The Beginning and the End
By
Carlos G. Naval, MD
President, PAO

As we approach the end of the year, we know that a new year is about to begin. Another year of the expected, of the unforeseen, of the exciting, and of the mundane. We don't exactly know what will happen but we do know that it's not going to be the same as this year. Some events will affect us, some won't. A few changes we will have to adapt to, a few we will initiate ourselves. So the world goes, a constant wave of change, despairing many, especially those who dream of the past, for the glory days that seem more glorious because they have been scrubbed clean by time and selective memory. Pity those who are disappointed with the present and long for those golden years. Perhaps, they have so little grasp of the present and feel powerless to influence the future. But why?

Every January, we have a chance to change our future. We have our resolutions, promises to eat less, exercise more, and, many others that we have no intention of keeping beyond February. This January, I invite you to reflect not only on the personal but on your professional lives. What was the past year like for my practice? How many patients did I see? How many patients could still see me after surgery? I mean, would still see me, because they are happy and satisfied? Did they suddenly disappear? How many of them referred their friends and relatives? I urge you to look at the numbers and not merely reflect on your memory, which will only give you your version of the past. Remember the mantra: what you can't measure, you can't manage.

After reflecting, plan your year. What will I do differently this year? Do I expect to see more patients? Why will I do better? What do I have to change? And, I honestly ask you to dwell on things that you are in control of: yourself, your staff, and your relationships with your patients, your colleagues, your employees, and your industry partners. It takes some humility and will to first admit that it is you who can influence your practice most; not the hospital where you are, not the socio-economics of the nation, not the marketing department of your institution, and, not your competitors. Blaming those outside of your practice is easy and tempting but it gets you nowhere. Sure, they will influence your practice but those are given and beyond your sphere of influence. On the other hand, you can do a lot more than mope about your misfortunes "caused" by those elements by making a concerted effort to improve and transform your practice style. A simple analysis, establishing cause and effect (and, cost and effect) relationships between what you do and what subsequently happens is the best way to identify areas that require the most attention. Identifying the core problem to come up with a targeted solution to the underlying cause is facilitated by asking yourself an endless series of why questions.

Only by admitting to yourself that you are fundamentally the primary influential factor that affects your practice will you be able to create your own golden years of practice. If you are concerned about being too biased in your assessment, validate your observations and analysis through your friends and brutally candid colleagues. Experiment by trying something new, check the effect, consider making the transition permanent if it has a positive effect, and look for more things to improve - a never ending cycle of continuous improvement.

Can you ever stop? Yes, when you reach your peak, rest on your laurels. But what is your peak? Your peak is defined by your decline. Just like any mountain or graph, the pinnacle is only evident when the trajectory starts going down. Ergo, once you stop, your decline can't be far away.

Be like the trees in countries where it snows in December. Shed your leaves, prepare for the spring, and sprout new leaves to capture the fresh rays of the sun. Be grateful for the passage of time, which allows everything to move and change. It is an opportunity for renewal, to free ourselves from the shackles of imperfect memories and chart a new course into the sea of what is to come. Cast a huge shadow and gleam in your golden years! I end this article and my presidency of the PAO by sharing with you a guiding prayer from the English explorer Francis Drake and more recently attributed to Bishop Desmond Tutu:



"Disturb us, Lord,

When we are too pleased with ourselves,
When our dreams have become true
Because we dreamed too little;
When we have arrived in safety
Because we sailed too close to the shore.

Disturb us, Lord
When with the abundance of things we possess
We have lost our thirst for the water of life;
When, having fallen in love with time,
We have ceased to dream of eternity;
And, in our efforts to build a new earth,
have allowed our vision for a new heaven to grow dim.

Stir us, Lord

To dare boldly
To venture on wider seas, where storms shall show Thy mystery
Where losing sight of land, we shall find the stars.
In the name of Him who pushed back the horizons of our hopes and invited the brave to follow Him."



It's been a joy getting to know most of you, interacting with the sublime and the dastardly, working with the dedicated and the jaded, inspired by both those who believe it can be done and those who say it can't be done, and, jointly transforming our organization into one that is not only prepared for the future but capable of creating it.

Salud!