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It's hard to soar with eagles when you're surrounded by ducks quacking 'No!'
“It’s hard to soar with eagles when you’re surrounded by ducks quacking ‘No!’” ~unknown
This is my own modification of the famous “It’s hard to soar with eagles when you’re surrounded by turkeys.” The source of this original quote is unknown. I have used my modification of this quote for most of my career.
It seems anything I have accomplished of any significance in our federal bureaucracy for the last 24 years has revolved around finding those “eagles” in the system with the courage to say, or find a way to say, “yes.” Admittedly, “no” is the far safer choice when dealing with innovation or change (or me). “‘No” instantly reduces paperwork, stress, responsibility, blame and gets you home in time for dinner.
As I write this, the impact of federal budget sequestration is days away. Already, “no” seems to be the overwhelming answer, now and for the foreseeable future, for just about everything that needs doing. I understand that “no” is often the right answer for both the individual and the organization. My concern is that fear, apathy and uncertainty created by the budget brinksmanship that appears to define our congressional leaders will severely damage our federal healthcare system when warriors and their families need it most. I am concerned this fear will inspire a chorus of irrational “no” at all levels that can only degrade professional development and patient care.
I cannot predict the impact looming budget battles and the realities of spiraling healthcare costs eventually will have on federal medicine. I think it is safe to expect everything we do is going to get a bit more difficult in the near term. We have certainly faced challenges as significant, if not more so, in our collective past.
Federal medicine providers said “yes” to turning the Old Patent Office Building (now part of the Smithsonian Institution) into a temporary hospital for the unexpected influx of thousands of wounded soldiers from the Civil War’s failed Peninsula Campaign and the many battles that followed. Federal medicine survived plenty of fiscal “belt tightening” during the Depression and even managed, through the “yes” efforts of the Tennessee Valley Authority, to banish malaria from the American South. Throughout American history, federal medicine has responded in times of war, fiscal crisis or national epidemics because the providers and support personnel that make up federal medicine have found ways to say “yes” when conditions at the time would have suggested a resounding “no” was the safe play.
Once again, we are faced with conditions and fiscal realities that seem overwhelming. For many, these conditions will be overpowering and they will have an irresistible urge to quack “no” at everything that comes to them for a decision. Perhaps I have taken my metaphor too far, but I believe all will understand the importance for our collective success in striving to be eagles in the coming fiscal uncertainty, not ducks.
During difficult times like these, ducks will complain, chastise, find fault, offer excuses, lament their circumstances and use “no” as much as possible. It is easy to get to “yes” in times of plenty; the challenge is to continue to move the federal medicine “ball” forward when times are hard. After 12 years of conflict, our patients will need federal medicine to find innovative ways of maintaining quality healthcare within our system despite budget lapses. It likely will be harder to accomplish many things we have taken for granted in the recent past.
Examples of this already abound with limitations on travel, meetings and reductions in contract employees. We will need to all, collectively, work a little bit harder, have a little bit more tolerance with each other, do a bit more paperwork and strive to be a bit more innovative to get to the “yes” that our patients and colleagues need and deserve. Each of us, within our spheres of influence, will need to strive to be eagles, rather than mindless quacking ducks.
If history is any predictor, federal medicine providers and support staff will rise to this latest challenge by finding new and innovative ways to maintain quality care in the face of stark budget realities. I have no illusions that federal medicine practiced under the Draconian cuts represented by sequestration will be anything but tough. Even if Congress manages to agree to kick the can further down the road or (irrational hope) actually works together for a long-term budget agreement to deal with our nation’s deficit, the realities of a military in drawdown following war will strain our health system. After 24 years as one among you, I know this system is up for this challenge. I will leave you with a quote from Theodore Roosevelt (1858-1919), a man who knew a thing or two about adversity, “There has never yet been a man in our history who led a life of ease whose name is worth remembering.”