By Jenny Leiser, MD
Does it ever feel like we have enough? As human beings, we always seem to feel like there is more that we want, and we always worry about what we may lose. If we have a car, we want a nicer one. We worry about losing it if we can’t make the payments. If we have a business, we want it to grow and make more money. We also worry it may go bankrupt. At work in clinic, we think “I could do so much better if I had another medical assistant/a nicer office/a better computer system.” Going home, we worry about paying the bills or how to get our kids what they need.
The fear of want is deeply imprinted on our collective psyche. Our ancestors knew hunger, violence, and disease, and we fear these ancient problems as they rear their heads in modern times. As a child, I grew up feeling the long shadow of the Great Depression reaching out toward me. My parents and grandparents shared stories of loss, suffering and survival. Other families tell their own histories and recall their own suffering. Our fears go back to the dawn of the human race. Because this is so visceral, we instinctively resonate with a fear-based narrative of scarcity. The scarcity narrative tells us to do things a certain way: Hunker down, take care of your own, hoard resources. Instead of cooperation, take what you can get. We don’t have enough for “us,” let alone “them.”
Health care in the United States is a booming trillion dollar business, with plenty of money changing hands. Scarcity is not the operative word in many places. High tech specialties make front page news with the latest treatment for an unusual situation. In primary care, we live a different reality. Our core mission is caring for all, meeting the needs of the greatest and the least without regard to any of the divisions in society. We spend our passion in ways that don’t sell newspapers: prevention, wellness, chronic disease management, behavioral health. Our tools are empowerment, support, palliation, the touch of a human hand and the sound of a human voice. Sometimes curing, sometimes healing without curing, always caring, we accompany our patients and communities in grief, loss and joy.
Streams of resources do not easily change direction to move away from centers of power. In primary care we often feel like we are in a fight for the survival of our programs and the missions we hold dear. With our deep seated fear of want, the scarcity narrative rises to the top. Politicized attacks on healthcare, uninsured patients, short staffing, and provider burnout: these make headlines in the paper and in our hearts. How will we navigate these times when one baffling and threatening event piles on the next?
As a person in a leadership position, I struggle to express a leadership response to the anxiety and fear that scarcity engenders. Should everyone know of threats to the mission, or will that just discourage those on the front lines? Some might define good leadership in this setting as “Get in there and fight for my people. Let’s go after our piece of the shrinking pie.” I have been there more than once in my own leadership journey. I don’t like the result. Living and leading from the scarcity narrative keeps us tied to our default state of fear.
There is another narrative we can live, the abundance narrative. The abundance narrative is based in hope and expectation. The abundance narrative tells us that we have resources at our command. It focuses not on what we lack but on what we have.
The leadership challenge of the abundance narrative is to deeply understand the current reality while turning your team from fear. General Colin Powell is quoted as saying “Perpetual optimism is a force multiplier.” As a military leader, General Powell surely did not mean optimism is a sunny, rose-colored view. With deep knowledge of the situation, the team harnesses resources with tenacity and the will to succeed. I have not led the nation into war as General Powell did. However, I have lead a group of discouraged professionals as they shift focus from what they lack to what they have. What seems a grinding setback becomes another way to creatively harness what we have in service of our mission.
Like flowers blooming in a gravel pit, we tap our tenacity, our will, and our resilience. Because our mission in primary care is so clear and so compelling, we will always find a way to meet it with abundance.
Jennifer Leiser, MD is the Family Medicine Division Chief in the Department of Family & Preventive Medicine at the University of Utah School of Medicine.