Welcome Back

Jim Guest

I want to make a couple of comments. I think this process is working. This unusual and more organic way of working seems to be the way this group of people and alliance has worked.

When it came to the third round of work for my track yesterday, we didn’t go into the small groups as we planned. We stayed in our large group because we had significant concerns about the good medical practice document. There were comments that it is overly long, overly redundant, whether or not can we get buy in, and other issues. What struck me is that people were willing to talk about it.

We talked about the purpose of this document and not the wordsmithing. This document is something that has grown out of the earlier summits. There were about 25 people who worked on the first draft. Before this document goes to a wider audience, it was really important to have this input. The dialogue was a reflection of the organic process we’ve had. Not having a highly structured process made this possible. It was a dialogue not a debate. It was so important that this didn’t get stuck under the surface. This is an affirmation of the process we’re willing to go through.

The importance of getting all the voices to weigh in on this is essential.  It was important that we put aside our institutional perspectives, sometimes even our personal perspectives to allow all the perspectives to come in.

I’m not going to receive the entire Mending Wall by Robert Frost (see below), but I do want to point to something from it. There were two farmers, one of who was more short-sighted and more constrained and he repeats through that good fences make good neighbors,, while the other farmer who is more mature starts considering the fact that something there is that doesn't love a wall, This can be our guide for today.

Comment: As you’re taking down the wall it’s good if you don’t take down the stones and throw them. (laughter)

Michael Kaufman

Any other reflections about yesterday?

I think what happened with the GMP document shows the diversity that we reflect. This is a complex document and if it were accepted right away, I would be suspect. This has been a respectful dialogue. This stretches our imaginations. We should celebrate that our alliance is working this way.

I think when I was doing work in the group, there had been confusion about whether we working on a process that might lead us to the next five years down the road. A lot of times several groups said this is a good idea but might never exist. There is confusion about whether we should be aspirational or practical with what is available today. There needs to be clarity about where we put the stake in the ground.

This is an ongoing process. Where will the further refining of the GMP document happen?

MK: The track two group will decide that.

This dynamic of unclarity is not something new. This is how the whole process has been.

I want people to think about this but not answer it. The document could be vetted through all physicians and the public. I don’t know if it’s technically possible, but with Jim Guest here, maybe we could have an article in Consumer Reports that people could comment on, or if the group bought an ad in the New England Journal of Medicine, maybe people would respond.  I don’t know what 8000 physicians think about this but maybe we could find out. There may be implications to this I haven’t thought of but I wanted the idea out there.

We need to balance having the dialogue and getting to results.

The results this process has produced are not necessarily visible. There are lots of results of these conversations, such as with the certifying boards. Another is with the portfolio that emerged from the third summit that has been taken forward. The process of dialogue here has resulted in conversations that we don’t spend time talking about.

A new way of thinking about the continuum of development from school to practice has really changed my way of thinking of how to approach my students.

Margaret Wheatley says that when good people get together to talk about things that matter to them, good things happen.

I sit here thinking of the Iroquois nation and the analogy of the single stick versus the five.

MK: Okay, let’s break into our three tracks..

Scribing

 

MENDING WALL

Robert Frost

Something there is that doesn't love a wall,
That sends the frozen-ground-swell under it,
And spills the upper boulders in the sun,
And makes gaps even two can pass abreast.
The work of hunters is another thing:
I have come after them and made repair
Where they have left not one stone on a stone,
But they would have the rabbit out of hiding,
To please the yelping dogs. The gaps I mean,
No one has seen them made or heard them made,
But at spring mending-time we find them there.
I let my neighbor know beyond the hill;
And on a day we meet to walk the line
And set the wall between us once again.
We keep the wall between us as we go.
To each the boulders that have fallen to each.
And some are loaves and some so nearly balls
We have to use a spell to make them balance:
'Stay where you are until our backs are turned!'
We wear our fingers rough with handling them.
Oh, just another kind of out-door game,
One on a side. It comes to little more:
There where it is we do not need the wall:
He is all pine and I am apple orchard.
My apple trees will never get across
And eat the cones under his pines, I tell him.
He only says, 'Good fences make good neighbors'.
Spring is the mischief in me, and I wonder
If I could put a notion in his head:
'Why do they make good neighbors? Isn't it
Where there are cows?
But here there are no cows.
Before I built a wall I'd ask to know
What I was walling in or walling out,
And to whom I was like to give offence.
Something there is that doesn't love a wall,
That wants it down.' I could say 'Elves' to him,
But it's not elves exactly, and I'd rather
He said it for himself. I see him there
Bringing a stone grasped firmly by the top
In each hand, like an old-stone savage armed.
He moves in darkness as it seems to me~
Not of woods only and the shade of trees.
He will not go behind his father's saying,
And he likes having thought of it so well
He says again, "Good fences make good neighbors."

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