Extra from the Ordinary

July 19, 2020 By David Griesing Leave a Comment

For some writing that I have ahead of me, I’ve been researching how to make good use of a refuge that you’ve created from the outside world. When bad things are happening out there and they’ve torn you apart, how do you re-group enough to go back out and face them all over again?

For that project, I won’t be writing directly about the pandemic, but some of what I’ve unearthed also speaks to our efforts to recover our internal focus, sanity and productive drives while trying to stay safe from the risks outside.

We’re working more at home, seeing fewer people and keeping our distance from almost everyone else. Health threats have made living and working an isolating experience. There’s more time alone to stew on our feelings than when our routines kept us busier and more people would take us out of ourselves.

The disorder ot the outside world leaks in too. It’s harder to make even small things—like getting a haircut or going to the gym—happen, or to manage whatever confronts us after we leave home. Moreover, today seems a lot like yesterday and the day before that, the drift of hours and days making it harder to feel grounded in time or able to put one foot in front of another. As panic, despair or hopelessness sets in, it can feel like the disorder outside is living inside too, that the shelter from the storm we thought we had isn’t protecting us any more.

Several years ago, Arthur Kleinman was in “the slow motion calamity” of caring for his wife Joan during her 10-year struggle with Alzheimer’s disease. To keep his feelings of isolation and disorder at bay, Kleinman (who’s a Harvard psychiatrist and anthropologist) brought new joys into the most ordinary routines of the life that they shared by focusing more attention on how they were doing them.

[I]ntensifying attention [on] mundane tasks, we filled those moments with passion and awareness. Exercise, cooking, eating, reading, work and even watching the news became more deliberate components of our daily ritual, giving us happy moments to look forward to, creating a mood of anticipation rather than paralysis. In a time of randomness and uncertainty, it made us feel proactive instead of reactive.

They created together a sustaining home life that enabled both the caregiving that went on there and his outside endeavors as a teacher and doctor.

Now living alone but still hard at work, Kleinman continues to conduct his ordinary routines with attention to their details, like preparing “a proper meal” for lunch everyday and taking the time that’s needed to enjoy it. He called the essay he wrote about those routines “How Rituals and Focus Can Turn Isolation Into a Time for Growth” because repeating these rituals every day has brought him a kind of “joy” that he’d never known before.

Charles Eisenstein takes Kleinman’s ideas about attention to our rituals both deeper and wider.

In “Every Act a Ceremony,“ Eisenstein notes that religious people and indigenous communities in many parts of the world view each of their daily actions as important and meaningful. As a result, their individual actions regularly unite “the ceremonial with the pragmatic.” Think of the daily routines in monastic communities that range from praying and singing at set times throughout the day, to rituals around farming, fishing and food preparation, and on to marking the seasons or “feast days” in suitable ways. Making yourself susceptible to discovering new ways to celebrate the practical details of life and work can make the ordinary feel extraordinary.

It’s preparing and then taking the time to enjoy a sit-down lunch everyday, or using a special cup for the first coffee you drink each morning. One says: valuing the food you’ve selected, preparing it carefully and well, setting it out in a pleasing way and taking the time to savor your efforts are all important to you. Because they’re special, they’re worth your time and effort. The other says: how you wake up every day, the feel and look of the cup, the smell, taste and heat of the coffee, noticing how the day streams in around you as you wake up, these are important and valuable too, bringing you pleasure from your attention to their details. They are rituals you can look forward to, structure the rest of your day around, and enjoy because you’ve taken the time to uncover what’s special and important to you about them.

Eisenstein says that ceremonies like this are not so much created as discovered.

Here is how it might work. You start with a rudimentary ceremony, perhaps lighting a candle each morning and taking a moment to meditate on who you want to be today. But how do you light the candle perfectly? Maybe you pick it up and tilt it over the match. Then where do you put the match? On a little plate perhaps, kept off to the side. And you put the candle back down just right. Then maybe you ring a chime three times. How long between rings? Are you in a hurry? No, you wait until each tone fades into silence?….
To discover a ceremony, follow the thread of ‘Yes, that is how to do it,’ that mindfulness reveals. Watching, listening, concentrating the attention, we discover what to do, what to say, and how to participate.

Our intuition learns how to unite the ceremonial with something as practical as starting every day. It’s only aim is to support your well-being in whatever ways feel right to you.

I know this might have “a New Age vibe” to it, but it doesn’t have to. Candles and a plate for the match may not equal “ceremony” to you. Something with less fuss perhaps. Every day, Dr. Kleinman simply takes the time he needs from his appointments and other demands to enjoy “a proper lunch.” Waking up may involve no more than your favorite cup and appreciating every part of it before you launch yourself into the rest of your day. It’s whatever makes that launch special or ceremonial for you, the equivalent of a champagne bottle across the bow.

Eisenstein argues elsewhere that taking one action like this creates a “field” around it that makes other, similarly motivated actions more likely. I think he’s right. The first time on a path makes it easier to follow the second time.

[A]ny change that happens in one place creates a field that allows the same kind of change to happen elsewhere. Acts of kindness strengthen the field of kindness, acts of love strengthen the field of love, acts of hate strengthen the field of hate.

It’s the same with discovering daily ceremonies: a ritual at the beginning of the day makes another one more likely to mark the middle or the end of the day. “[A] practice in doing everything just as it should be done,” he writes, “is like a magnet that aligns more and more of life to its field.” It could turn more of your ordinary routines (at work or after work) into bulwarks against panic or resignation, particularly given how easy it’s been to feel isolated and disordered in recent months.

Start small. Try this wisdom out, particularly if too much time in your head and desperate news cycles are wearing you down. Try it because today’s disruptions are likely to continue for months (if not longer) and because bringing enjoyment into the most ordinary parts of daily life are like free vacations.

Some of these rituals will occur face to face while others (of necessity these days) will happen on-line.

When I was growing up, my parents and their friends sometimes gathered at one house or another for cocktails on Friday nights to end the work week and start the weekend. Well the Frick Museum in New York City started a similar tradition as the pandemic overtook the City and even virtual get-togethers were treasured. They called their weekly gatherings “A Drink With a Curator,” each one featuring one of the Frick’s curators, an item or more to discuss from the museum’s collection, and a special cocktail you could enjoy with the conversation for 15 or 20 minutes every Friday evening at 5 p.m. (EST).

There are several episodes you can preview on You Tube. I’d recommend that you get a taste of the proceedings by viewing curator Aimie Ng’s discussion of John Constable’s “The White Horse.” To many, Constable is the greatest British landscape painter, and “The White Horse” may be his best painting. For me, the virtual gathering was like a short trip to the English countryside. Moreover, Ng is a delightful tour guide of the artist and painting, enjoying (while she does so) the same cocktail we’re told that the Queen enjoys during the ceremony of her lunch everyday. If you’re taken with this episode of “A Drink With a Curator,” you can subscribe to the weekly series, learn the identity of the piece to be discussed, and gather the cocktail ingredients in advance of your next Friday-at-5 date with a Frick curator.

There is nothing more ordinary than ending the work week and beginning the weekend until you turn it into a ceremony.

This post was adapted from my July 12, 2020 newsletter. Newsletters are delivered to subscribers’ in-boxes every Sunday morning. You can subscribe too by leaving your email address in the column to the right.

It’s Working That’s Essential

May 10, 2020 By David Griesing Leave a Comment

Trying to identify who is (and isn’t) “an essential worker” is the wrong game to be in today. As the current upheavals are making plain: all workers are essential workers.

Everyone who wants to work in America should be able to do so because:

– the economy depends on all workers, and not just somebody’s idea about who is essential and who is not;

– economically, strong families and communities depend upon wage earners and the kinds of livelihoods that generate those wages; and

– psychologically, the well-being of families and communities derives from their members feeling like they are (or can grow up to be) productive members of these basic social groups.

As a result, if a country like the US is to thrive, its democratic institutions must ensure that the benefits of capitalism and hard work flow not only to the “factory owners” but also to everyone who wants to work in those “factories” and in the communities that sustain them.

During the bloodletting of American jobs over the past 8 weeks, the government has tried to cobble together a safety net of small business loans, stimulus checks and enhanced unemployment benefits to protect the workforce. But every day that passes makes these efforts seem more like a fool’s errand. For tens of millions of American workers, these stop-gap measures are failing them and the anxious testimony about their daily struggles is heart-breaking proof. A labor market that was already teetering before March 1 has begun to collapse.

Over the past 50 years, the US has put economic growth (championed by the Right) and victim compensation for those that a growing economy fails to help (the band aids championed by the Left) at the center of government policies that most affect workers. As if there weren’t enough proof already, the Covid-19 crisis has revealed the bankruptcy of this approach for all but a wealthy few. It’s long past the time to make the economic welfare and psychological wellbeing of every American worker our national priority.

In the great rebuilding that lies ahead, it’s the ability to work, to support ourselves “with the fruits of our labor,” and to feel like we’re contributing to our families and communities that is essential. That means we’ll need to start treating all workers in America like they’re essential workers.

Empty the Old Glass & Help Fill a New One

Over Easter, a young Episcopal priest in the Park Slope section of Brooklyn delivered a sermon called “The World is Empty Now. How Should We Fill It?” His impassioned plea later appeared in The New York Times, which is where I read it.

Father Paulikas heralded the remarkable opportunity that’s been presented by a time when the old ways of living and working seems to be vulnerable (or breaking down altogether) and new ones that are more durable and humane can not only be imagined but also realized if we have the courage to do so.

Physically isolated and emptied of our usual lives, we are being forced to face ourselves in a way that few alive today ever have before… Having emptied ourselves, what do we really want to fill our world with once it is time to rebuild?

After the crucifixion on Friday, we’re in the empty tomb on Saturday, he said, daring to hope for the resurrection on Easter Sunday. In other words, this empty but hopeful time is an opportunity to ask basic questions about how we want to live and work tomorrow.

What does it say about our economy that it depends on the labor of people whose lives we are willing to sacrifice? Do we want to continue participating in an exhausting economic system that crumbles the instant it is taken out of perpetual motion? And what is the virtue of a desire for constant accumulation of wealth and goods, especially when they come at the cost of collective welfare and equality? These are not just policy questions. They are spiritual concerns that come into view with sharp clarity in the emptiness around them.

Since this is where we find ourselves, what should we do about it?

It Starts With Deciding What’s Most Important and All the Other Things That Aren’t

While accepting that our top and lesser priorities might be different, I tried to puzzle through the process for myself a couple of times last year as it relates to my jobs as a writer, arbitrator, citizen and member of a community where difficult choices between one thing and another always have to be made.

In a January, 2019 post, I’d recently finished Edmund Phelp’s Mass Flourishing and had just read Oren Cass’s The Once and Future Worker: A Vision for the Renewal of Work in America. I found myself in broad agreement with how each of them viewed the challenges confronting workers today and at least some of their proposals for addressing them.

Phelps argued that for America to flourish, its workers need to flourish by taping into their native resourcefulness—the kind of free enterprise that’s been blossoming here and there since this novel coronavirus pushed us into a corner. Prior to 1970, the vast majority of workers flourished as entrepreneurs and small business owners, Phelps argued, tapping into their creativity at the front end of their work and their feelings of accomplishment at the backend for sustenance.

By giving us an opportunity to demonstrate our capabilities, work allows us to realize our potential, be proud of our abilities to provide for ourselves and our families, be similarly proud of what we’re making or doing, and be more confident when facing the future because we feel that we have a stake in it and that it is not merely ‘happening to us.’ When enough individual workers flourish like this, Phelps argues, an economy overall flourishes.

For his part, Cass argued that “a labor market in which workers can support strong families and communities is the central determinant of long term prosperity, so it should [also] be the central focus of our public policy.” When we fail to produce enough jobs to serve that objective, the human toll weakens the nation as a whole, and tears its social fabric. To help prove his point, Cass cited studies finding that:

workers never recover economically from unemployment; that men only form families when they have work that can provide for them; that unemployment is a trigger for divorce; and that children have better outcomes when at least one parent is working. Moreover, communities where people are working are more vibrant and tend to attract more investment. In other words, communities filled with workers are good for those living there and good for everyone else too.

Before an April, 2019 post that was called “The Social Contract Around Our Work is Broken,” I’d been reading how Soshana Zuboff distinguished between the pre-1970 American economy and the roughly half-century of work that has followed in one of her essays. From say 1980 to the present, when the benefits that companies gained from pro-business policies failed to “trickle down” to the vast majority of workers, the result has been a yawning wealth gap between the top 10% and all other American workers. But this almost “feudal” system of lords and serfs was hardly inevitable.

American companies after World War II were expected to offer a kind of communal reciprocity that involved hiring the available workers, hiking wages when possible, and sharing their prosperity rather than hoarding it… Zuboff cites [Karl] Polanyi’s post-War study of General Motors not only for the ways that fair labor practices, unionization and collective bargaining preserved ‘the organic reciprocities’ between its workers and owners but also for how much the public appreciated these shared benefits at the time.

The period between 1945 and 1970 featured some glaring social and political divides, but it also saw many companies maintaining “the basic reciprocities” between them and their workers. Unfortunately, it’s a balance we’ve failed to strike since then. I’d argue that at least some of the human desperation we’ve been hearing during the current economic meltdown stems from the fact that it’s our state and local governments and not the companies we work for that have become the guarantors of our jobs.

It doesn’t have to be this way.

A Smile and a Frown

In the debate over who is (and isn’t) “an essential worker,” I saw this posted on-line this week.

It’s pretty funny until you realize that it also depicts the average McDonald’s worker before his status was “elevated” by the current state of emergency. (The rake says it all, don’t you think?)

This week’s news has been loaded with reports about “disposable workers” in farming and meat processing. We’re hearing about home health workers risking their lives for low pay and seniors who have worked their whole lives moving back with their children because they could never save enough for their retirements. As it relates to work, America’s social contract has failed on nearly every front to safeguard “the basic reciprocities” between our companies and our workers.

In the emptiness of today, we have a chance to re-consider whether this is ok with any of us.

There was a report from the Brookings Institution this week arguing that “essential” workers should receive “hazard pay” during this health emergency. In a sidebar that included audio were comments from one of these temporarily essential workers. The following is some of what Matt Milzman, a Safeway cashier in Washington D.C., had to say, in the plainest of ways, about what we’ve lost but could regain:

[A]ll of these millionaires and billionaires who run these companies are thinking, how do I maintain my profits? I think there needs to be a fundamental restructuring of how we think and do things in this society that focuses on humanity. The humanity of us in the grocery stores, the humanity of the doctors and nurses in the hospital, the humanity of the people who continue to pick up your trash every day, the humanity of all people in this situation who are going in every day, risking their lives to try and carry on as normal.

If it’s working that’s essential, we should aim to recover the humanity in every job.

This post was adapted from my May 3, 2020 newsletter. Newsletters are delivered to subscribers’ in-boxes every Sunday morning and the contents of some of them are later posted here. If you’d like to receive a newsletter each week (and not miss out on any), you can subscribe by leaving your email address in the column to the right.

Technology is Changing Us

February 4, 2020 By David Griesing Leave a Comment

When we change our routines in a fundamental way—either because we need that change or the interruption is foisted upon us—we sometimes experience our world differently when we return.

Glimpses of those differences are possible after vacations, but they usually need to be long enough and far enough away. These differences in perspective also need to become realizations: our conscious efforts “to capture” what our time away “was really about” and consider its impacts “on what we do next.” At this point, the contrast between before and after might be bold enough to change our outlook going forward—like eat more pasta or dance everyday—but these realizations seldom change the basics about our living, our working or how we think about them. They’re more like souvenirs.

Clearer and longer breaks between departure and return generally have a greater impact because there’s more time to ponder the differences between this new place and the one we left behind. When we return to where we started, we are able to compare how it seemed before with how it seems to us now in light of the new perspectives that we’ve gained. As a result of these realizations, we sometimes do change our basic routines or broaden our rationales for doing them.

Insights about what-came-before, what-came-next and now-that-you’re-back can be even more profound if your physical or mental abilities changed during this interval. For example, you needed a new environment because you were injured in some way or found yourself facing an unfamiliar limitation. Only after time-away were you healed enough to return to the world you had left behind. Your judgments can be more nuanced when the changes to your body or spirit have also sharpened your awareness of where you’ve been and where you find yourself now.

Insights about before, next and now might be sharper still if changes in your perceptual abilities were behind your initial departure. If, say, you’d been partially blinded and had to rely on the heightened senses that remained to “map” the new environment where you retreated and the old one that you returned to “with new eyes.”

Finally, your insights might be at their sharpest and most valuable if the world you left had also changed in some fundamental way in the months or years before your return. The heightened awareness that you gained while away would be encountering this new topography for the first time. It is this final vantage point that Howard Axelrod brings to his new book, The Stars in Our Pockets: Getting Lost and Sometimes Found in the Digital Age.

Axelrod’s short story is that he was accidentally blinded in one eye during a college basketball game, took the next 5 years to graduate and recover physically, and spent the two years that followed living off the grid and reorienting himself with his natural environment in the woods of northeastern Vermont. After his time away, he began a teaching career at two urban universities.

Between his partial loss of sight and his return to civilization, smartphones had not only become ubiquitous, but in startling contrast to his back-woods life, these “stars in our pockets” seemed to be changing “how we navigated the world” right in front of him. It was an insight that might not have been possible if the contrasts between the world he’d departed, the one he retreated to and the one he re-entered had been less stark, or the realizations that he took from his experiences had been less acute.

In the “cognitive environment” of northern Vermont, Axelrod deepened his sense perceptions, made lucky discoveries as he wandered in the outdoors, and cultivated a sense of curiosity and patience that had been commonplace for much of human history. He learned to pay attention to the weather, the seasonal changes, the time of day, the life of the forest around him, and realized that doing so reinforced a particular kind of “mental map” that enabled his understanding of the world and how he could find his way through it. When Axelrod returned to urban life, he realized that the smartphones people were now holding as they walked down the street or sat across from one another at lunch were changing how almost everyone—including him—understood and experienced the world. In other words, the mental map that a smartphone enables is fundamentally different from the mental map he’d been using to navigate during his time off the grid.

The message in Axelrod’s book is not that one map is better than the other. His writing is more “meditation” (as he calls it) than argument or indictment. Instead, he wants to highlight some of the complications that can arise when you alternate between how humans have always navigated their lives and work and the new ways of doing so that mediating devices like our smartphones have enabled. In a recent interview and from postings on his website, Axelrod wants to convey what happens when adapting to a new environment means “losing traits that you valued” in your first one.

Just as we’re losing diversity of plant and animal species due to the environmental crisis, so too are we losing the diversity and range of our minds due to changes in our cognitive environment.

Several of these losses are worth our noticing with him. For example,:

–Tech tools may replace natural aptitudes and weaken the memories that they depend upon. Axelrod suggests that relying on GPS to navigate undermines not only the serendipity that often comes “when you’re finding your own way,” but also your reliance on innate navigational memories so that you don’t get lost. Axelrod says:

Our memory is tied inextricably to place. In our brains, the memory center, the hippocampus, is the same center for cognitive mapping — figuring out the route you’re going to take. If we’re no longer using our brains to navigate [and] coming up with these cognitive maps, studies show that we start to have problems with other kinds of memory.

–External prompts change our attention spans. As we grow more accustomed to on-line suggestions before taking the next step, autonomous actions—including immersing yourself in an activity and entering into what psychologists call productive “flow states”—become more difficult.

What [American philosopher William] James [once] said is that an attention span is made of curiosity. It’s the ability to ask subtly different questions. Whether you’re talking about intellectual attention, or sensorial attention, if you’re looking at a tree or watching a bird. Are you asking subtly different questions? Can you ask a question about one facet and then another? It feels like you’re paying attention steadily, but you’re really paying attention to a lot of different things, driven by your curiosity.
Online, there’s always something prompting your attention. It’s like a pseudo-curiosity. It comes in and will give you the next thing to purchase, the next article to read, the next video clip to watch. You don’t have to ask the next question — it’s provided for you. Your attention span will shorten because you don’t need to ask those questions, you don’t need to drive your own attention.

–Rapid-fire “likes” on-line also requires much less involvement from us than empathy requires off-line. Axelrod notes how disorienting it can be as we shuttle between our tech-enabled environments and the rest of our lives and work, where we often need to come to what he describes as “slower” understandings of one another:

[W]hen you’re on social media, part of what’s being called for is attention that can shift really rapidly from one post to another post. And also what’s being called for is a kind of judgment: Do you like this? Do you love this? Do you retweet this? Whereas in real life, what’s called for is a slower attention, where you’re able to listen, be patient while the person is pausing, thinking, not quite sure what they’re saying. And also what’s called for is to defer judgment, or not judge at all. To have empathy. Those are very different traits, depending on which environment you’re in.

–It is hard to reconcile or internalize the different, competing ways that we use to navigate our on-line and off-line realities. Moreover, the world we experience behind the screen can become a substitute for (or even replace) the frameworks that come from navigating in the off-line world. What we risk losing, says Axelrod, are:

our connection to something larger than ourselves, our sense of perspective, our sense of what came before us or what will come after, our sense of being a part of the natural world — that doesn’t really show up anywhere on the maps on our phones.

As we adapt to a virtual world, we’re often disoriented because its cognitive maps are so different and “we’re effectively living in two places at once.” But our adaptations change how our minds work too. In what Axelrod calls “neural Darwinism,” a kind of “natural selection” also happens “on both sides of your eyes” as we adapt to living and working through our screens. “[C]ertain populations of neurons get selected and their connections grow stronger, while others go the way of the dodo bird.” In other words, the faculties that we exercise on-line grow stronger, while those from the off-line world that we rely upon less frequently weaken from disuse.

These losses are tangible: Remembering how to navigate the world without on-line short-cuts. The longer attention spans that we need for concentration. The slower attention spans we need for empathy. Perspectives that extend from the past and into the future. Feelings that we are a part of the natural world.

Our smartphones and other virtual companions are changing our capabilities in each of these ways, but like that frog in water coming to a slow boil, too many of us may be lulled into complacency by the warmth of their star-power.

Axelrod returned from the Vermont woods when the rest of us were already caught up in their magic. With the heightened sense of being human that came from his own particular odyssey, he could see more clearly not only what we’d been gaining while he was away but also might be losing as we gradually moved off our old navigational maps and started our pell-mell quest to adapt to very different ones.

The map at the top of this post illustrates how navigation, weather, visibility, air pollution—a dozen different variables—might change in light of the fires that have recently burned through much of the western US. A poor attempt at metaphor (perhaps), but many of the fires on this map also originated in northern California, where many of the technologies behind our smartphones originated.

These “stars in our pockets” with their shortcuts, search engines and diversions are causing us to adapt to the navigational demands of an entirely new environment, where the potential costs of doing so include the loss of deep-seated memory, the ability to make our own choices, and discomfort with the “slow art” of interacting with others. Because we don’t exercise these aptitudes when navigating our new mental maps, we risk losing them as we attempt to navigate the old maps of our parallel, off-line worlds.

In a December post, I shared Tristan Harris’s theory that our brains may simply not be able to handle the challenges posed by these tech-driven interfaces. Harris went on to argue that the overwhelming information they provide also produces a kind of learned helplessness in us that’s not so different from where the frog, coming to a slow boil, finds herself.

The trick, I think, is making a deliberate effort to exercise the human capabilities that enabled us to navigate the world before these awesome devices came along—not letting them atrophy—even if we have to spend some equivalent of Howard Axelrod’s time in the northern Vermont woods to come to that realization.

We may need the sharpness, the clarity, of something like his departure and return to notice that much seems to be going awry before we resolve to do something about it.

This post was adapted from my February 2, 2020 newsletter. Newsletters are delivered to subscribers’ in-boxes every Sunday morning and the contents of some of them are later posted here. If you’d like to receive a weekly newsletter, you can subscribe by leaving your email address in the column to the right.

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.

Nostalgia Can Help Us Build a Better Future

October 29, 2019 By David Griesing Leave a Comment

There is a widespread consensus that we’re on the cusp of a workplace revolution that will automate millions of jobs and replace millions of workers.

Among the many questions is whether these displaced workers will still be able to support themselves because technologies that are on the rise, like augmented and artificial intelligence, will spawn millions of new jobs and a new prosperity.

Those fearing that far more jobs will be eliminated than created have argued for fixes like a universal basic income that would place a minimum financial floor under every adult while ensuring that society doesn’t dissolve into chaos. How this safety net would be paid for and administered has always been far less clear in these proposals.

Others are arguing that the automation revolution will usher in a new era of flourishing, with some new jobs maintaining and safeguarding the new automated systems, and many others that we can’t even imagine yet. However, these new programming and maintainence jobs won’t be plentiful enough to replace the “manual” jobs that will be lost in our offices, factories and transportation systems. Other “replacement jobs” might also be scarce. In a post last January, I cited John Hagel’s argument that most new jobs will bunch towards the innovative, the most highly skilled, what he called “the scaling edge” of the job spectrum.

On the other hand, analysts who have considered the automation revolution at McKinsey Global Institute noted in a July, 2019 report that automation will also produce a burst of productivity and profitability within companies, that employees will be able to work more efficiently and reduce their time working (5-hour days or 4- day work weeks) while gaining more leisure time. With more routine tasks being automated, McKinsey estimates that the growing need to customize products and services for consumers with more time on their hands will create new companies and an avalanche of new jobs to serve them. At the same time, demands for more customization of existing products and services will create new jobs that require “people skills” in offices and on factory floors.

As we stand here today, it is difficult to know whether we should share Hagel’s concern or McKinsey’s optimism.

Predicting the likely impacts at the beginning of a workplace revolution is hardly an exact science. To the extent that history is a teacher, those with less education, fewer high-level skills and difficulties adapting to changing circumstances will be harmed the most. Far less certain are the impacts on the rest of us, whose education, skill levels and adaptability are greater but who may be less comfortable at the “scaling” edges of our industries.

Then there’s the brighter side. Will we be paid the same (or more) as we are today given the greater efficiency and productivity that automation will provide?  Will we work less but still have enough disposable income to support all of the new companies and workers who eager to serve our leisure time pursuits?  Maybe.

It is also possible to imagine scenarios where millions of people lose their livelihoods and government programs becomes “the last resort” to maintain living standards. Will vast new bureaucracies administer the social safety nets that will be required? Will the taxes on an increasingly productive business sector (with their slimmed down payrolls) be enough to support these programs? Will those who want to work have sufficient opportunities for re-training to fill the new jobs that are created?  And even more fundamentally, will we be able to accommodate the shift from free enterprise to something that looks a lot more like a welfare state?

While most of us have been dominated by the daily tremors and upheavals in politics, there are also daily tremors and upheavals that are changing how we work and even whether we’ll be able to work for “a livable wage” if we want to.

As I argued recently in The Next Crisis Will Be a Terrible Thing to Waste, the chance to realize your priorities improve significantly during times of disruption as long as you’re clear about your objectives and have done some tactical planning in advance. As you know, I also believe in the confidence that comes with hope OR that you can change things for the better if you believe enough in the future that you’re ready to act on its behalf.

Beyond finding and continuing to do “good work” in this new economy, I listed my key priorities in that post: policies that support thriving workers, families and communities and not just successful companies; jobs that assume greater environmental stewardship as essential to their productivity; and expanding the notion of what it means for a company “to be profitable” for all of its stakeholders.

From this morning’s perspective—and assuming that the future of work holds at least as much opportunity as misfortune—I’ve been not only thinking about those priorities but also about things I miss today that seemed to exist in the past. In other words, a period of rapid change like this is also a time for what Harvard’s Svetlana Boym once called “reflective nostalgia.” The question is how this singular mindset can fuel our passion for the objectives we want—motivate us to take more risks for the sake of change—in the turbulent days ahead.

Nostalgia isn’t about specific memories. Instead, it’s about a sense of loss, an emptiness today that you feel had once been filled in your life or work.

Unlike the kind of nostalgia that attempts to recreate a lost world from the ruins of the past, reflective nostalgia acknowledges your loss but also the impossibility of your ever recovering that former time. By establishing a healthy distance from an idealized past, reflective nostalgia liberates you to find new ways to gain something that you still need in the very different circumstances of the future that you want.

Because the urge to fill unsatisfied needs is a powerful motivator, I’ve been thinking about needs of mine that once were met, aren’t being met today, but could be satisfied again “if I always keep them in mind” while pursuing my priorities in the future. As you mull over my short list of “nostalgias” and think about yours, please feel free to drop me a line about losses you’d like to recoup in a world that’s on the cusp of reinvention.

MY SHORT LIST OF LOSSES:

– I miss a time when strangers (from marketers to the government) knew less about my susceptabilities and hot buttons. Today, given the on-line breadcrumbs I leave in my wake, strangers can track me, discover dimensions of my life that once were mine alone, and use that information to influence my decisions or just look over my shoulder. Re-building and protecting my private space is at the core of my ability to thrive.

I want to own my personal data, to sell it or not as I choose, instead of having it taken from me whenever I’m on-line or face a surveillance camera in a public space. I want a right to privacy that’s created by law, shielded from technology and protected by the authorities. The rapid advance of artificial intelligence at work and outside of it gives the creation of this right particular urgency as the world shifts and the boundaries around life and work are re-drawn.

– I miss a time when I didn’t think my organized world would fall apart if my technology failed, my battery went dead, the electricity was cut off or the internet was no longer available. I miss my self-reliance and resent my dependency on machines.

If I do have “more free time” in the future of work, I’ll push for more tech that I can fix when it breaks down and more resources that can help me to do so. I’ll advocate for more “fail-safe” back-up systems to reduce my vulnerability when my tech goes down. There is also the matter of my autonomy. I need to have greater understanding and control over the limits and possibilities of the tech tools that I use everyday because, to some degree, I am already a prisoner of my incompetence as one recent article puts it.

One possibility is that turning over [more] decisions and actions to an AI assistant creates a “nanny world” that makes us less and less able to act on our own. It’s what one writer has called the ‘Jeeves effect’ after the P.G. Wodehouse butler character who is so capable that Bertie Wooster, his employer, can get by being completely incompetent.

My real-life analogy is this. Even though I’ve had access to a calculator for most of my life, it’s still valuable for me to know how to add, subtract, multiply and divide without one. As tech moves farther beyond my ability to understand it or perform its critical functions manually, I need to maintain (or recover) more of that capability. Related to my first nostalgia, I’d meet this need by actively seeking “a healthier relationship” with my technology in my future jobs.

– I remember a time when I was not afraid that my lifestyle and consumption patterns were helping to degrade the world around me faster than the world’s ability to repair itself. At the same time, I know today that my absence of concern during much of my work life had more to do with my ignorance than the maintenance of a truly healthy balance between what nature was giving and humankind (including me) was taking.

As a result, I need greater confidence that my part in restoring that balance is a core requirement of any jobs that I’ll do in the future. With my sense of loss in mind, I can encourage more sustainable ways to work (and live) to evolve.

-Finally, I miss a time when a company’s success included caring for the welfare of workers, families and communities instead of merely its shareholders’ profits, a model that was not uncommon from the end of World War II through the 1970s. I miss a time, not so long ago, when workers bargained collectively and successfully for their rights and benefits on the job. I miss a time when good jobs with adequate pay and benefits along with safe working conditions were protected by carefully crafted trade protections instead of being easily eliminated as “too expensive” or “inefficient.”

While this post-War period can never be recovered, a leading group of corporate executives (The Business Roundtable) recently committed their companies to serving not only their shareholders but also their other “stakeholders,” including their employees and the communities where they’re located. As millions of jobs are lost to automation and new jobs are created in the disruption that follows, I’ll have multiple opportunities as a part of “this new economy workforce” to challenge companies I work for (and with) to embrace the broader standard of profitability that I miss.

+ + +

Instead of being mired in the past, reflective nostalgia provides the freedom to seek opportunities to fill real needs that have never gone away. With this motivating mindset, the future of work won’t just happen to me. It becomes a set of possibilities that I can actually shape.

This post was adapted from my October 27, 2019 newsletter. When you subscribe, a new newsletter/post will be delivered to your inbox every Sunday morning.