Well, the Brody School of Medicine at East Carolina University is certainly in the news. The Daily Reflector has published two articles of real significance about our school. Recently, there was an accounting of the history of the development of the school, and Sunday, there was the report that indicates that the school is achieving what it was intended to do – produce primary care physicians who want to stay in North Carolina.

We here down east don’t brag much and are most comfortable being modest. But this is just too much good news for me to stay quiet. We should all be very proud of our school!

Before I sustain a deluge of “bless your hearts,” I want to explain what I meant when I was quoted as saying, “We don’t really deserve that praise – that is what we’re supposed to do. That’s precisely the mission the school was created to serve.” The report was indicating the stellar statistics that our school has achieved in creating primary care doctors.

Technically, my statement is sound. However, it falls short in giving credit to the many mission-driven, dedicated faculty and staff who have given their all to make the remarkable statistics our reality. Our school was created in a time of turmoil and challenge, and today’s results would not have been achieved without the “service-before-self” attitude that has been displayed every single day since the school was created.

We were given a “mission impossible” more than 40 years ago. First, recruit underrepresented students from North Carolina and make them into doctors; second, make them into primary care doctors who want to serve in our communities; and last, cure the disastrous health conditions that even today run rampant throughout the eastern third of our state.

These were the challenges that our leaders took on courageously at the inception of our school. Some may have said they were foolish and reckless. As impossible as this mission seems to us today, the early leaders worked undaunted to accomplish the dream of a transformed health system.

Today, 26 percent of North Carolina doctors who attended medical school in the state are ECU graduates. Those graduates are bringing healing and financial wellness to the communities they serve. As much as $2 million is generated within each of the communities served by these doctors by the downstream economic effects of their practice. This economic benefit is a valuable byproduct of the social good that is being created.

I’ll let you in on a secret: We are still learning how to serve our citizens in even more efficient ways. It is not a coincidence that we are embedded in a health sciences campus with the most prolific and well-respected colleges of nursing and allied health sciences in the state. Add in the new dental school and the other resources across the campus, and, in collaboration with our sister schools, we are poised to revolutionize health care in our region.

Undeniably, the success that is evident today could not have been achieved if we did not have willing and supportive partners. At the inception, there was the Pitt County Memorial Hospital, then University Health Systems and now Vidant Health. Valuable support came from physicians in private practice who quickly learned that the integration of a medical school within eastern North Carolina would add to their abilities to serve their patients. Doctors across the region have been incredibly supportive. There are many others within the local business community and the region in general who have been generous in their support as well.

The miracle of medicine that has occurred in Greenville, by the banks of the mighty Tar River, and in the Pirate Nation will of necessity require that continued dedication and caring that was necessary when the school began. Medicine is undergoing a transformation as we speak, and we believe we can achieve even more as we work together to create an even more positive outcome for the benefit of our citizens. Our school has favored collaboration over competition, and we believe that this approach will be an essential component for our success in the future.

Finally, I must say that I am not really concerned about the “bless your hearts” that may be inevitable. I have always welcomed comment and critique. These comments have allowed me to adjust my thinking and are incredibly valuable. This is one component of strategic planning. We must plan our futures together. I am only perplexed when there is unwarranted criticism of the school. Invariably, this is due to a lack of understanding and, therefore, becomes an opportunity for me to educate and advise.

We are poised to continue the work. Expanding the capacity of the school to continue to serve is clearly on the agenda. My colleagues and I pledge to continue to work to serve our region’s needs while continuing this track record of success.

Go Pirates!

Paul

I have sympathy for presidents of our country – every one of them has to satisfy every constituency in 45 minutes or less. Our current president has turned gaunt and gray under this pressure. Check the before and after picture of each of our modern presidents and tell me what you see?

Compared to a president, I have a micro-responsibility. However, even at this scale, I have found the need to send messages that forecast a future that is positive, and yet they must relate directly to whatever change and transition we are weathering right now.

When the president gave the State of the Union address this week, I am sure he was put to task to not only incorporate some of his own ideas, but also to adopt a stance that could predictably suit “everybody.” I’d like to know who “everybody” is in our country!

On the news, I heard one obviously distressed woman indicate that she wanted the president to tell her that she and others would be getting a job. Huh?!

Closer to our business, leaders were asked their opinions, and the “demands” were as wide-ranging as you could possibly imagine.

I heard issues of missing transparency in health care access, to way-out-there innovation. Reform of our payment system and elimination of waste; nutrition education and revamping Medicare; fixing the national debt and physician payment. All were mentioned.

One bright person said, “And it’s in everybody’s interest. We all contributed to the problem, so we all have to pull together.” Wow! That’s a revelation!

So, as we weather the storm – the fiscal cliff being one of many threats – we need to rely on the resiliency we have built up over the years as a nation and here at the Brody School of Medicine.

It’s like walking down the hallway after a trauma page, not knowing what you will find, and yet feeling confident that this is what you trained for all of your life. More importantly, there is a patient who is going to rely on you.

I like to think of each of us as missionaries. Undaunted, we will carry on.

Talk to me!

Best,

Paul

Living here in Greenville offers the opportunity to see much of Gate E38 at the Charlotte airport and beyond that location fly over much of the country. Quite frankly, I am glad that the important traveling is completed for this season! Much of the work on behalf of the school is accomplished right up close and personal, here at home in Pirate Country and within the state of North Carolina. I could substitute 30,000 feet measured in altitude with the number of human feet that are coming and going to our meetings here, each two at a time!

The view from 30,000 feet in the air can be quite useful. On one of the recent trips, we could see the eye of Hurricane Sandy off the starboard side of the plane. It may have been a hundred miles away, but the eye wall was clearly visible.

Just as fascinating, here at work, it sometimes is useful to see the issues from a different perspective – from high altitude. It provides a view that erases boundaries and creates otherwise unappreciated opportunities.

Photo by Scott Birge/treknature.com

It’s still crucial to come down to earth. While at height, the eye of an eagle would be the most appropriate animal comparison, the corresponding view at ground level is closer to that of possessing the eye acuity of Musca domestica – the common housefly.

Flies have compound eyes with many lenses that offer high-resolution imaging. They allow an almost complete 360 degrees of vision. Just try to swat a fly! They can react from almost any angle of attack!

Many of our issues today present levels of complexity that need sharpened focus and, at the same time, 360 degrees of vision. We face great challenges and wonderful opportunities that will be evident in the next several months and the upcoming years. The ability for us to go from wide angle to laser-like focus is an indispensable capability.

I am glad then to be down to earth with all of the brightest humans here at the Brody School of Medicine and at East Carolina University. It is wonderful to know that, in aggregate, we have compound eyes capable of creating possibilities that could not be achieved “up there, somewhere.” That’s even with the eyes of one eagle.

All the best,

Paul

Hot summer days can cause daydreaming. Thoughts drift toward occasions and things that have influenced me and made my own life richer and more meaningful.

One of my role models, Dr. Arthur H. Aufses Jr., professor emeritus of surgery at Mount Sinai Hospital in New York.

Some of my most pleasant memories have been built around cars. In fact, I have been fascinated by anything that involves movement and machinery. This delight in mechanical things likely developed as I followed my grandfather in his rounds through our family’s chocolate factory in Jamaica. The more serious and chronic “infection” occurred as I “helped” my father with his car repairs. That was until he tired of my so called assistance and dismissed me to “go to your mother!” Until then, I would ask questions and absorb all that I could about the underpinnings of whatever car he was working on.

Of course, I had my own collection of model cars: Matchbox cars, Dinky cars and many other brands I can’t seem to remember. Some had wind-up motors, some scooted off, driven by an internal flywheel, and others just looked racy. Many became victims of a curious young mind and were irrevocably dismantled to find out what made them go.

Some of the largest ones were all shiny and made out of tinny metal. They certainly were created to catch a young child’s eye. As a budding car enthusiast, it soon became clear that the better and more durable value was to be found in the less flashy, more densely weighted die-cast models. They had much more detail and depth to offer.

Today, one also has choices in “roll models,” or role models, to be more precise.

I understand that today one can find a role model online. The value apparently is in the communication, no matter how impersonal.

My role models have all cast a long shadow in their close and available presence. I have admired them in some very significant and personal way. They each have displayed qualities that I feel are worth emulating.

Interestingly, all of the role models in my life have been what would be considered “real people.” Perhaps the better description would be to say that they were compellingly authentic. Candid, reliable and lucid in thought, compassionate and caring in style.

All have been confident in who they have been and understandably proud of the journey that took them to the place in their lives they occupied.

It has been a personal pleasure to recognize that there are so many accomplished individuals who have dedicated themselves to the work of the Brody School of Medicine. It is easy to recognize that we have hundreds of role models here. All that is necessary, then, is for each of us to understand what being a role model means and be comfortable in that recognition.

Our patients, our students and our colleagues interdependently rely on us for this conscious authenticity. So do our families, acquaintances and our community at large.

Are you aware that you are someone’s role model right now? If you could pick your own role models, who would they be, and why?

But don’t let the heat get to you!

Paul

Rawl

In a recent testament, I received a call from a person in Conetoe to emphasize how Dr. Rawl has been such a comfort to the community.

I remember when I first came to eastern North Carolina and settled in Windsor. The shortest way to Raleigh then was along old U.S. 64 to Route 42. It took us through Williamston, Everetts, Robersonville, Parmele, Bethel, Conetoe, Pinetops and on to Wilson. Only there was one able to connect with U.S. 264. There were still many other small towns to pass through, but the road became somewhat wider, and there were not that many stops left. There were thriving roadside businesses all along the way.

I drive that route sometimes just for old times’ sake. In some areas, if you look to the north, through the trees, you can glimpse the cars on the new U.S. 64, travelling at 70 plus miles per hour. The tourists to our region hardly know about these old roads. The 64 bypass has become the fast lane to the beach!

Dr. Ken Steinweg, Dr. Rawl and others have clearly struggled to maintain really close and convenient services in Bethel for years. Some folks can literally walk from home. It is easy to see how that convenience would be valuable.

There are clear and compelling reasons to consolidate our services in the new Family Medicine Center. We must provide the same upgraded “patient-centered care” that all the folks now experience in the new state-of-the-art facility. Even though this is an imperative, every one of the caring individuals I have spoken with has reacted to the emotion that individuals from Bethel have clearly demonstrated. The sense of loss is real and should be respected and acknowledged. In full context, the community has already lost most of its commercial enterprises, and the clinic that has held on for 62 years, is clearly the last victim of circumstances. I can only imagine what that loss means in terms of the emotional content.

To try to do all that is humanly and technically possible, we have left no stone unturned. Over the last decade, this work has included many carefully planned ways to reduce costs while maintaining services. The building is old, and we have tried to keep it occupied and maintained in the most cost-effective manner. Most recently, we have started a conversation on exploring the possibility of having the Pitt Area Transportation System reach out to Bethel. This could potentially help with transportation for those without cars or sufficient finances. This effort is an attempt to close the 15-mile distance between our towns.  We have inquired at the Bernstein clinic, but this facility has all that it can handle right now. We have even looked into creating the opportunity for home visits by Dr. Rawl. The community itself has rallied, and most recently, out of love for the people of the area, a very caring Bethel community member has indicated a willingness try to open a private medical clinic. He is a very generous man, and I applaud him for his very kind gesture.

Here at The Brody, even though we are not experiencing “business as usual,” our dedicated staff members have maintained their focus on the mission without a sideways glance. Such is their passion for serving others!

We remain hopeful for all who live in eastern North Carolina. We will be smart and will use our resources most effectively, for the benefit of all of the citizens that we serve. That pledge to maintain focus on our mission includes Pitt County, and of course, all those beyond.

We are truly blessed.

Paul

This Jamaica shop shows a unique way of working together.

The last few days have offered the opportunity to learn in support of leadership. For me, sometimes, it takes a distracting set of personal real-world experiences to gain insight on the journey to clarity.

First came the visit from the Liaison Committee for Medical Education and the accreditation review of our school. We have received their draft report and have responded. There were no surprises. The snapshot of our educational programs revealed that our purposes and goals align with the “purple and gold.” Our faculty members are dedicated to the success of our students, and we remain steadfast in support of our tripartite mission. Bottom line is that we have done well, and now we must do better!

The last couple of days have been spent at the Council of Deans spring meeting in Florida. This was a very useful meeting as there was the opportunity to explore the boundaries of medical education and health care with the other deans from across the nation. Linking our health system to the real social and economic needs of the communities that we serve was one of the major themes. As you know, the Brody School of Medicine has ranked seventh in the nation in this regard, so we had something to contribute to the conversation.

Florida is about an hour and 50 minutes from my mother in Jamaica, so I decided to stop in for a couple of days before returning home to Greenville. She lives in the center of the island in the mountains.

So, having come from Miami where the hotels and services are “over the top” to a county town in Jamaica where a hotel upgrade means air conditioning and hot running water on demand, there was sufficient contrast for some reality-checking. (Add spring break in full swing in Miami for additional distraction!)

As you may have recognized, we have been seriously engaged in talks with our partners at Vidant Health with regard to clinical integration. Not so obvious is the fact that the complexity in creating a full strategic alignment comes from the fact that we often duplicate services and functions. Almost invariably, we are both proud and satisfied of the quality and value of these services. Double helpings of motherhood and apple pie!

During a customary walk at dawn in Jamaica, I was thinking about “the Brody” and happened by Kenneth OR Ben’s upholstery shop, just down the road from “Lane” in Mandeville. Back engineering the thought process could offer insight into the decision-making for the wording of the sign. The sign on the wall of the establishment perhaps signaled a complex process of negotiation between Kenneth and Ben.

Rent and costs are expensive, and in a micro-economy where survival depends on meager margins, the most efficient deployment would necessitate sharing of the costs. Further, for efficiency, one telephone number, with an efficient “back-office” triage system would be optimal. For customer retention, the product must be of high quality and competitive in a very dynamic marketplace.

Kenneth and Ben are very smart people. Whenever I visit next, I’ll look for the next evolution in the business relationship. I am predicting that the sign will say Kenneth AND/or Ben’s upholstery.

Can you make the connections? How efficient do we need to be with health care reform in full implementation? What are the plausible scenarios in the future for Kenneth and Ben? What do you think?

Paul

 She was at mass one day and heard the priest repeat a few lines very slowly and oddly. In thinking that he was having a stroke, she approached the pulpit. As a diabetic educator and research nurse, she quickly realized that he was hypoglycemic. In caring for him and talking with him, she noticed severe symptoms such as a potential deep vein thrombosis and indication of infection. They negotiated that he would go to the hospital immediately following mass, as he had come up for the first communion ceremony and was determined to finish it for the children. Afterward, he went to the hospital and was admitted for immediate antibiotic treatment and therapy for the clot.

Although he asked for no visitors, he requested that she come and see him. Together they talked about what she knew best: diabetes. She helped him understand the disease and the problematic symptoms. It was through her ability to identify a problem, follow her gut and demand that the priest, an obvious authority figure, trust her and seek treatment that she was able to change and potentially save a life.

This was a great example of a “Just do it!” story. It is one of more than 400 stories of peak experiences heard late last year by a team of 60 staff, faculty, M2s and senior administrators who interviewed their peers in the school’s community. Their goal: to discern what gives life to BSOM when we are “creating possibility.” On Friday, Jan. 20, these interviewers came together in energetic fashion to make sense of what they had heard.

Together they identified enduring factors that appeared again and again in the interviews: unconditional respect; “get your ego out of the way;” feeding the fire; “persistaverance.” Metaphors were created to more deeply describe the medical school when it is at its best in creating possibility: a team of rowers with a common goal; balloons of many kinds rising together; a tree with strong roots and many possibilities for the spring; a single family of healers embracing our community.

What will be done with so much work? First, a group of six will refine the afternoon’s outcomes into a white paper that will be shared with the Brody community. We’ll then begin imagining together a future BSOM that gives life to those peak experiences and the positive core of the Brody School of Medicine.

Stay tuned.

Paul