Comment

We bring our priorities into our work–making it more purposeful and satisfying–by using our capabilities more deliberately and by demonstrating our values when we do our jobs.

Our basic “capabilities” include our personal autonomy (or the drive to realize our gifts) and our generosity (or encouraging the autonomy of others who are touched by our work, from co-workers to bosses, customers, suppliers and the broader community that supports our efforts).

Our “values” are moral intuitions (or feelings) that frame our experiences and help us decide how we should respond to them. Examples include freedom, fairness, equality, personal security, an ordered life or the sanctity of living things. For each one of us, some values more than others provide quick, intuitive signals that guide us as we try to figure out how to interact with the world around us.

Work is more satisfying when it engages our capabilities and serves our values, because they are among our most basic priorities.

When talking about these ideas, people often ask me: “On a practical level, how do I align my priorities with the work that I do everyday?” It’s often followed by a second question: “What if my employer’s priorities are different from mine—won’t this put us at odds with one another?” My quick answers are as follows.

Alignment of personal priorities with job priorities usually comes down to your mindset: how you see yourself in that job. Is it doing the bare minimum, “staying within your lines” and keeping your eye on the clock so you can leave for home after you’ve put in your time OR do you pour yourself into that job, finding opportunities for your priorities either within or right along side the priorities of whomever you’re working for? In other words, how hard are you trying to find more satisfaction in every job that you do?

Sometimes these alignments are nearly impossible, as in my recent post about gig-economy workers at Uber and Amazon. At each of these companies, the capabilities of their ride-hailing and delivery drivers are being exploited instead of respected. Uber’s and similar companies’ business models depend on offloading as much risk and cost onto their workers as possible. These workers’ recourse? They have to look to governments (like California’s) to safeguard their basic priorities on the job, leave those jobs altogether, or tamp down these basic drives because their economic necessities override the personal costs.

On the other hand, in many jobs it is both possible and desirable to align your priorities with those of your employers and others who benefit from your work. It is what organizational psychologists have called “job-crafting.” When you bring a suitable mindset to your job—when you ask, “how much instead of how little can I make out of it?”—many jobs become opportunities to build more satisfaction, and even fulfillment, into your hours spent working.

After elaborating on job-crafting and my own take on it, I’ll share some fateful testimony from two practitioners of “this highly practical art” from an interview I overheard while on the road earlier this week.

The Opportunity to Job-Craft More Rewards Into Your Work

Amy Wrzesniewski, a psychologist at Yale’s School of Management was talking about job crafting on a terrific podcast called Hidden Brain this week. I hadn’t heard this episode, but a regular reader wrote me about it (thanks Joe!) and listening reminded me of how long so-called industrial psychologists (who study our behaviors and expectations around work) have been tinkering with the boundaries of our jobs and the perceptions we bring into them.

Take (as Wrzesniewski did) a janitorial job cleaning a hospital. Let’s also assume two different men filling that job: I’ll call them J and B. Both were hired to show up at regular times and keep the floors and available surfaces in their parts of the hospital clean. With the tools and working hours available, they can clean everything they’re responsible for in their 5-day workweeks. The following Monday, J and B each start the same circuit over again.

Let’s assume that J always does what’s expected of him without complaint, but rarely does more than is required. Viewing his job as a paycheck, he’s hardly fulfilled by it. Instead of satisfaction at the end of a workday, he’s more likely to feel a tinge of resentment, that it’s beneath him to clean up after other people, but he needs the income so he puts up with the indignity and has done so for twenty years. J rarely interacts with the hospital staff or patients, although he understands that keeping the place clean contributes to the overall mission of the hospital, which is to help people to stay alive and hopefully get well.

B couldn’t see his job more differently. Feeling that he’s part of a team improving patient outcomes, B regularly makes a point to give a cheerful word to patients he’s noticed have few visitors, will go the extra mile to clean parts of his area that no one else seems to be getting to, and gives staff members he’s known for much of his working life words of encouragement when he senses that they’re feeling down. Unlike J, B connects his job to something bigger than himself—promoting the health of everyone who is around him everyday—and goes home with both satisfaction and pride that he’s contributed to the hospital’s mission along with a paycheck from it.

B accomplished this by “job-crafting” the way he sees his work and the importance of it in the broader scheme of things. From my perspective on work, he has also engaged both his capabilities and his values when it comes to service and community in order to gain additional rewards from it. As podcast host Shankar Vedantum put it, there are people who quit their jobs when they win the lottery and others who still want to work. B might keep working because the rewards he brings home aren’t just monetary ones.

After 25 years of studies in the psychology journals—from scholars like Arnold Bakker, Maria Tims and Justin Berg as well as Wrzesniewski—there seem to be three different approaches that workers take when “crafting their jobs.” Sometimes they rearrange how they characterize their job responsibilities, emphasizing certain aspects over others. Is a chef simply cooking a meal that her customers will keep paying for or is it far more important to her that she’s creating plates that are pleasing to the eye and producing delightful experiences for friends who keep coming back? One is a successful economic exchange while the others are more than just that.

A second approach focuses not on the end product but the interactions that help to produce it along the way. Instead of B deriving meaning from making the floors shine, he finds it in those interactions with patients, visitors and staff along the way.

The last approach is how you see yourself on the job. J would say, “I am a janitor” or define himself apart from this job altogether if asked “what do you do?” B on the other hand might say proudly, “I am an ambassador for the university health system, creating an environment that promotes the healing process,” and really mean it.

In a post from last February, I made an argument that uses terminology from economics and ethics instead of psychology to try and prove a similar point. When you take responsibility for your job satisfaction and don’t expect somebody else to provide it, you act like a stakeholder instead of an employee. Because job satisfaction is important to you, you collaborate to solve work-related problems that involve everyone (co-workers, suppliers etc.) and everything (like the communities and environments) that your work impacts. The compensations that follow are always more than the paycheck attached to your job description, because you’re consistently investing your effort into yielding a more satisfying job experience by addressing what’s important to you and to others.

I’m Bringing You More Than Tomorrow’s Weather

In a week that was dominated by students demanding that older generations take bolder steps to ensure that they have a livable planet in their future, it’s worth noting that most people still fail to recognize that rapid global warming is one of the most important problems confronting them. Until a proper majority engages with this problem politically, policy makers will simply avoid taking the necessary actions. Perhaps no American workers see the need to engage more of the public—while also having the ability to engage people effectively–than the men and women who bring tomorrow’s weather to millions of people who have little scientific background or knowledge in their communities.

When I overheard on the radio a conversation with two meteorologists a couple of days ago, it was clear that these weather reporters (along with increasing numbers of their colleagues) are engaging the public on the imperatives of climate change by grounding their daily reports or 5-day forecasts in statistical evidence that goes back (or extends forward) 20 or even 100 years where they and their viewers live.

They might ask: how many unusually hot days did we use to have in July or unusually destructive storms in September, and how many are we having now–before providing the relevant numbers. These men and women are accustomed to explaining climate-related information to non-scientists—so they’ve already developed more skills and gained more trust than perhaps anyone, in any other line of work, when it comes to placing the recent developments involving weather and climate in a meaningful, scientific context. Moreover, by sticking to hard data and avoiding political “calls to arms,” they are building audience knowledge and engagement while maintaining their impartiality.

When these meteorologists make the deliberate effort to locate today’s weather in a much larger story (instead of just sticking with whether their listeners need to bring umbrellas to work tomorrow), they are “job crafting” or “taking responsibility for common, work-related problems” far beyond the media contracts that they’ve negotiated. In other words, they could easily “get by with less” but refuse to do so. Both interviewees made clear how much providing a broader context for their weather reports was enhancing their job satisfaction. It was also clear how much of an impact they and a growing number of their colleagues are having when they engage the public with a problem that has long been too difficult for most non-scientists to understand.

Mike Nelson, the chief meteorologist at ABC 7 in Denver, and Amber Sullins, in the same role at ABC 15 in Phoenix, both see themselves as providing this bridge. Each realized that they needed to locate their weather reports in a climate-change context when they were confronted with new generations (Sullins having a daughter and Nelson a grand child). Nelson explained that even with only a few minutes on air, telling a broader or deeper story than tomorrow’s weather “is not as difficult as you might think.” If he knows in advance that his producer has a story about the fire season or current drought, he can work in an “explainer” about the 2-degree increase in temperatures in Rocky Mountain National Park over the past century or how ,at this rate of increase, the “climate in Denver in the next 50 to 70 years will be more like Albuquerque, New Mexico.” Sullin does much the same for her viewers when she explains the 115 degree day today by noting that prior to 1960, there were only 7 days this hot every 20 years, while in the current 20-year period, there have been 42 of them. They’re providing viewers with some relevant facts and leaving it to them to figure out what to do about the picture they paint.

Nelson says there is occasional blowback even though he sticks “to physical science instead of political science.” But he adds that for every complaint or attempt “to bully him,” there are 20 audience members expressing their gratitude. Since people are inviting him into their living rooms, he feels it’s “his responsibility” to tell them the whole story. Sullins also feels she is building an additional level of trust with her audience, explaining how the positive feedback she gets from emails and Facebook posts are continuing and broadening the conversation. As viewer’s grapple with the issues, she sees “more wheels spinning in their heads” and their pursuit of even more information. Both Nelson and Sullins are actively working with new meteorologists too so they can learn how to provide this broader context in their weather reports and avoid having their new careers derailed by a political backlash. More than “weather reporters,” Nelson and Sullin see themselves as “educators” of both their audiences and their younger colleagues.

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In a post of mine last May called “How to Engage Hearts and Change Minds in the Global Warming Debate,” much of the answer seemed to depend on how much those hearts and minds trusted the messenger who brought them the information. According to one poll I cited, that need for trust comes from the fact that only 60% of Americans think that global warming will affect the US, only 40% believe that it will affect them personally and 2/3rds never talk with anyone else about what lies ahead. Addressing climate change is still not on most people’s list of priorities, but letting trusted people “in their living rooms” to talk about it could change that.

As long as a group trusts you enough to ‘give you the floor and listen to what you have to say,’ you’ll likely engage them in your argument when it’s grounded in your values, demonstrates your care about where the group is headed, and provides a glimpse of a better future for all of you if you succeed in persuading them.

Meteorologists are “job crafting” their weather reporting and “taking responsibility” for educating their viewers who have found “what’s at stake” and “what can be done about it” difficult to understand until now. They are bringing their already trusted voices to a broader definition of their current jobs because it’s filling them with pride and they know that by doing so they could be making all the difference in the world.

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Notes: I just started publishing some of my weekly posts on Medium, an on-line opinion network, and my recent post on Uber drivers and Amazon packages was featured by its Business and Economy editors this week. Stories on Medium are usually available behind a paywall, but it you want to see my post or check out the site, here is a link that will get you there for free. (Of course, it would be much appreciated if you give it a quick read and check out the new pictures when you visit!)

This post was adapted from my September 22, 2019 newsletter. When you subscribe, a new newsletter/post will be delivered to your inbox every Sunday morning.

We Find Where We Stand in the Space Between Differing Perspectives

September 16, 2019 By David Griesing Leave a Comment

When you hear an argument on Tuesday and its opposing argument on Thursday, it’s always a challenge to arrange a further date where you can line them up at opposite sides of the room while you sit in the middle to figure out what you think and feel about the issue. Rescheduling your attention like this always seems to get lost in the shuffle.

On the other hand, the opportunity to listen, process and react almost immediately to opposing points of view is what can make live debate and virtual encounters with discordant perspectives both clarifying and satisfying.

They may also be ways to move beyond the polarizing shouting matches that characterize much of American democracy today.

When an issue “gets joined” you can figure out where you stand either on the spot or while continuing the conversation with yourself and others immediately thereafter. All you have to do is build this new information and its subtleties into your own perspective once you’ve had the chance to sleep on it.

When it comes to processlng opposing views, time compression seems critical. Being part of a live audience interacting with live “actors” or encountering real people in a virtual world is too. Another factor is your decision “to make yourself available to their persuasion” by the physical act of showing up, something you rarely do when you’re watching people testify on the other side of a screen. On each of these “live” or “almost alive” occasions, you’ve chosen to immerse yourself in a world of different perspectives where you’re open to changing your mind.

A final factor is also critical. Theater that is built on counterpoint stories and virtual worlds that make us confront our own preconceptions are jarring experiences. Both demand that your thoughts and feelings connect across a broader waterfront than you recognized before. They challenge moral certainties and provide building blocks you can use immediately to construct a more nuanced point of view. Their wake-up calls can often make you behave differently too—impacting the jobs you do as community members or citizens. They offer highy engaging ways to figure out where you stand and what to do next.

All of these dynamics were apparent in a recent theater production in Portland Oregon, where actors playing members of the community and its local police force held the stage in front of an audience from that same community, told their distinctive stories and changed some minds.

Similar changes in perception became evident when people put on the virtual reality (VR) headsets that were recently developed by a California company. VR technology can take you places and put you among people you may think you know about until you are literally walking among them at Rikers Island prison, on the US-Mexico border, or in a Syrian refugee camp.

What used to seem black and white and came cloaked in moral certainties can be shaken into reconsideration by these “live” or “virtually alive” experiences. Abstraction and over-simplification are no longer quite as possible when issues that we thought we understood have faces. Once we’ve learned more and have the experience to know better, we may no longer wish to view ourselves (or be viewed by others) as being so cold in our certainties or so removed from the blood, sweat and tears of most people’s lives.

Do these kinds of experiences offer a way to move past the knee-jerk polarities that undermine our collective purpose?

Are they vehicles for helping at least some of the undecided and disengaged in this country to make up their minds and help build a future that they want instead of leaving their prospects to others?

Finding Shared Human Perspectives While Looking At and Listening To One Another

The chasms between diverse communities and the police who are charged with protecting them yawn widely across America. In Portland, some creatives in the performing arts and forward-thinkers in law enforcement came together to try and reduce them. Their approach: a stage adaptation of the dueling perspectives, only this time with several rarely heard points of view along the stark divide—including the witness provided by minority police officers who, in more ways than one, have come to embody it.

Much of this story about perspective building in the community, and all but one of the quotes here, come from a PBS NewsHour segment that ran on the same day in August that New York City police officer Daniel Pantaleo was fired for his involvement in subduing Eric Garner, an arrest that ended in Garner’s death.

Kevin Jones and Lesli Mones founded the August Wilson Red Door Project, a theater company, to provide a platform for addressing issues of importance to the City’s African American residents. The other driving force in this story is Robert Day, the former deputy chief of the Portland Police Bureau. Jones and Mones asked him to gather perspectives from policemen who serve in minority neighborhoods like theirs and he pursued their invitation with relish.

What ultimately came together in one performance were a series of monologues from two different plays. “Hands Up” was written by African Americans about their experiences being racially profiled by police. “Cop Out” tells the stories of individual police officers when they are wearing their uniforms as well as the lingering effects after they take them off.

Jones and Mones each described the intent behind bringing witnesses from both perspectives onto a single stage. Said Jones:

We’re not dividing the story into two sides, right, the good guys and bad guys. On both sides, we have a group of people who feel that their stories are not being told, that they’re being vilified, that they’re being shunned, that — and nobody wants to really hear their story.

For her part, Mones addressed early criticism she’d heard from the African-American community in an earlier interview with the Portland Mercury:

From a social power perspective, you can’t compare the experiences of the two groups of people. But from a shared human perspective, the feeling of being unseen, depersonalized, and stereotyped is something both groups can relate to. It’s in the DNA of Red Door to honor a multiplicity of viewpoints, because we know it’s imperative in producing a healthy racial ecology for the community.

Four excerpts from the monologues suggest the power of this “shared” and “deeply human” approach.

– Community member: ‘They slammed me to the ground. One of the officers had his foot on the back of my neck. Another officer pointed a gun to the back of my head and said, ‘Move one inch and I will blow your head off.’ Oh, I went into survival mode. I tried to convince them I was one of the good ones.’

` Policeman: ‘I used to think nothing about being a cop would shake me up. But when you arrive on scene and watch your partner pull an infant out of a microwave because his meth head father couldn’t stop the kid from crying, your lens gets colored.’

– [A community member asks everyone in the audience to raise their arms in the air]:

A voice representing the police: ‘Hands up.’

Members of the community: ‘Don’t shoot.’

A voice representing the police: ‘Hands up.’

Members of the community: ‘Don’t shoot.’

-Policewoman: ‘The only reason I carry a gun if for protection, primarily mine, sometimes yours, sometimes, in highly specific circumstances, like an active shooter, or –no, that’s about it.’

The theater company is hoping to take performances of these combined monologues across the country, starting later this year. However, the fundraising and logistical hurdles that need to be surmounted before the show can hit the road are daunting. But no one provides a better reason for persevering than former deputy police chief Day:

We’re touching on sort of the third rail conversations of race and policing. And I think they are conversations that are happening in African-American families in homes and communities, and I know they’re happening in police communities, because I have heard them, been a part of them, I have seen them.

But they’re not happening publicly, and they’re not happening generally across from each other, because of the sort of high-voltage nature of them. So, the theater allows us to put it all out there. We can speak what has been left unsaid.

Only when “it’s all out there” and being processed by the folks in the audience who are most impacted by it can there be any hope of actually “seeing the other,” identifying shared objectives, and pursing them together.

The Issues Are No Longer Vague. They Feel Like Lived Experiences

With VR or virtual reality, the divides aren’t personified on a stage and the processing doesn’t begin when you’re seated in front of it. Everything you need for your views to be jarred into a broader perspective is brought into the perceptual space “between your ears” by this advanced technology.

Emblematic is a VR studio that was founded by Nonny de la Pena and is based in Santa Monica. De la Pena was profiled as one of 2018’s top innovators by the Wall Street Journal, both for developing groundbreaking VR technology that enables you to feel like you’re moving through a real space (instead of just standing in it) and for the rationale behind her inventiveness.

The author of the profile explained her intentions this way:

The idea is to put people in places they wouldn’t normally find themselves, experiencing situations they would not normally experience. Often, these are related to urgent issues, issues that are, in their sprawling complexity, seemingly difficult to grasp or even care about. But suddenly, there you are, standing in a cell in solitary confinement, or at the foot of a melting glacier, or before a protest line outside an abortion clinic. When you are in these places—hearing the anguish of a prisoner, the calving of a glacier, the vitriol of the protesters—the issues no longer seem like issues, with vague names attached, like prison reform or global warming or women’s health. Rather, they seem like lived experience, like people you’ve met and places you’ve been—like memory.

Within Emblematic’s VR headsets, the perspective you’ve brought with you is jarred by the unfamiliar in “real” time and you’re invited to start responding immediately to the flood of new information that’s washing over you. Particularly when you enter environments with other people in them, it feels like you are entering a reality as it’s being lived by someone else, providing unprecedented opportunities for connection and empathy.

Before you put the headset on, you also know where you’re going and have made yourself available to broaden and deepen your point of view. You find a new place to stand in the neurological mindspace between your thoughts and feelings about this issue before and the virtual experience that you’re having now. As long as it’s programmed as an exercise of free will, this technology can help you to make up your mind or intensify your most important commitments.

Unlike the challenges of putting the “Hands Up/Cop Out” show on the road, the financial and logistical challenges for de la Pena and Emblematic are likely making their technology cheap enough and portable enough that it can someday travel on its own to wherever people are undecided or simply want to know more. They (and other monitors) will also need to mind the gap between its use for illuminating an increasingly complex world and simply manipulating our reactions to it.

Sometimes, groundbreaking innovations like de la Pena’s have their roots in childhood, and so it is with the story of how she first learned the value of differing perspectives–even when one of them is hers. The Journal’s profile of her actually begins with it:

When Nonny de la Peña was in junior high, in West Los Angeles, her math teacher wrote a note home to her parents. ‘It was about something I’d rebelliously done,’ she says. ‘It was something minor, like speaking up, or speaking too loudly.’ Her father read the note, then turned the paper over and looked at her. ‘This is what she says you do, he said to me,’ de la Peña recalls. ‘Tell me about her. What does she do?’ De la Peña listed some of her own unflattering observations about the teacher, and her father wrote them down on the back of the note, so that now the piece of paper contained two notes, two different perspectives. Then her father signed it. ‘So what does that make you do? Of course [says de la Pena], it makes you think about the structure of things…. Of how situations are multidimensional.’

Her father knew, and early on it seems that she came to know too, that the truth can usually be found somewhere in the space between perspectives.

+ + +

I’ve written before about the space “where we can make up our reasonable minds” because I’m concerned (and sometimes alarmed) about how our demonizing of those we disagree with has disabled us from building anything of consequence in America today. It also comes from how others’ “not caring enough to have points of view” further undermines “what those who do care enough” hold in common. These sentiments were behind my post on the remarkable public exchange between two academic friends, the left-leaning Cornel West and the right-leaning Robert George, and what we all gain (but seldom enjoy today) from politically charged conversations, as well as another about the clarifying nature of dissent.

These arguments (and the one today) feel personal to me.

When I abandon my reasoned points of view, or don’t bother to come up with them anymore, I cede control of my future and my family’s future to somebody who may know less and care less. As long as I hold this right and it has not been taken away from me by those who want to control my mind, I’d be a fool not to exercise it.

Where I decide to stand and what I decide to do about it in the work I do and the way I live are among the most valuable contributions that I can make to myself and others. As long as it’s mine, I’ll continue to find the space for evolving my perspectives because it’s part of feeling alive.

This post was adapted from my September 15, 2019 newsletter. When you subscribe, a new newsletter/post will be delivered to your inbox every Sunday morning.

How to Engage Hearts and Change Minds in the Global Warming Debate

May 5, 2019 By David Griesing Leave a Comment

Conversations that change minds always appeal to people’s priorities.

These are conversations we’ve had here about subjects like the risks of climate change (“An Enabling Perspective for Our Wounded World”), the current imbalances in the American economy (“The Social Contract Around Our Work Is Broken”), the impacts of innovation (“Whose Values Will Save Us From Our Technology?”) and their effects on workers, families and communities.

Unfortunately, many of us don’t talk to anyone about how a warming planet is already impacting us, how the risks are accelerating, and what each of us can do about it. “What has climate change got to do with me?” or more pointedly, “What has global warming got to do with what is important to me?”

What environmentalists consider a horrifying catastrophe barely registers as a concern for many of us, and much of that disconnect comes from how environmentalists have talked about it. It’s almost as if they think the health and beauty of the earth (remember “the snail darter”?) is more important than the freedom or prosperity of the people in it– when the challenge should never be expressed as an either/or.

Arguments about the sanctity of the biosphere that may seem obvious to me won’t persuade skeptics who are far more concerned about making a living off the land. So it’s fair to ask: why can’t the risks of global warming be conveyed in terms of its impacts on human freedom and prosperity—that is, through the lens of a very different set of priorities? Otherwise, we’re doomed to leaving half of the constituency that’s needed for change out of the loop.

Whether a skeptic is open to listening to someone who wants to persuade them is also key. I’m never going to change your mind if you don’t trust me already, and much of that trust comes from having credibility within a community that already shares at least some of your values. It’s how Nixon’s legacy as an anti-communist gave him credibility with conservative constituents when he wanted them to change their minds about improving relations with communist China in the 1970s.

Until recently, there were very few leaders in the community of global warming skeptics whose minds were changed by the environmental record AND who were also willing persuade others who share their values to change their minds too by discussing how they became convinced by the enormous risks that are involved. Whether the issue is climate change or something else, the stature of the persuader and his or her willingness to explain their evolution from skeptic to believer in a language that speaks to common values also matters.

Some recent polling data about the gulf between believers and non-believers when it comes to global warming speaks to the enormity of the bridge-building challenge.

According to a Gallup poll in March, nearly 70% of Republicans believe that alarm over a warming planet is “generally exaggerated” while nearly the same number of Democrats (67%) believe that global warming will pose “a serious threat” in their lifetimes. When political affiliation is removed from the polling questions, the results are equally compelling. The Yale Program on Climate Change Communication found that only 60% of the public think that global warming will affect people in the US, only 40% believe it will affect them personally, and 2/3rds of those polled never talk about climate change with anyone else. For many people, climate-related threats to our way of life are not even on their radar.

Those most knowledgeable about climate science are almost unanimous in their alarm over global warming. But those who aren’t paying attention or are waiting to be convinced are unlikely to persuaded by “the facts” that fuel the experts’ alarm. On the other hand, they might be persuaded by someone they are listening to already and are open to hearing out.

This openness to persuasion was evident from studies Charlan Nemeth shared in her 2018 book on the power of dissent. I discussed her findings in a couple of posts (“Why Voice Your Dissent?” and “Dissent That Elevates the Group”) about how somebody who disagrees with you–often vehemently–can also change your mind.

As long as a group trusts you enough to “give you the floor and listen to what you have to say,” you’ll likely engage them in your argument when it’s grounded in your values, demonstrates your care about where the group is headed, and provides a glimpse of a better future for all of you if you succeed in persuading them.

You raise your voice because what you believe and what you know can’t stay silent any longer. You dissent because you care about being true to yourself and because you care about what will happen to the group if it doesn’t hear what you’re saying. [As a result,] the group will grapple with your knowledge and beliefs even when they don’t agree with them…In addition…the most productive dissent also contains at least a piece of the future that you are convinced that everyone in the group should want. A dissenter’s convictions engage our convictions about what we know and believe, but so does her hopeful vision about the future [we can] create together.

When dissenting opinions contain these three elements, those who disagree at first are more likely to open their minds and question their own positions. When you are “in it” together (whatever the basis for that commonality), people will listen to your reasoned testimony when they sense your heart is in it too. Someone else’s grounded, caring and hopeful dissent essentially creates the space for reconsidering what we think and believe to be true.

Of course, to persuade a skeptical group with your “dissenting” opinion, the group has “to give you the floor” in the first place, and the easiest way to receive that invitation is if you already share at least some of the group’s basic values. For example, to reach conservative, often Evangelical communities that have tended to be dismissive of the threat of global warming, climate scientist Katherine Hayhoe grounds the facts she knows as a scientist in the biblical values she believes in as a Christian.

In her 2009 A Climate for Change: Global Warming Facts for Faith-Based Decisions (co-written with her husband who is a minister himself), as well as in her TED talk last December, Hayhoe’s persuasiveness arises from both her expertise and these shared beliefs.  She’s convinced that fear, even when justified by the science, only causes people to flee the issue or become demoralized because nothing they could ever do will really matter. On the other hand, a “rational hope” that individuals can make a difference when it’s tied to the values of her largely Evangelical audience has a much better chance to change minds and get her listeners to engage in solutions, even small ones.

The Bible calls on Christians “to serve the least of these”—the poorest and most vulnerable in the developing world, who are already among the most affected by global warming. Hayhoe utilizes her scientific knowledge to paint a vivid picture of the suffering that billions of the poorest people will face if the world continues to ignore the scientific evidence. The message in her book and when she’s speaking is always clear. She “connects the dots” between their shared values and why her readers and listeners need to confront the challenges of a changing climate.  “Doing something, anything, about climate change is a step in the direction of caring for people,” she says. It’s a reason to believe that her audiences can feel, understand and act upon.

Hayhoe’s expertise as a climate scientist gives her knowledge-based credibility with her largely Christian audiences. Many of Nemeth’s dissenters who changed skeptical minds also had (or managed to build) subject-matter credibility that could be harnessed to values they shared with the groups they were trying to reach. Jerry Taylor, originally a Republican global-warming skeptic, supplemented his authority by reviewing the evidence of climate change and convincing himself that the risks it poses to his priorities—like its impacts on private property and personal freedom—demand that it be confronted without any more delay. Taylor runs the Niskanen Center, a libertarian-leaning Washington think tank. Over the past 5 years, he and his colleagues have been quietly building support among Republican legislators and staff for an aggressive federal carbon tax.

Since Taylor’s commitment to Republican and libertarian values is unquestioned by his peers, his “change of heart” given the evidence of global warning and the carefully tailored carbon tax he proposes to address it have been taken seriously by his colleagues. “This is one of our own,” he knows what he’s talking about, we need to hear him out, and maybe open our minds to the persuasion in his arguments. The significance of overtures like his to global warming skeptics cannot be overstated.

An April 16 article in the MIT Technology Review argues for the “science” (or at least the method) that seems to be operating here. The article is “How the Science of Persuasion Could Change the Politics of Climate Change,” while its tagline is: “Conservatives have to make the case to conservatives, and a growing number of them are.” In order to change minds on a hot–button issue that has been reduced to partisan sound bites, several factors are relevant.

The first is understanding how political stalemates first arise. We become polarized when members of “our elites,” our so-called “thought leaders,” rally us in one direction or another. By the same token, to reduce political polarization the convictions of these thought leaders are the first convictions that need to be changed.

The real focus shouldn’t be on convincing the public, hitting people over the head again and again with the science and dangers of climate change. Instead, the goal should be to change the minds of the elites.

When they send clear and consistent signals, mass opinions that seemed strong and fixed can swing in the other direction”…. The good news is this means you don’t have to change as many minds. The bad news is the ones you do have to change can be particularly stubborn ones.

This is why Jerry Taylor’s conversion experience is significant. No one else changed his mind. He changed his own mind by studying the evidence around climate change, and, as a result, he and his allies are well-positioned to change similar minds in the elite government circles where they operate.

Another element in this kind of persuasion relates to the common values that the persuader shares with those who need persuading.

[Taylor] and his staff attempt to craft fact-based arguments designed to appeal specifically to their political interests, and present policies they can rationalize within their ideologies.

Notably, the Niskanen Center isn’t pushing the environmental regulations that conservatives despise. They’re advocating a revenue-neutral carbon tax, a market-based tool. Carbon pollution costs real people real money. It’s just that the polluters aren’t necessarily the ones bearing those costs. In a market that respects the property rights libertarians champion, that ‘externality’ needs to be priced in, Taylor says.

The MIT Tech article suggests that Taylor has been making headway with Republicans in Congress, but no one is “naming names” yet, suggesting that there is still “a ways to go” in getting these legislators out in front on America’s response to global warming.

To make their changes of heart even more palatable, the article also cites the so-called “co-benefits theory” advanced by some political scientists. In listing our gains once we cut greenhouse gas emissions, the newly converted can claim that they are also promoting goals like technological innovation, energy independence, national security, air quality, health and job creation.

+ + +

The necessary coalition to address global warming will never coalesce until respected leaders in skeptical communities engage with those who deny the seriousness of climate change.

A skeptical community can be reached by both expertise and potential solutions that are consistent with that community’s’ priorities and values.

This kind of outreach recognizes that people’s identities are tied up in their political certainties and how those certainties reflect their basic values.

An appeal to values can change hearts enough so that an expert’s appeal to reason can also change minds.

There is a “rational hope” today that a skeptical public can be engaged deeply enough so that we will be able to come together to address global warming as well as almost every other intractable problem that requires a critical mass of public engagement.

It’s about finding a few leaders who can reach enough people where they live.

This post was adapted from my May 5, 2019 newsletter. When you subscribe, a new newsletter/post will be delivered to your inbox every Sunday morning.