Reflections on Physicians’ NEJM Rant

By Pascal Dennis

Jan 14 issue of NEJM included an interesting Opinion Page piece by Drs Hartzband and Groopman

With all due respect, the good doctors voice opinions that were canards a century ago, and are outright howlers today.

Here are just a few:

• Standardization does not apply in medicine


• People are not cars


• Lean means stop-watching the patient-physician interaction

The authors continually equate Taylorism with Toyota, despite the obvious and well-documented differences in philosophy and practice.

NEJM readers and many of our colleagues, notably Mark Graban, have provided a cogent point by point rebuttal

I’m struck by the authors’ degree of frustration and sense of grievance.

The medical profession is in the midst of epochal change. Used to be most doctors were self-employed. Now most work for large organizations and the trend will only accelerate.

Are physicians comfortable working in teams, thinking laterally, making problems visible, and having their thinking regularly challenged by uppity nurses, patients and others? Perhaps not.

Physicians are very indeed at good scientific thinking and structured problem solving. In my experience, they also quickly absorb other Lean fundamentals – provided we translate them together and prove they work.

Fair enough, no?

So to Drs Hartzband and Groopman, with great respect, please reflect on the all feedback you’ve received.

Lean is not your enemy – quite the contrary.

Best regards,

Pascal

Pascal Dennis Bio

On Labels – ‘Expert, Master, Sensei’ and the like

By Pascal Dennis

My friend and colleague Mark Graban, always astute, has highlighted an important issue for Lean thinkers.

Is it right and proper to call one’s self an ‘expert, master or sensei’?

In a word – no.

It's important in my view to recognize that we humans are sly, lazy, imperfect beings. (At least this one is.)

Granting one's self such a label usually means we've stopped learning.

My best Toyota senseis had no trouble saying, "I don't know." They'd run experiments and study the results to fill in their knowledge gaps, of course.

But they never put on airs, and never granted themselves lofty titles.

I remember Mr. Hayashi, our TMMC OMCD sensei, sitting at the picnic tables by the production line, quietly doodling in his notebook.

He was 75 years old at the time, and one of Toyota’s most senior and respected senseis.

"What are you doing, sensei?" I asked.

"Working on a problem,” he smiled. “It's eluded me for a long time. But I think I’m getting somewhere!”

Still humble and open at the age of 75.

Needless to say, Mr. Hayashi would never dream of calling himself an expert!

Best regards,

Pascal

Pascal Dennis Bio