How far should you compromise your ideals in order to gain “a seat at the table” and the opportunity to influence decision makers? This question was explored in the British Medical Journal (BMJ) a couple of weeks ago in an article headed “How medical leaders win friends and influence people (1)”. Normally, I skim this sort of thing over breakfast, file it in the circular file under the sink, then once a year, pretend I’ve read it in order to scrape together enough Continuing Professional Development points to keep my medical licence going for another year. So I duly filed this in the usual place and went to work. However, something about it kept bothering me, so when I got home, I retrieved it from the circular file and thought long and hard about its implications.
I will never hold public office, be the president of a medical Royal College or sit in a think tank (whatever that is). When I die, my colleagues won’t write a glowing obituary praising my achievements and my leadership abilities. My portrait will never hang in the corridors of power. For a start, I find meetings intensely boring and I would rather be gardening, walking in the countryside, playing music or doing almost anything else other than sitting in a meeting. But more importantly, my views are so divergent from the mainstream that my presence in most meetings would be disruptive and would make it hard for the meeting to reach consensus.
For example, I believe that the world’s food and energy supplies will decrease during the course of this century. Most people think they will increase. I believe that infinite economic growth is physically and mathematically impossible. Most people think that it is not only possible, but necessary and desirable. I believe that we should be educating people to expect fewer and simpler medical services during the course of this century, and to take more responsibility for their own health. Most people would denounce this as “austerity” or “cutbacks” and believe that in future we will be delivering more technically advanced treatments such as pharmaceutical and genetic therapies which are tailored to individual patients, and that we will find “cures” for cancer, heart disease, Alzheimers disease and the like. Put me in a meeting with a group of “normal” people and you have a recipe for arguments, frustration and complete lack of progress.
The BMJ article advocates a “soft power” approach. The whole article is available to read online, but I can give you the flavour of it with a few extracts. According to the BMJ, “colleagues who are very vocal and say exactly what they think…just did not get invited to discuss things.” “To do your best by the members and fellows you need to be at the table to be part of the discussion to find the solution.” “Colleagues who criticise a particular politician for coming up with a ludicrous policy get the response you can imagine from that politician…You’re certainly not going to be invited to come and give your views”. “Those who take an adversarial approach may not even get the opportunity to influence politicians”.
In recent years, mainstream environmental organisations seem to have taken this advice on board. For example, in my younger days I can remember organisations like Greenpeace, Friends of the Earth and the Green Party being much more outspoken and in the public eye than they are today, and Greenpeace in particular engaging in many highly publicised direct action campaigns, mostly illegal. Nowadays, they are much less likely to be in the news, and when they are, they are more likely to be promoting positive non-threatening messages about renewable energy and sustainable development. I have no doubt that they are following the BMJ’s advice and engaging with their respective governments in a co-operative way in congenial, non-confrontational meetings behind closed doors.
The problem with this approach, though, is that it works best if only small or incremental changes are needed. For example, suppose you represent doctors and they want a 4% pay rise. The government says it can only afford a 2% pay rise. You have a meeting in which pleasant and civilised negotiations take place, you explain your position, the government explains its position, and you compromise on a 3% pay rise. Problem solved, everyone’s a winner, all off down to the pub for a pint. What’s not to like about that?
However, this approach fails to deliver when major changes are needed. Let’s take, as a hypothetical example, climate change. Let’s say that you believe that we need to stop digging carbon out of the ground and burning it, stop wasting oil on frivolous things like flying on jet planes for foreign holidays, stop building airports and spaceports, and start a major program of reorganising our energy and food supplies on sustainable principles. And you believe we need to do these things now. Right now. Immediately.
If you adopt the BMJ approach, here’s what will happen. You will not be invited to take part in discussions about the subject owing to you being too “vocal” and “adversarial”. Instead, participants will be invited who adopt a more conciliatory, collaborative approach and are willing to make compromises. The meeting or meetings will eventually produce a position statement in which any action or targets are postponed until far off in the future, when those around the table will be long since retired or dead. Agreements will be voluntary rather than compulsory. There will be loopholes giving governments ample opportunity to opt out. Instead of cutting carbon emissions, the favoured approach will be to redistribute the emissions, with high emitting governments having the opportunity to “buy” the right to emit carbon from low emitters. Meeting targets will be dependent on the development of new technologies which do not currently exist in any workable form, but might exist at some unspecified future date. An “echo chamber” mentality will develop, in which all the people at the meetings have similar views (give or take minor variations) and reinforce each other’s views, and people with significantly dissenting views are marginalised as being difficult, disruptive or unrealistic. Consensus is achieved, and the participants leave the meeting with a sense of a job well done.
Does any of this sound familiar?
As I said at the start of this piece, I have no ambition to be offered a “seat at the table” for discussions about the future course of humanity. I will leave that to the great, the good and the wise, and good luck to them. I hope they all have fantastic obituaries. I have, however, written a book “Post Peak Medicine” containing what I hope will be some helpful suggestions for anyone wondering what a post-peak healthcare system might look like, which is available for free download from my website https://postpeakmedicine.com/
However, I don’t expect it to be reviewed in the BMJ.
Slaynt vie, bea veayn, beeal fliugh as baase ayns Mannin
(1). How medical leaders win friends and influence people. Tom Moberly, British Medical Journal 23 February 2019. https://www.bmj.com/content/364/bmj.l707