FROM THE POLITICS OF ‘LIVID PUS’ TO THE POLITICS OF NUDGING
Address to the Hospital & Community Dentistry Conference - Ian Powell, Executive Director, ASMS
31 July 2010
Thank you for the opportunity to address you again. As always my comments are personal observations although in broad terms at least I believe they are consistent with the Association’s view on the matters discussed. My theme today is how one should approach some of the key challenges of the moment.
But first I would like to briefly pay tribute to one of your highly respected colleagues, John Hawke who passed away earlier this year. John was elected to the Association’s first National Executive in 1989, was our third National President (1995-97) and was our first life member. It is difficult to think of a more decent honourable person than John. It has been interesting to learn of the high regard of so many ASMS members who trained under or worked with him in dentistry and intensive care in Auckland. One of our National Executive members who had trained under John aptly described him as one out of the box. He adhered to values which stand the test of time and one became a better person by knowing him. He was also known for his wicked sense of humour often used as a weapon to treat people with respect. Aside from his telephone jokes, my personal favourite comes from a Tauranga anaesthetist who had trained under him – John used to say to registrars in his unit that he would give up his career if he could become a rich woman’s plaything.
The inspiration for the title of this address came from an article I read on a phenomenon in France, Paris in particular, in the 1780s prior to the French Revolution. The article was a fascinating account of a surprising number of semi-underground scandal writers who made their name and income writing about the French nobility and monarchy in the most unflattering manner. Their level of abuse would make Michael Laws look like a diplomat. But they were also in competition with each other attacking their rivals in similar tone. I was struck by the vivid language of one writer attacking another describing him as having “a mouth from whose corners there is a constant trickle of livid pus”.[1] Sometimes the passionate and angry debates in the health sector can have a trickling ‘livid pus’ feel about them.
Trickling ‘livid pus’ (or frothing at the mouth) may be a useful release for pent up emotions (personally I doubt it) but it does not advance a good argument. Instead I like to think of the ASMS as a compulsive ‘nudger’. Rather than dribbling mouths and bad hygiene, we nudge, we nudge there, and we nudge everywhere. In a generally incremental manner we seek to prod, push, persuade, nag and bore the government of the day and DHB leaders in the direction we believe the health system should go. We are like a dog with no teeth. These dogs have strong gums and can suck very hard.
Rarely are decisions made as a result of a ‘big bang’ approach, knock-out punches are few and far between, and there are no magic bullets. Persistent nudging is our methodology. It recognises the wisdom of Will Rogers who observed that “even if you are on the right track you’ll get run over if you just sit there” but also recognises the futility of drama queen behaviour. It is interesting to note that there is a theory of economics called ‘nudgenomics’ located somewhere between Friedman and Keynes.
Having said this I am tempted at times by the observation of General MacArthur that “whoever said the pen is mightier than the sword, obviously never encountered automatic weapons.”
Within the context of nudging rather than ‘livid pus’ the main issues I want to discuss today are:
1. Cross-dressing central health leadership
2. Wither clinical leadership
3. Specialist workforce incapacity
[1] ‘Paris: Notes from the Underground’, Colin James, New York Review of Books, 13 May 2010, p.41.
