Archives for category: Management

I should preface this review that I found The Pitt riveting television. I’ve always liked Noah Wyle as an actor and ER was always a favorite show of mine. This review will have some minor spoilers for the show so if you have not watched it – go watch it! Then come back and see whether the same things struck you as they struck me. The Pitt has a couple of problems, and they not only take me out of the show when they occur, they also perpetuate the myths that surround human and veterinary medicine (my world).

Administration is the Bad Guy

The character of Gloria Underwood, played by Michael Hyatt, who is credited as the Chief Medical Officer but acts as more of a non-medical Hospital Administrator, is portrayed, except for one scene (more on that later) as the bad guy throughout. This is not because they do anything particularly bad, but because they care about how long patients have been waiting and how they are treated by the doctors and nurses. The show treats this push back against the tyranny of customer service as a noble endeavor, as our hero character championing medicine over business.

The big problem with this mindset that can often be found in both human medicine and veterinary medicine is that “my time (the doctor) is more important than your time (the patient). There will always be wait times in medicine, but that does not mean they are a badge of honor that shows how much more important the medicine is from treating patients respectfully. Patients who leave because they won’t or can’t have an extended wait time are punished with worse outcomes. If we want what’s best for our patients we have to care about wait times.

The Pitt then seemingly redeems its portrayal of Gloria by showing just how good she is at her job. When the staff are informed of a mass casualty event, Gloria shows that she is three steps ahead of our hero Robbie, played by Noah Wyle, in having emergency supplies of all kinds already on the way. It’s a great moment and the disconnect between the doctors and nurses as they realize that this person who they consider the enemy is just someone who sees the wood for the trees.

…And then they go and spoil it by having Robbie curse Gloria out and call her a micromanager because she questions their use of unscreened blood from team members in patients.

The fact that Robbie is shown on multiple occasions to be struggling with his own mental health, and that while often right, he prefers to use his own intuition rather than facts or rules is shown as an honorable sacrifice. I hope that in season two we get to see Robbie be wrong because to do otherwise is disingenuous to the professions involved.

Likewise; Dr. Gregory House, from TV’s House, is a great and fun character to watch but nobody wants him as their doctor. When you are purporting to show a hyper realistic medical drama, falling into using these well-worn tropes does the show and its audience a disservice.

Poor Doctors

I have the upmost respect for human doctors and nurses, just as I do for veterinarians and veterinary nurses. I believe they all deserve to be paid well. However, The Pitt plays fast and loose with the socioeconomic realities of the ER and human medicine as a whole.

Dr. Michael “Robby” Robinavitch  is a Senior Attending Physician and probably earns in the region of $361,072 per annum.

 All of the other doctors of The Pitt are residents who are likely to be earning $75,000 per annum although it seems this could increase to almost $100,000. The medical students shown in the show would not be paid.

Robbie is unlikely to walk to work, or take the train, as is implied by his backpack as he walks through the park late at night, after his shift, where he can share a beer with other members of his team. Many of his team will have to use public transportation because they won’t be able to afford not to. Robbie will drive his BMW, which is parked in the hospital parking garage, he may even have his own parking spot, to his home in the suburbs.

Just when you think I might be being unfair about Robbie, I should mention that Pittsburg’s cost of living is about 2% below the national average.

If Gloria is a Hospital Administrator, her salary would be in the range of $223,561

If the job title of chief medical officer is correct we are looking at a salary of $462,913

By making Robbie seem like just one of the team rather than a member of senior leadership it frames Gloria, and therefore by example all Hospital Administrators / Chief Medical Officers, as only interested in money – rather than the health of the hospital and the team as a whole. Whereas in truth, Robbie is much closer or even exceeds Gloria in compensation than to the doctors and students he works side by side with. By framing him as “one of the boys” and therefore the hero it paints Gloria as the villain.

When Robbie complains about the lack of nurses and Gloria points out that there is a national nursing shortage. His response is to say “pay them a living wage and they will be lining up to work here.”

The average wage for a registered nurse in Pittsburgh is $82,458.

As Gloria points out “other hospitals are managing” but Robbie dismisses this and  because he is our hero we are encouraged to dismiss this too – rather than see it as a failure of his management of the ER. I’m all in favor of paying nurses more, just as I am in favor of paying veterinary nurses more, but dismissing $82,000 as less than a living wage is ridiculous and manipulative.

You can do so much better “The Pitt.” These are real issues the divide the treatment of patients and the management of hospitals both in the human world and the veterinary world.

Buying into lazy tropes does not help.

This article is going to use the term AI, even though the more accurate and less marketing friendly term “machine learning” is the term I much prefer. But this article is about you, dear reader, not me.

Reason to Worry #1: Mid-Level Practitioners

I should preface this section by stating that in theory I have no issues with the idea of the creation of a midlevel practitioner in the vein of Nurse Practitioners in the human world. My main concerns are with the fact that the veterinary profession has decidedly steered away from this kind of thing in the past; I’m looking at you Veterinary Technician Specialists (VTS). Show me an LVT / RVT / CVT with a VTS in dentistry who can’t extract any teeth and I’ll show you a missed opportunity.

Colorado State University (CSU) has become ground zero in the midlevel practitioner debate. The idea of a Veterinary Professional Associate (VPA) was proposed as early as 2009 by a member of CSU and an alliance of multiple non-profit animal welfare / rescue groups. This alliance gathered enough signatures for a proposition which was passed despite significant opposition from just about every veterinary professional body. A more in-depth retelling and an examination of the issues can be found here: https://www.avma.org/news/veterinary-professional-associate-role-moves-ahead

My other concern is that there is so little appetite for a midlevel practitioner in the profession that my “spiddy sense” starts to tingle as to what else might come of this VPA.

More on this later…

Reason to Worry #2: The Erosion of the VCPR

Across the country, before, during, and after the pandemic, moves were made to reduce the needs and requirements of the Veterinary Client Patient Relationship (VCPR).

Ostensively, to allow the use of telemedicine to initiate treatment without the need for a physical exam of the patient. While there are some champions of telemedicine from within the profession, clients only seem to have a stomach for it if it does not cost anything or if it allows them to buy medications online.

If the pandemic taught us anything it was that Zoom is a poor substitute for meeting in person.  Meanwhile, the push to allow telemedicine to replace an exam continues..

Reason to Worry #3: AI medical record writing is not what you think.

It seems like every cloud-based PMS software and every veterinary startup is selling a service that takes the conversation from the exam room and writes up medical records in a format that every vet board will love. Sounds like the perfect product: cheap, quick, and removes the drudgery of a task that just about every veterinarian hates – a task that takes time away from patients and clients.

Ignoring the inevitable veterinary board cases where the AI service just gets things wrong and the DVM did not double check – there is where these services are going and what they will turn into.

Machine Learning requires data to learn from. It takes large data sets and as AI commentator Subhasish Baidya states that AI currently is “decent summarization engines and lukewarm guessing machines.”

As Apple recently stated we are a long way off from “Thinking Machines” and the hype about Artificial General Intelligence is misplaced.

So if AI needs large data sets in order to work, so what? It just makes the product better right?

But what if the end product is actually something else entirely?

What else could a machine that learns what is talked about in an exam room do? If the medical record is meant to reflect the diagnostic process, and we are even very nice as to correct AI tools for writing the record when they get things wrong, how long before they starts suggesting the diagnosis for us?

At this year’s WVC conference I was told that it would launch this year.

A Problematic Veterinary Triad

Suggesting a diagnosis based on existing data is not particularly new. The issue is, and I know I start to sound like a conspiracy theorist here, the other two reasons to worry. Because if I can have a midlevel practitioner or even a credentialed veterinary technician perform the exam and talk to the client, and have the results reviewed by an AI that’s reasonably good at coming up with what might be wrong, why do I need a DVM?

Well the practice acts for one I hear you say! Well, my response is to remember about all that weakening of the VCPR? Why does the vet have to be on site? They could be in a different state or even a different country.

We are devaluing what it means to be a veterinarian and the role that they have to play in the care of pets.

I wish that I was super smart and that I could say that nobody else was thinking in these terms and I could claim my tech bro title. That way I could make my AI startup and combine it with my chain of low-cost veterinary clinics bankrolled by venture capitalists which I could then turn around and sell for billions. If I am… well then tech bro’s you’re welcome to my idea – my ethics can’t stomach it.

When I talk to vet students about this problematic triad they are horrified – literally horrified. When I talk to people who think about the future of veterinary medicine, they say “of course” and then tell me how they are planning to leverage these things.

When I talk to practice owners, they either reject the premise or shrug their shoulders and say “so what.” Nobody is looking to make AI models that replace upper management at the moment. We are the ones who buy those tools – tech bros are not stupid in that way.

When I talk to AI companies at trade shows (one of my favorite pastimes these days) and ask where they got their modeling data they are surprisingly evasive – particularly when you bring up the ownership of records and privacy.

The fundamental issue is that using machine learning to reduce the need for a DVM onsite, or the number of DVMs will come down to how much money is saves / generates. It’s a rare company that puts anything ahead of the bottom line. Particularly as those companies get larger.

A common saying from the AI world is that AI will not replace you but that a human using AI will. I hate this saying because it is so disingenuous. If I employ 10 technicians with AI tools and a DVM in another state to review everything, to replace 10 DVMs I am technically in line with this quote. But nobody would agree that AI has not replaced the 10 DVMs. Even if I just gave those same 10 DVMs those same AI tools their productivity is not going to increase to the level where the technicians and AI don’t make more sense from a purely economic standpoint.

Reason Not to Worry #1: AI is Self-Limiting

Ignoring the lawsuits about copyright infringement in the training of machine learning models for the time being, AI always needs new data to “learn” new things. Who is going to provide this new data for the diagnoses of new conditions or new treatments if we are just relying on an AI to make the diagnosis in the first place?

I also feel that the reliance on AI to write records will increase the reliance on AI tools that will summarize records into a few simple sentences. I have enough faith in my fellow humans to hope that the result of this will just be recognition that simple records are just better in the first place and why don’t we just write them that way. The alternative is complete madness when data is kept in some arcane format that no one actually reads.

In addition, the “hallucination problem” with AI does not seem to be anywhere close to being solved. For those who are unaware, AI’s “hallucinate” wrong data all the time. In technical circles we call this “getting things wrong.” Yes, you heard right; AI’s get things wrong all the time. There are numerous lawyers who have been cited by judges for submitting AI briefs that contain references to cases that just don’t exist.

The AI world calls these missteps “hallucinations” to make their products seem better than they are. More complex and “thoughtful.” What they actually mean by hallucination is that the AI got things wrong and they don’t know why.

Reason Not to Worry #2: Human Interactions Matter

There will be value in not using AI. Just like there is value in not allowing your work to be scraped by AI. Just like in film, music, and art, the use of AI is distinctly frowned upon because the consequences of doing so are so harmful for everyone involved. Why pay to use a tool, made by someone in Silicon Valley, that would not exist without the theft of material that the tool must have used in order to work?

Likewise some clients, admittedly not all, will value face-to-face interactions with their veterinarians as long as we make it worth what we are charging. If COVID taught us nothing else it is that a virtual appointment, like a virtual meeting, is a sorry excuse for the real thing. Why would veterinary medicine be any different? Medical records that read like they were written by a human and are understandable will have far more value than those that might be more technically proficient but don’t reflect the personality of the DVM.

In fact, humans are so much better at these interactions than AI that a surprising number of AI startups and tools are actually just low wage humans working in other countries remotely.

Reason Not to Worry #3: The Power of Community

While the midlevel practitioner for veterinary medicine bill was passed in Colorado, nobody seemed particularly happy about it. An alphabet soup of state and national organizations came out against the idea of midlevel practitioners and this bill in particular. Even the vet school at Colorado State, from what I can tell, was not enthused about being connected to this new position.

If the profession can fight back against the midlevel practitioner it can fight back against other things such as remote DVMs and hospitals just staffed by technicians all the way through to AI’s role in the diagnostic process. It might even win some of these fights and we will be stronger as a profession if we get used to fighting for what we believe in.

I do actually think machine learning does have a role in veterinary medicine – just like I think it has a role in business in general. My issue is that we are giving little to no thought to the consequences of using these tools wherever we can squeeze them into.

Part of the thought behind these six points is that I do believe that it will probably all work out in the end. It is the damage done to the profession in the meantime that concerns me most. That it might be too difficult to undo that damage and far too late to avoid the suffering caused – whether its lower wages, missed diagnosis, or a radically changed business model for the average veterinary practice which will now lack the skills needed to reject using AI even if it wanted to.

I’ll leave you with a final thought. If AI is writing all your emails so that you don’t have to write them and summarizing all your emails so that you don’t have to read them, would you then have the critical thinking skills to know when the AI had made a mistake? Why would we think veterinary medicine would be any different? I’m not suggesting that all technology is bad, but I think this quote, often attributed to folklore hero John Henry, says it best;

“When a machine does the work of a man, it takes something away from the man.”

Image by aytuguluturk from Pixabay

Veterinary Medicine is about communication. Our patients don’t speak. They can’t advocate for themselves so pet owners, doctors, and team members must communicate with each other on their behalf and as clearly as possible.

However, there is a relationship within the practice which is even more important. It is that of practice owner (PO), usually a DVM although the same applies to corporate practices with a medical director, and the hospital administrator / practice Manager / office Manager (OM).

If these two people cannot agree, or agree to disagree, all the other great things that can happen within the practice are subject to failure on a monumental level.

Everything flows from this relationship.

Protocols and standards of care can’t exist if the two people responsible for implementing them can’t agree on what they are and how they should be applied. How can equitable and fair human resource decisions be made if one of these two people plays favorites and overrides the other when it suits them? They must be able to have difficult conversations, where they both will have strong feelings about the results, and must be able to come out of that conversation without hard or hurt feelings that get in the way of their continued relationship.

Vision, Mission, and Core Values statements can go a long way to resolving these issues – but only if they are the living breathing guidelines of the practice. More fundamental is that there is mutual respect between PO and OM for both their respective roles and their responsibilities. They also need to present a united front on matters of change.

Unfortunately, this relationship is often unequal. Practice Owners, by definition call the shots and have the last word. Ideally, they empower their OM as their representative to make decisions and implement policy. However, if there is no trust, no respect, there is no way that is going to happen and no way for the OM to do their job. Likewise, if the OM is constantly aligning themselves as an employee rather than as a member of senior management / ownership they are unlikely to receive the trust from a PO that they would want and rightly so.

There is a balance to be reached and that’s why I advocate that the relationship between PO and OM has to work for anything else in the practice to work. This is also the reason why I am always against PO and OM being married or related in other ways – other parts of their relationship creep into the PO and OM dynamic. PO and OM should not be best friends – there are times they are going to disagree and that’s fine – that’s how it is supposed to be. They represent different interests of the business.  

So what if that relationship is not there or there has been a breakdown?

Communication.

Communication.

Communication.

Fundamentally if PO and OM can’t communicate then the relationship is dead. Unfortunately, that probably means the OM needs to leave either by resigning or being let go. It does no good to anyone for there to be infighting between the leaders of the practice. It certainly does not help the practice.

What sucks for the OM in this situation is that jobs of that type in the veterinary industry are usually one per practice. That means if there are ten practices in your town then there are only nine possible jobs for the OM and there are no guarantees that any of them are looking. There are, of course, opportunities in other industries; good leaders and managers are always in demand; however, that means learning another industry.  

If the relationship between PO and OM is broken something must change because this is the relationship that can’t be broken for the practice to function. Take care of your own mental health and that of your team.

Be honest about this relationship and either fix it or move on.

Feature image courtesy of Zahid H Javali & Dmitry Abramov from Pixabay

Blood in the Machine cover

What comes to mind when you think of the term “Luddite?”

For the more historically minded of you it might be that they were a British 19th-century grass roots movement that were opposed to, and smashed, technology due to losing their jobs at the start of the industrial revolution.

More usually, “Luddite” is used as an epithet to describe someone who refuses to embrace change, usually technological, or insists on doing things the hard way when a simple technological solution exists. Reactionary idiots who were doomed and dumb. Malcontent losers.

These are both corruptions that were deliberately foisted on the public by those who had the most to gain by discrediting the movement: the State and the “big tech” entrepreneurs of their day.

In “Blood in the Machine: The Origins of the Rebellion Against Big Tech” Brian Merchant does a most remarkable thing for a book on a historical subject. He places events from the beginning of the 1800s in context with the events of today and the same challenges we currently face when it comes to technology and work.

The first half of the book is a history of the Luddite rebellion. Its early beginnings with workers refusing to cooperate with inventors on the design of machinery that was clearly created to put them out of work, to civil disobedience and protest, and then ultimately to the very brink of civil war. While the first half of the book does occasionally highlight just how close some the challenges that 19th century weavers were facing are to modern day concerns, it is the second half of the book which focuses on the “gig economy,” A.I., and other forms of modern automation.

What becomes clear throughout the book is that the Luddites were not sheep afraid of change. This was a nuanced, decentralized movement that had clear goals and wanted to embrace technology and change, but wanted their needs and livelihoods taken into consideration. Weavers were artisans who worked for themselves, setting their own hours, and involving the whole family in their work – but on their own terms. The industrialized mills that replaced them employed mostly woman and children working long hours for low pay and producing a lower quality product that was “good enough.”

A theme that crops up both in the 19th century section and the 21st century section is the concept of the replacement of skilled workers with cheaper lower skilled workers. Mr. Merchant also spotlights the outsized role that venture capitalists play in this dynamic – financing a cheaper alternative to one industry to the point of bankruptcy and then either raising prices or lowering wages of those now forced to work for the bright and shiny new thing: Uber and Lyft I’m looking at you.

The Luddites were met with brutal resistance. Factories became fortresses and soldiers were based in every northern town. This was a time when Britain was in a deeply unpopular War with France and was losing its American colonies. Dozens of Luddites were hanged, mostly for the breaking of machinery, and those who took the Luddite oath were often transported to Australia – a life sentence at the time. All for opposing profit over people.

While not only warning of the impact that disruptive change, both in the past and the present day, the author also adds the note of caution about how people are already pushing back against the same type of change as the Luddites fought against over two centuries previously. The strikes, organizing, and protests by Uber and Lyft drivers to be considered employees rather than contract workers. The organizing at Amazon during COVID-19 over safety concerns. The Hollywood writers strike over using A.I. technology.

These are not isolated incidents.

They form a pattern of how technology is often imposed on people without thought as to its impact. That the technology that is supposed to alleviate work often just degrades it. Just the lexicon of Silicon Valley points to this: “disruption,” “move fast and break things,” “Revolutionize.” To ignore these warning signs could quite possibly doom us to repeat the mistakes of the past.

There is often, from both Hollywood and the media, a hysteria that “the robots are coming for your job.” As Brian Merchant points out; the robots are not coming for anything. It is the people who run companies and implement technologies that decide the impact they will have on peoples’ jobs, and ultimately their lives. This needs to be a discussion, separate from the also highly needed discussion on how machine learning is trained, and how venture capital distorts the business landscape. All these discussions are related, but we have real choices ahead that we will all need to make.

It is interesting to reflect on what might have been if the Luddites had won. There would still have been an industrial revolution, but perhaps the assumed antagonistic relationship stances between management and employees, whether real or perceived, might have had a very different starting point. We can’t change what happened to the Luddites, but we have all the indicators that we have an opportunity ahead of us now.

This is a book for our times and a warning about one possible future.

Management is different.

Often, managers are not owners of a business, but they are required to act as if they were. That can mean that they become the person that both team members and ownership feel is there to solve their problems. To be on call all the time. To be the fountain of knowledge whatever the time and whatever the day.

And often they are.

But that does not mean they are not entitled to time off and a personal life.

Setting boundaries with your owners and your team does not mean not being there for them when they really need you, but it should mean that your time is respected and valued by those that depend on you.   

Schedule Boundaries

As a manager, it is easy to feel that it is your duty to be there for your team, or whomever you report to, at all hours of the day and every day.  

And to a certain extent this is a sign of a good manager. Your team needs to be able to count on you being there when they need you to be.

But….

And this is a big but…

There is a huge difference between being available for an emergency and being available at all times for all things. You have a life to live and just because you hold the title of manager and all that it entails, does not mean that your job gets to monopolize all your time.  

Have a schedule and make all efforts to stick to it. The work for most managers will be there the next day. That means you can leave on time. While staying late will reduce that work pile a little, it will not be as beneficial to the business and certainly not as beneficial to you if you just leave when you are supposed to. There will be times when you absolutely will not be able to leave on time. Make those the exceptions rather than the rule.

Take your vacation time and take the holidays you are owed. Never feel guilty about taking the days off you are due. Your mental and physical health will thank you. As one of my favorite phrases goes; “Make time for your wellness or make time for your sickness.”

If there are times that you don’t want to be interrupted – turn your phone off. You turn your phone off when at the movies or at the theater (if you do not there is a special place in hell for you) so a couple of hours of being unreachable is not an unreasonable thing even for the most connected of managers. Your partner and family will thank you.

Communication Boundaries

Managers need to have a system for how and when they should be contacted. If there are things that you require your team to contact you about then make sure they know this. I, for example, want to be called as soon as possible if there is a major I.T. issue so I can have time to fix it – even if that means a phone call at 2AM. If there are things that you don’t need to be informed about, make sure you let your team know that as well (be nice – just redirect: “please email me about this and I will deal with it when I’m next in the office.”

Email is for when you are at work. Do not check your email outside of working hours unless you are explicitly told that there is something you need to read immediately. An example of this would be a phone call or text message that says “check your email. If you have a workplace communication platform, such as Slack, turn off the notifications when you leave the office for the day.

Text messages should be for urgent things that need your attention when you have a second but can’t wait till you are next in the office. Again, if they could be an email – politely redirect and have them send an email. Stay away from work related text message groups and Whatsapp groups. Group messaging in general is not respectful of your time so if they are part of your team’s communication system – find a way of being able to dip out when you are out of the office.

In fact, while you are at it…

Turn off all the notifications on your phone. Notifications should be for things that are true emergencies. You can thank me later.

Answer phone calls. It might sound counterintuitive in an article about setting boundaries, but I believe that when teams need to get hold of their manager, they really need to get hold of them. If they abuse this privilege just redirect and move on. There are times when you’ll wish your team called you. The excuse “we did not want to bother you” is usually a reaction to mishandled boundary setting in the past.

Longer Absences

There are times when you need to not be working.

Vacation, maternity leave, and leaves of absence are perfect examples of this. An email to your team, or whatever communication method you use, that lays out explicitly your level of availability will work wonders. You just have to stick to it. It is not anyone’s business whether you are floating at home in your pool or hiking at the North Pole and it should not change your level of availability outside of what you laid out to your team before leaving.

The Boss

But what happens when it is the business owner, or whomever you report to, who is not respecting your boundaries?

Ideally, an owner / director should understand that your time is your time. Yes, there will be occasions when they may need to talk to you or have you do something, or even come into the office outside of your normal hours, but as mentioned before this should be the exception. If it is not, be sure to keep track of these occasions and bring them up when negotiating salary and other parts of your compensation package.

Like with your team members, don’t be afraid to redirect politely when a communication method is inappropriate. Likewise, if you are being asked to do something and you have other commitments, don’t be afraid to say that you have other commitments; however, if you can give an alternative solution that often is a preferable option – such as calling someone else. Depending on the circumstance, it might be more appropriate for you to take temporary ownership of the issue and then to delegate the response to someone else if that is possible and you are unavailable.

Personal Boundaries

A manager’s life is much simpler if they are not friends, and do not socialize with, the people they manage. It’s harsh, particularly for managers who may have worked alongside team members they are now being asked to manage, but it invariably leads to issues and it is just simpler for it to never happen.

Likewise, never confide in a subordinate. Being a manager can be lonely – particularly if you are the sole member of management. But find a mentor, or a peer to confide in and vent to. A subordinate you like and feel you can trust is still a subordinate and you don’t know when conversations you felt were in confidence might come back to bite you when you have to manage or discipline that employee.

It should also go without saying that relationships between managers and subordinates are a terrible idea for both parties. Even if the relationship is not inappropriate and fully consensual the damage it does to the team can be significant. In some companies, having a relationship with a subordinate would be grounds for termination. If you find yourself in a relationship with a subordinate, disclose the relationship to whomever you report to and make sure that you and the other party sign a relationship agreement.  

Appropriate Outlets

As mentioned earlier, management can be lonely. Finding outlets to discuss issues and the challenges you face are extremely important. There are often local manager groups you can take part in. If there is not one – start one!

Internet groups can be an extremely useful in connecting you with likeminded managers, but also extremely rewarding when you are able to help others who may be struggling with issues you have already resolved.

Find a mentor, go for coffee or lunch, and use them as an outlet. Mentors can be found in the most unlikely of people and places; however, it is tough to beat LinkedIn. Connect and make your connections more than just people for whom you like their posts.

You can have boundaries and still be there for your team. However, you must also demonstrate respect for your team’s boundaries. Do you really need to reach out to one of your team on their day off for a piece of information or can you just email them and wait for the answer when they are next in? Yes, it is inconvenient, but you can’t ask for boundaries yourself and then not respect boundaries for others.

Boundaries are selfcare for managers. Boundaries will be different from one manager to the next.

That’s fine.

Just take care of yourself.  

There are a lot of books about Twitter out there right now. That is perhaps not a surprise given (Spoiler Alert) that it has become a corporate / Silicon Valley dumpster fire.

Mr. Wagner’s account is balanced and well researched; however, one cannot feel while reading the work that it is missing the insider juicy details that make tech CEOs squirm. Perhaps because so much of Twitter’s (now X’s) dirty laundry has already been aired there is little new revelations in the work.

What” Battle of the Bird” does do is provide a clinical timeline from Twitter’s founding through to the events leading up to its purchase by Elon Musk and the unravelling of the technology institution under his stewardship. This in turn provides insights into the failure of Jack Dorcey (Twitter’s former CEO and co-founder) and Elon Musk’s failures with X.

As I talked about in my review of “Kingdom of Happiness” by Amiee Groth which referenced the failures at Zappos and the Downtown Project, both Dorsey and Musk in hindsight have had a failure of leadership due to a lack of management. It is all very well being able to persuade people to jump out of a plane, but you have to ensure that they have parachutes and know how to use them.

There is no doubt that Dorsey and Musk both do, or more appropriately have at one time, loved Twitter and what it has brought to the world. While Dorsey, according to Mr. Wagner’s book, seems to have lost interest in Twitter as a company once the reality of being a public company set in. Musk on the other hand, seems far too interested in his own press and ego once he understood the challenges Twitter faced and continues to face even after his pointless rebranding to X. It is hard to feel sorry for billionaires when the world does not work the way they want it to.

There is a theme throughout the book that perhaps Twitter can’t be a company. Dorsey in particular laments that what Twitter should be is a technology like email, that allows for the exchange of information, but that is not gatekept by any one platform. This is the kind of wishful thinking of people who have been made rich by the decisions to take their company public and have second thoughts. That they wish the world could be a different place. It can be, but only if different decisions are taken – the kind of decisions that don’t make entrepreneurs and venture capitalists rich.

Like I said, it is hard to feel sorry for billionaires when things don’t go their way.

Mr. Wagner does go into some reasonable depth as to the ethical dilemmas brought up by Donald Trump’s tweeting and his eventual banning from the platform. These are bigger issues than Twitter, but the impact on Twitter for both Dorsey and Musk were profound and still rancor the platform to this day. I’m not sure I want a committee of Twitter employees making decisions on whether what a world leader says is appropriate for public consumption, but at the same time I am positive I don’t want Elon Musk making those decisions.

As a grounding in the backstory and drama that is Twitter, now X, Battle for the Bird is a great document. Not a thrill ride or exposé, but a methodical grounding in the facts.

This is probably for the best given its subject matter and the turgid realities of Twitter’s recent past.

Perhaps this is the account we need rather than the one we might want.

As a society we tell ourselves stories that, while convenient, are not always, or even ever, true. In what is probably Malcom Gladwell’s best book “Outliers” (which I can’t believe I have not reviewed) the author tells of the often decade long stories, and tales of extraordinary advantage, of seemingly overnight successes. David Epstein, in “Range: Why Generalists Triumph in a Specialized World”, is also debunking one of the stories we tell ourselves – that to be really good at something, or to have great success at something, we have to have focused on that thing for a long time – if not forever.

Before I go any further a word to my veterinary and human medicine readers. In this post, and indeed in Mr. Epstein’s book, when we talk about “specialization” we are using it in the general sense as opposed to the legal (small “s” rather than capital “S”). Although, I do believe that there are lessons for students from Mr. Epstein’s excellent book. Don’t be in too much of a hurry to map out your career. It’s a good thing to try out different interests and to change your mind – you’ll be better in the long run for it.

The pressure to focus on one thing, whether it be in sports, music, or entrepreneurship is all pervasive and often has business interests behind the marketing of “hyper specialization.”

 It is a good story.

The Tiger Woods story is one that the author highlights. It is a story of the very young Tiger playing golf before he could talk and spending all day at the golf course. It is a story of winning tournament after tournament and having an unflinching goal of winning more titles than anyone else. Mr. Epstein juxtaposes the “Tiger story” with the far less well-known story of Roger Federer. Federer’s mother was a tennis coach but she refused to coach him and actively tried to dissuade him from playing tennis. A young Federer also seemed far more interested in soccer, basketball, skateboarding, handball and skiing. It was not until his teens that Federer started to gravitate towards tennis and then his goals were not lofty, but the rather quaint “meet Borris Becker” and “play at Wimbledon.”

This wide range of experience and lack of focus is the author’s main argument – that, more often than not, it is range that leads to success rather than specialization. That depth of experience of different fields matters more than depth of experience in just one. Interestingly, the evidence that Mr. Epstein quotes, rather persuasively, is that while early hyper specialization can lead to children getting a head start in that chosen area, they tend to fall into line with their peers rather than stay ahead as time goes on.

Where the book misses, for me, is that it seems to continue to fall back to specialization being a worthy goal via a route of different experiences, rather than the range of experiences being a worthy goal in itself. However, this minor quibble aside. The book makes a very strong case for experience in general and for following one’s interests. A great example is the idea to not ask kids what they want to be when they grow up, but rather to ask them what they are interested in. Our education, and in our careers, we often ask others where they are headed and penalize them for not knowing. This may be a mistake.

When I look at my career, I’ve had very specific goals at different times and while I have met some of them, I have taken some spectacular left turns that has led me to areas I would never have even considered just a few years earlier. No one is more surprised than me that I live in Las Vegas, watch a lot of hockey, and write poetry.

This is an important book for those who mentor, or lead, others. How we choose to guide – matters. We are often a deciding factor in whether to specialize in an area or to follow seemingly unconnected interests. There is value in a range of interests and experiences that benefit both the person and the employer.

A more enlightened view of the goals of mentoring will benefit everyone.

Chef 1:- I just… I don’t think it’s fair (talking to Chef 2)

Kiki: Chef!

Kiki: Chef!

Chef 1: Yes, Kiki, what is that?

Kiki: A man on table six wants an eggless omelette. He wants an egg…

Chef 1: Kiki you can’t have an eggless omelette, can you?

Kiki: Why do we not have any?

Chef 1: No, they don’t exist, do they? Because there’s no… Breadsticks, what are they made of?

Kiki: Bread.

Chef 1: Bread, very good. OK, take away the bread, what are you left with?

Kiki: Sticks?

Chef 1: No, Kiki! (Sprinkles a few herbs on an empty plate) There you go, that’s an eggless omelet.

Kiki: Okay (takes plate)

Chef 1: No, don’t take the plate, Kiki, what are you doing? Please!

Chef 2: Kiki, just ask the nice man if he’d like his omelet made with whole eggs or just egg whites. (Kiki smiles and goes to leave)

Chef 2: You can leave the plate.

When I was first shown this scene from the British restaurant-based sitcom “Whites” I found it amusing like I’m sure most of you did. How we can laugh at how silly Kiki is being and how she lacks all common sense. And the scene is funny, but it reflects a real behavior that we see every day, admittedly pushed to extremes.

But this is an attitude that needs to change. Just like to scene where the security guard gets humiliated for not stopping the scruffy young man from entering the fancy building and not recognizing that he in-fact owns the building and is ultimately is the security guard’s employer. The poor guard is just doing his job. Just because you walk around like you own the building does not automatically mean you actually do. We’ve all seen the videos that prove you can get it almost anywhere if you are carrying a ladder. Employees, just like clients, can suffer from being of the loosing end of the curse of knowledge.

The curse of knowledge is where we humans can’t understand that others may not have the same life, education, and training as us and therefore may not know the same things. What is obvious and, in that most awful of phrases, “common sense” may not in fact be widely known or common sense. For more on my hatred of “common sense” you can read this post.

But yet we do this all the time. The client who does not know to vaccinate their new puppy. The coffee drinker who does not know that Starbucks calls its large “Venti” or a regular coffee an “Americano.” There is a whole video just about that too.

With employees a lack of knowledge is a teaching moment. Of course, it can be frustrating and if we find ourselves teaching the same thing over and over again we have a different problem, but we can’t criticize, or worse snap at, for a lack of knowledge – even when we think employees should have this knowledge. In any other environment, we would recognize this behavior for what it is; bullying.

Recognizing that teams need be able to express when they don’t know something helps to create a safe space for learning. Teachable moments should be embraced for what they are – a chance to get better, to improve. Its also just the decent thing do to. There can also be more going on than just not knowing something.

New employees, for example, don’t know the limits of their knowledge yet. So while they may not of heard of something does not mean that it does not exist. We don’t want them to guess – so employees ask. They need to praised for checking and confirming that what we think is obvious is actually not. We all need to be better about this. I for one know that I can be bad at this but, as with most things, recognizing when you have a problem is the first step in fixing it.

The Kiki’s of the world deserve that we try.

Let me tell you a secret about most business books – they are not about business. Oh yes, they claim to be about business, how to work with people, and affect change, but in reality a lot of them are not. They are often about the hard things – finance, cost control, selling, and product development, or the soft things – people management, team dynamics, and marketing. Rarely is a book about how all these things fit together, and how to grow while at the same time dealing with the realities of business day to day.

Which is why Will Guidara’s book “Unreasonable Hospitality: The Remarkable Power of Giving People More than They Expect” is so refreshing. This is part memoir of a restauranter and part business manual on blending soft and hard skills that all businesses try to do – with varied levels of success. Mr. Guidara was the general manager of a number of fantastic restaurants, including Eleven Madison Park which became the number one restaurant in the world.

For a book that talks a length about people, values, growth, and mission it is so unusual to hear the real world politick of “I’m also clear about what my job is, which is to do what’s best for the restaurant, not to do what’s best for any of you (the staff). More often than not, what’s best for the restaurant will include doing what’s best for you. But the only way I can take care of all of you as individuals is by always putting the restaurant first.” Just wow!

And that quote really sums up the problems with a lot of books on management and leadership – they are two different things people and not mutually exclusive (I can shout that louder for the hacks with the crappy memes) – we are often being asked to hold ourselves to an impossible standard. People are sometimes not the right fit, sometimes we just have to get through the shift, sometimes we are not going to be perfect. An illuminating passage deals with the idea that while it is often trotted out that employees have a language of appreciation, they may also have a language of criticism – people may need feedback in different ways depending on their personality and work history.

I love the advise to “not let things slide – those small things become personal slights.” This is often ignored because every manager today fears being labeled a micro manager. Just like I also appreciate Mr. Guidara’s works to be maniacal on cost control for 95% of your costs and then to spurge for the last 5% to make a difference to the guest experience.

There are times when this book feels like it is written by the staff from the movie “The Menu,” yet at the same time one has to appreciate what Mr. Guidara was trying to do with his business and why he was doing it. The book says, there is nothing wrong with striving for perfection, as long as perfection is not the standard – little things are always going to go wrong. That does not mean one should not try, but it means managers and leaders have to accept realities.  

It may seem extreme and over the top, and it is, but that is the whole point of being “unreasonable.” To give people more than they ever expected in a controlled manner so it can be systemized and scalable. I’ve been banging on about scalability for years, and so to read it in this book was like having to tell the author to get out of my head.

This book should be required reading for managers and leaders of any business who want to deliver a better experience for everyone – including the owner of the business. This is appreciation that businesses are businesses. They must make money and they have to be able to work when you are not there. There has to be systems in place, protocols and procedures, so that everyone knows what to do and new people can be easily trained on what to do.

Unreasonable Hospitality is what business books should be. Simon Sinek, who wrote the introduction and I have been on record for forever as having no time for, could learn a lot from this book for example.

This is where the rubber meets the road. For those who want to add to their passion, or just rekindle it, it is hard to find a better way to do so than to read this wonderful book.   

How should we feel about those whose work we admire, or even love, when they turn out to be awful human beings or even just deeply flawed? Are you a better artist if you become more selfish? This is the subject of Claire Dederer’s exceptional book – Monsters: A Fans Dilemma.

Do great artists become assholes (or monsters) because of their singular commitment to their art or do assholes / monsters become great artists because they know their transgressions will be forgiven? How should we feel about Wagner, Miles Davis, Roman Polanski, Woody Allan, David Bowie, Sylvia Plath, Joni Mitchell, Valerie Solanas, Doris Lessing, and many, many more?

Male artists who are considered monsters are usually considered so because of violence or abuse. When female artists are considered monsters, it is usually because they have abandoned their children – something that male artists do without seeming consequence or judgement. There is also an added dimension of racism. As Ms. Dederer points out by quoting the often-maligned Kanye West; “I’m not a rap star, I’m a rock star.” Why? Because rock stars generally do not experience what Kanye West has experienced ad nauseam: repercussions. A fact that Ms. Dederer points out by not covering the army of white make rock stars accused of sexual predatory behavior.

This is perhaps one of the most complex questions of our times. Claire Dederer does a superlative job of sorting through the mixed emotions we all feel about such figures, and she herself feels as an artist with the choices she has made on her own artistic journey as a writer, a mother, a partner, and as an alcoholic. She also tackles whether this is a price too high for the #metoo movement (spoiler alert: it’s not.)

At its core, Monster is an exploration of the meetings of biographies; the biographies of those with fans and the biographies of the individual fans themselves. It also embraces the fracture points of our society, racism, sexism, and violence. Our reactions to the transgressions of those who make the art we love are subjective and are based on both the artist and the viewer. We can still consume the art of terrible people because there is a difference between what we feel – the emotional response to great art – and moral thoughts. We can look at great art and see the stain left by the actions of its creator. For some the stain will ruin the piece, for others they will see past the stain. What is right for one person will not necessarily be right for someone else.

Monster also places this discussion in a historical context. We often feel that we are in an enlightened time. That we are in an apolitical present where we know better than the past. As Ms. Dederer states – we don’t know better because we woke up, we know better because some people spoke up. We can all look back on the past and say we would have spoken up, however, how many of us do when the world around us burns? The things we thought we had transcended are still there – minority communities have always known this. It is not helped by the fact that everyone still loves an asshole. How any of our beloved characters in book, television, and film we would abhor in real life if we had to deal with them? “Don’t you know who I am,” is an awful and entitled addition to any disagreement. Yet we all love the scene where the clueless front desk clerk tries to stop someone from entering the building they actually own, and the clerk works in.

Stepping away from the art discussion for a moment. Monster is also an excellent discussion of the pressure of career vs. motherhood and the goals of careers in general. Returning to Kanye West for a moment, the line; “People want power and vacations” is an insightful view of what drives people in the modern world. But the balance of motherhood and career is where Monster shines brightest. If it is a real choice to trade levels of career success for the time a mother spends with their children – how does that express itself with professionals? How do both employers and employees recognize this dilemma and neutralize its effects for everyone to get what they want and need?

While the author eschews the term “cancel culture” as non-useful it permeates the book. Is a love of a piece of art enough to make up for the transgressions of the past by the artist? The is the fans dilemma – the subtitle of the book. Ms. Dederer gives no easy answers here but does give us a lot to think about. Is art, or career, worth the price that the artist (or professional) will have to pay or make others pay? Both the viewer and artist need to make that decision.

Monsters is a start to that conversation.