April, 2017: What am I doing Now? Contribution and Effectiveness

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“This Business Supports Rainbow Crosswalks” – Washington, DC USA – 2017.04.16 DC People and Places 02453 (View on Flickr.com)

Greetings from Washington, DC (of course) and welcome to my second now update, April, 2017.

My Now profile and my contribution

Link: Ted Eytan, MD Profile on NowNowNow.com

What was great about this process was the questions asked in the creation of the profile.

To the question “What do you do?” I answered:

I create things and support people who help the world learn to love better.Ted Eytan, MD – NowNowNow.com Profile

I didn’t even think about creating a response based on my job duties. It was a wonderful coincidence, then, when I read the following passage in Peter Drucker’s “The Effective Executive“:

The head of one of the large management consulting firms always starts an assignment with a new client by spending a few days visiting the senior executives of the client organization one by one. After he has chatted with them about the assignment and the client organization, its history and its people, he asks (though rarely, of course, in these words): “And what do you do that justifies your being on the payroll?” The great majority, he reports, answer: “I run the accounting department,” or “I am in charge of the sales force.” Indeed, not uncommonly the answer is, “I have 850 people working under me.” Only a few say, “It’s my job to give our managers the information they need to make the right decisions,” or “I am responsible for finding out what products the customer will want tomorrow,” or “I have to think through and prepare the decisions the president will have to face tomorrow.”

The man who focuses on efforts and who stresses his downward authority is a subordinate no matter how exalted his title and rank. But the man who focuses on contribution and who takes responsibility for results, no matter how junior, is in the most literal sense of the phrase, “top management.” He holds himself accountable for the performance of the whole. (emphasis added by me)

Drucker, Peter F. (2017-01-24). The Effective Executive: The Definitive Guide to Getting the Right Things Done (Harperbusiness Essentials) (p. 59). HarperCollins. Kindle Edition.

I believe this type of thinking is a feature of the health professions. We tend to think about our purpose rather than our position in a hierarchy.

And Now

  • Assisting in Washington DC’s 10th Capital TransPride. It’s my 5th. This year the event will be hosted by Washington, DC’s Studio Theatre (@Studio_Theatre). It continues to be a great experience to work with this team – 360 degrees of people who are unapologetically proud 🙂 .

Capital TransPride producers, at the Studio Theatre, Washington, DC USA #theta360 – Spherical Image – RICOH THETA

  • Stil working on email newsletter generation and deep-diving into customer relations management systems as well as e-mail marketing. What a fascinating science
  • Reading Stumbling on Happiness
  • Planning my next mini-retirement. Because life is amazing, and I can. Probably at the end of this month.

Updates since my last now update

  • Mini-retirement ended (and it was fantastic)
  • Lots more photos taken, including of the Ivanka Trump Dance Party which received quite a bit of press
  • Coding for a new theme for this blog complete – you’re looking at now, what do you think?
  • “The Case Against Sugar” – Finished – My review is here
  • “Tools of Titans” – still in progress (waiting for my rotation at my local library)
  • “The Effective Executive” – Finished – review coming soon

Is there anything I should be doing that I’m not? I’m turning on the comments with this update, feel free to let me know.

Updated 2017.04.17 – Based on a movement created by Derek Sivers

Photo Friday: At Q Street and at Q Street, NW, It’s LGBTQ Communities – Plural, Washington, DC USA

2017.04.07 The LGBTQ Communities, Washington, DC USA 02171
Rayburn House Building with Q Street, the professional association of LGBT lobbyists and public policy advocates and those working for LGBT equality – 2017.04.07 LGBTQ Communities, Washington, DC USA 02171 (View on Flickr.com)

This week’s photographs were taken about 30 minutes and a few miles apart from each other.

They illustrate what I learned this week. It’s not “The LGBTQ community,” it’s “LGBTQ Communities”

The photograph above is of Q Street, the professional association of LGBT lobbyists and public policy advocates and those working for LGBT equality, at a reception at the Rayburn House Building, in downtown Washington, DC.

The photograph below was taken at Whitman Walker Health, just a few miles away, at the Capital Transpride (@DCTranspride) planning meeting, led by our Co-Chair, Bianca Rey (@BiancaRey) (and event sponsored at the platinum level by Kaiser Permanente Mid-Atlantic States – @KPMidAtlantic). Ruby Corado (@CasaRubyDC) happened to drop by, which made the meeting extra special.

Whitman Walker Health (@WhitmanWalker), our awesome host, by the way, is just off of Q Street (NW) itself, in Washington, DC.

The concept of communities plural came from from Catalina Velasquez (@ConsultCatalina) who is not pictured in the photographs below, but was in the room.

2017.04.07 The LGBTQ Communities, Washington, DC USA 02172
Capital TransPride Producers Group – at Whitman Walker Health, just off of Q Street, NW – 2017.04.07 LGBTQ Communities, Washington, DC USA 02172 (View on Flickr.com)

2017.04.07 The LGBTQ Communities, Washington, DC USA 02174
Capital TransPride Producers Group – at Whitman Walker Health, just off of Q Street, NW 2017.04.07 LGBTQ Communities, Washington, DC USA 02174 (View on Flickr.com)

I’m almost embarrassed to realize that this concept didn’t resonate for me until Catalina explained it to our group. And then I developed the digital film my camera and realized I live this concept every day.

I am more comfortable in some LGBTQ communities over others, like most humans. If you assume that I’m more comfortable in the community in the first photo vs the community in the 2nd and 3rd photos, challenge your assumptions – it’s my 5th TransPride 🙂 .

Because biology is what it is, LGBTQ communities include every race, ethnicity, gender, gender identity in the human species. As a result a member of these communities is more likely than not to connect with more of humanity. That’s been my personal experience and it’s been an asset in every endeavor I’ve been a part of. I can’t think of a better gift to be have been given.

I’m not really embarrassed that I just figured this out, I’m celebrating that this life opportunity includes a mentor around every corner, who isn’t just like me.

To enjoy this gift in Washington, DC, the most protective of the diversity of these communities in the nation, is (cream cheese, no sugar) icing on the kale. Enjoy.

2017 Enterprising Women, Washington, DC USA

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With 2017 Enterprising woman Bianca Rey – 2017.03.21 Tagg Magazine 2017 Enterprising Women, Washington, DC USA 3904 (View on Flickr.com)

Tagg Magazine’s (@TaggMagazine) 2017 Enterprising Women, including Bianca Rey (@BiancaRey), Executive Producer of Capital TransPride.

This will be my 5th Capital TransPride (@TransprideDC), run by a fantastic team, in an even more awesome venue in 2017, Washington, DC’s legendary Studio Theatre (@Studio_Theatre)

Equality is the future. And the future tends to be born here. Washington, DC USA

Additional photos below.

Tagg Magazine's (@TaggMagazine) <a href="https://taggmagazine.com/features/2017-enterprising-women/">2017 Enterprising Women</a>, including Bianca Rey (@BiancaRey), Executive Producer of Capital TransPride. #theta360 – Spherical Image – RICOH THETA

Just Read: Moral Self-Licensing Part 2 – Challenge to Eliminating Bias in Health Care

It gets better.

This is a 2015 update from Author Daniel Effron at London Business School (@lbs) – and yet another reminder that the business profession has done as much if not more work in the area of behavioral health as the medical profession.

Continuing from the previous post on this topic (Just Read: Moral Self-Licensing – a continual challenge to eliminating bias in health care), this update adds more information about human motivation.

I’m framing this post through the perspective of bias, but the principles apply to health behavior, consumer behavior, etc….


  • Counterfactual transgressions – humans will license biased behavior even if they didn’t do something bad in the past (as opposed to doing something good)
  • Prefactual virtues – when a human plans to do something good in the future, they may act biased today
  • Counterfactual virtues – when a human would have planned to do something in the future, they may act biased today
  • Vicarious virtues – the one that concerns me most in health care – when humans reflect on good deeds that the group they are in performed. Why the concern? The general posture of health care as a healing profession and the way organizations inhabit this space provides a tremendous amount of license. It explains, in my mind, why I have seen very UN-virtuous behavior in my career, almost implausibly so, in the profession and in the organizations in this space (well described in this TEDx talk I did with @ReginaHolliday).

This paper adds a scientific lens and the validation that these are human behaviors, with an effect size of 0.31 to be exact, which is

modest in size but robust … (As benchmarks, the average effect sizes in the fields of motivation, social influence, and attribution have been estimated as, respectively, d = .30, .28, and .26; Richard, Bond, & Stokes-Zoota, 2003).

The overall picture, then, is of multiple avenues, real and imagined, that humans use to support biased behavior while engaging in impression management – the view of others and their view of themselves that they are virtuous. It turns out the view of ones’ self is more important than the view of others, which is an asset to leveraged, see below.

And as I wrote about in the last piece, the managed impression tends to be seen as more virtuous by people in the ingroup, and less so by the people in the outgroup, which are often the most vulnerable populations in health care. This would be something along the lines of the scantily clad emperor ….

Impression Management – Leveraging bad for good

Science is great because it can be used to support good as well as not-so-good.

As I have seen in clinical medicine, even the most intractable, frustrating conditions that physicians treat can become less so when they understand the science. Actually, especially those because they are the ones that many practitioners don’t investigate as much, which only increases frustration (I am thinking about things like pain syndromes, musculoskeletal issues, nutrition, etc…).

Here, the fact that human beings are driven by impression management is an asset as much as a liability. Allowing employees opportunities to license themselves (which they will seek anyway) may increase their honest engagement in topics around bias, or to identify compliance issues more readily.

Who you are vs What you do

The other finding in the research is that

For example, framing a past virtue as demonstrating commitment to a virtuous goal (“who I am and what I believe”) compels people to act more virtuously, whereas framing it as progress towards that goal (“what I’ve done”) leads to licensing (Fishbach & Dhar, 2005; Susewind & Hoelzl, 2014).

My interpretation of this data is that linking a person to who they are may limit their tendency to search for evidence that they are “good” and center the impression of their deeds on who they are as a person, which the research points out is a most powerful motivator (vs. if other people think they are virtuous).

These are the pieces of good news – that these mechanisms exist because people want to be virtuous – they are not looking for excuses not to be virtuous.

It is this motive to protect a moral self-image that inhibits people from acting in ethically questionable ways without a license – and that drives them to execute a variety of mental gymnastics when they anticipate that they will need a license.

As usual, many implications for me, for clinical medicine, for health and society

As I mentioned in the last piece, there are well documented, significant biases in health care directed toward groups of patients by their doctors and doctors in training, and the research also shows that physicians have the same level of bias as those in the communities they inhabit. Not more, not less, the same amount. They/we are human.

The way I operationalize this research in my life (and I am human too, so I license) is to

  • Check my licensing with others not in my ingroup
  • Help others check their license, especially those not in my ingroup. An example of this is the conflation of free speech with moral virtue.
  • Avoid licensing opportunities like clicktivism or monetary donation to causes – I tend to give of my mind rather than my money

2017 will be my 5th Capital TransPride (@TransPrideDC), where I serve on the production team, working to be an ally, acutely aware of all the things I have access to because of my place in society, and at the same time as a member of another vulnerable population (LGBTQ) in need of allies. I also look for opportunities to bring leadership from the outgroup into the ingroup, and then leave the ingroup (“the physician role is to bring the patient story into every conversation, then to get out of the way and let the patient tell their own story”)

Always a work in progress. It’s not what you do, it’s what you tolerate.

Reference: Effron, Daniel A., Beyond ‘Being Good Frees Us to Be Bad:’ Moral Self-Licensing and the Fabrication of Moral Credentials (April 14, 2015). P. A. M. Van Lange & J. W. Van Prooijen Van Prooijen, (Eds.), Cheating, corruption, and concealment: Roots of unethical behavior. Cambridge, UK: Cambridge University Press, Forthcoming. Available at SSRN: https://ssrn.com/abstract=2594403

Just Presented: Working to be a Transgender Ally | Wright Center Family Medicine Residency, Washington, DC USA

Capital TransPride 2016
Capital TransPride 2016 – Photo Credit Chadwick Cipiti (View on Flickr.com)

I was asked by James Huang, MD (@semaj187) to give a presentation to the Washington, DC site Wright Center National Family Medicine Residency (@WrightCenterGME) on the policy issues relating to transgender person health.

So, not about how to deliver medical care, how to improve the health of the population. The two concepts are different and interrelated.

The conversation we are having in 2016 is vastly different than the ones I had in 2012, 2013, 2014, and even 2015 (check the way back machine on this blog to see for yourself). Many (most) of the policy levers and protections are in place and the science is clear. That’s not enough / the work is not done, though. It’s time for our specialty (family medicine) and profession (medicine) to lead in providing care and changing the environment so that the care is healing rather than hurtful.

As I commented on this blog previously, Medicare joined the 21st Century in 2014, 3 years ahead of schedule 🙂 . I hope these conversations inspire doctors/people/patients/humans to be as inclusive in their thinking about the total health of the people we serve.

I was asked at the end about the “why” I am engaged in this area. I appreciate the question, and it’s important. There’s a short version in the slides at the end of the presentation. Here’s the longer version.

Feedback and questions welcome, as always.

My 4th Capital TransPride, Washington, DC USA

Capital TransPride 2016, photo credit Chadwick Cipiti (View on Flickr.com)

Above is Capital TransPride (@TransPrideDC) 2016. Below is Capital TransPride 2013

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Capital TransPride 24779 (View on Flickr.com)

This past weekend was my 4th (!) Capital TransPride, the second one held where the future was born in Washington, DC, at 14th and U Streets, Northwest (there’s a short history of this intersection in last year’s blog post: My 3rd Capital TransPride, Washington, DC USA).

As predicted, the room became more full, with more doctors, nurses, therapists, health leaders, and future leaders in general. Even more photographers – as you can tell, mine was not the only camera in the room, nor was it the best one 🙂 .

In other words, just another day in Washington, DC, the capital of a world learning to love better.

Capital TransPride, photo credit Chadwick Cipiti (View on Flickr.com)

Capital TransPride, photo credit Chadwick Cipiti (View on Flickr.com)

Compared to my first TransPride, when there was little access to evidence-based medical care, less federal protection for science and the future, less respect for people being their authentic selves, there’s also less to be said about why to participate in this event compared to 2013. The future pretty much arrived.

The rest of my photos are below, enjoy!