Don't fix it

Next to doing nothing, fixing a problem is often the worst thing you could do with it. Fix a problem but miss the context, and you still have the problem--only it's bigger, it's weirder, it costs more, and everybody's grumpy. When something comes at you with a "problem" label, use it as an opportunity to connect things up, to explore, to ask the bigger questions, to find the new possibilities. When we react to a problem, we put ourselves into a dilemma. To find fruitful and creative solutions, we need to be in a place of choice, with many possibilities. Real participation--giving people real choice--is the only way you can bring people's intelligence and life experiences to bear on the situation at hand.     

Navigating the job search superhighway

The recent Cyberforum on "Navigating the Job Search Superhighway" gave 131 American College of Physician Executive members the opportunity to discuss the job search process, addressing questions and sharing what they've learned through their experiences in the medical management job market. Several comments that convey the essence of the discussion are listed, representing the various viewpoints of the participants. The words are from physician executives who have gone through the job search process and from some who have been involved in hiring decisions. The topics range from the value of experience to the importance of having a management degree to tips on networking to preparing for the interview. The final section on contract negotiation is a composite of comments on the subject during the Cyberforum.     

Believing is seeing

Useful, well-demonstrated, well-vetted ideas in clinical practice, disease management, health care management, ideas that would save lives, save money, and make life better for the patient, are sometimes simply ignored, dismissed as radical, as completely unfounded, dangerous, and without merit. Why are new ideas so slow to spread in medicine and health care? Because believing is seeing. We do not look for something we don't believe in. In fact, we do not even see a thing if we don't believe in it. We have dedicated ourselves so powerfully to medicine, to health care as we know it, that we often do not even see any alternatives. A combination of factors makes it likely that, in the coming decade or two, we will change almost everything that is fundamental about health care and medicine. In a time of such rapid change, we desperately need to root out and question our deep assumptions and beliefs, to get off the tracks laid down by training and experience and ask questions we have never asked before.     

Hired, fired, and not retired: an interview with a physician executive who has run the career gauntlet. Interview by Richard L. Reece

Richard L. Reece, MD, interviewed Robert J. Hudson, MD, on April 24, 2000 to discuss his experiences as a physician executive who has made the career transition from practicing physician to managed care executive to biotech entrepreneur. Along the way, he's hired and fired others, and been fired himself. Painful as it is, many physician executives' career realities include being fired. Organizations, after all, are living organizations--they grow, wither, and molt. And as they molt, organizations shed and regrow new skin. What do physician executives do when they've been fired? They go through their own cycle and retreat, reflect, and re-emerge, often reinventing themselves as they go. An essential part of this process is looking within to plumb likes and dislikes, strengths and weaknesses, nightmares and dreams, and positive and negative experiences. For most executives, out of these experiences has come a circle of friends and a Rolodex. Start by reaching out to the circle, by going through your Rolodex, and you can broadcast the news of your rebirth.     

IntroductionExposing Misinformation Concerning Child Sexual Abuse and Adult Survivors

This article introduces a special volume on misinformation about child sexual abuse. Despite extensive research findings on the long-term effects and consequences of child sexual abuse, misinformation on this topic is widespread. Several forces have worked to support and disseminate this erroneous information. Because it is difficult to comprehend the horror of sexual crimes against children, society's denial and disbelief have often unwittingly supported the agendas of those who want to discount or minimize the impact of these crimes. The media has also contributed to the aura of skepticism surrounding claims of sexual abuse and its mental health impact, and has reported favorably on controversial and unproven claims such as the “false memory syndrome.” In the hope of countering misinformation and thus raising the level of discourse to the engagement of real scientific issues, a number of well known and respected researchers and clinicians examine various facets of the problem.     

Crisis or creation?a systematic examination of "false memory syndrome"

In 1992, the False Memory Syndrome Foundation (FMSF), an advocacy organization for people claiming to be falsely accused of sexual abuse, announced the discovery of a new syndrome involving iatrogenically created false memories of childhood sexual abuse. This article critically examines the assumptions underlying “False Memory Syndrome” to determine whether there is sufficient empirical evidence to support it as a valid diagnostic construct. Epidemiological evidence is also examined to determine whether there is data to support its advocates' claim of a public health crisis or epidemic. A review of the relevant literature demonstrates that the existence of such a syndrome lacks general acceptance in the mental health field, and that the construct is based on a series of faulty assumptions, many of which have been scientifically disproven. There is a similar lack of empirical validation for claims of a “false memory” epidemic. It is concluded that in the absence of any substantive scientific support, “False Memory Syndrome” is best characterized as a pseudoscientific syndrome that was developed to defend against claims of child abuse.     

Lesbian Identity Management at Various Stages of the Coming Out Process: A Qualitative Study

This qualitative study is designed to explore how women at various stages of lesbian identity development make decisions about managing their identities. Management of identity was studied in terms of how women came out or stayed hidden and how they made decisions both to disclose and to conceal. The Cass (1984) Stage Allocation Measure was used as a means to categorize women at various stages of lesbian identity development. Twenty-five adult women were individually interviewed using a semi-structured interview schedule. A journal was kept by each woman for one month. The major findings indicated that women at different stages of lesbian identity development use both disparate and similar identity-management and decision-making strategies. Underlying and connecting lesbian identity management and development was the need to maintain self-esteem and safety.     

"At my age I should be sitting under that tree": the impact of AIDS on Tanzanian lakeshore communities

In 1992, the author led a participatory rural appraisal (PRA) exercise for a community fisheries project in Kagera region, on the western side of Lake Victoria, Tanzania. The PRA team visited four settlements: the prime harbor settlement on Kerebe Island; N'toro beach, in Bukoba district, near the Ugandan border; Chamkwikwi landing site in Muleba district; and Buzirayombo bay settlement in Biharamulo district in the south. This article draws on that research, to give an outsider's analysis of the ways in which AIDS was changing livelihoods in poor fishing and farming communities. On the lakeshore and islands, adults were falling ill and dying. This loss of men and women in their prime was causing major economic and social stresses for the single parents, grandparents, and orphans whom the authors met. They showed resilience and adaptability in the face of this threat to their already precarious livelihoods. The article ends by suggesting ways in which development policy makers and practitioners should support livelihoods in the era of AIDS.     

Screening new products for potential winners

New product success is predictable. This paper highlights the findings of an extensive study into new product success and failure, and pinpoints what separates winners from losers. The key success factors are: product superiority—delivering unique benefits to customers, upfront homework—before development gets underway, sharp and early product definition, a strong market orientation with constant customer contact and input, and quality of execution of key activities in new product process. Sadly many firms and new product efforts are lacking on these success factors. This points to the need for a more disciplined approach to product development. One solution proposed is the implementation of a stage-gate or formal new product process—a blueprint for the process from idea to launch. A generic stage-gate is outlined in the article. The experiences of managers in firms which have implemented such processes are investigated, and the performance results are positive: improved teamwork, less recycle, higher success rates and shorter cycle times.     

Effects of the Mechanism of Receptor-Mediated Gene Expression on the Shape of the Dose-Response Curve

A mathematical model of receptor-mediated gene expression that includes receptor binding of natural and xenobiotic ligands, protein synthesis and degradation, and metabolism of the xenobiotic ligand was created to identify the determinants of the shape of the dose-response profile. Values of the model's parameters were varied to reflect alternative mechanisms of expression of the protein. These assumptions had dramatic effects on the computed response to a bolus dose of the xenobiotic ligand. If all processes in the model exhibit hyperbolic kinetics, the dose-response curves can appear sigmoidal but actually be linear with a positive slope at low doses. The slope of the curve only approached zero at low dose, indicative of a threshold for response, if binding of the xenobiotic ligand to the receptor exhibited positive cooperativity (ligand binding at one site increases the affinity for ligand at another binding site on the receptor). Positive cooperativity in the rate-limiting step of protein synthesis produced dose-response curves which were "U-shaped" at low doses, also indicative of a threshold. Positive cooperativity in the metabolism of the xenobiotic ligand produced dose-response curves that increased more rapidly than linearly with increasing dose. The model illustrates the fact that response cannot be predicted from qualitative mechanistic arguments alone; any assessment of risk to health from xenobiotic chemicals must be based on a detailed quantitative examination of the kinetic behavior of each chemical species individually.