Forget Tokenism: Just Do It - But Show Up to Work

John McManamy Health Guide
  • I don't hold any stock in astrology or the related pseudo-sciences, but my daily horoscope two weeks ago is making a believer out of me.


    "Scorpio," it read. Sure enough, I was born within the Scorpio time frame. Right, so far.


    "July is propitious for dropping everything you're doing," my daily horoscope continued, "and focus on deconstructing mental illness and coming up with consumer recovery algorithms."


    Something about Pluto no longer being an official planet, I think.


    Naturally, I dismissed all this as superstitious nonsense, but sure enough last week I began deconstructing mental illness (see previous blog). And this week I've been slaving over algorithms.

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    Talk about uncanny.


    The consumer recovery algorithms project (readers, please refrain from coming up with an acronym) started over conversations with my housemate Paul back in January (see blog). Algorithms resemble flow charts. In the medical profession - which includes psychiatry - they are used to sequentially guide physicians through making diagnostic and treatment decisions. What about algorithms for patients? we reasoned.


    The first six months of the project went off without a hitch. Do nothing for six months, was our goal, and we exceeded our expectations with time to spare.


    Then, last week, at a high-powered meeting in Washington DC, Paul let the idea drop.


    "What do you mean you brought this up in a meeting?" I remonstrated. "Don't you know that no one listens to us?"


    A word of explanation:


    Meetings always require the presence of a token consumer. Paul was one of three or four. The idea is to find a consumer who has no idea what he or she is talking about, preferably with a raging personality disorder. That way the professionals and administrators on the committee can politely thank the consumer for sharing, benignly disregard everything he or she may have said, and continue with business as usual.


    Absolutely, in no way, are consumers meant to interfere with business as usual.


    Token consumers are broadly divided into three groups:


    The low-functioning patient with an unresolved severe mental illness smoking cigarettes in a day room iis your ideal token candidate. Thus, when say privacy safeguards for electronic patient medical records is raised for discussion, this is the cue for the token consumer to say something like: "I got a library card yesterday and I know how to use it."


    Don't laugh. I've seen this type of thing happen way too many times. Okay, laugh. That way you won't cry.


    Someone very high up in the advocacy pecking order is also ideal. These people have so much going on that there is no way they can adequately brief themselves for the issue at hand. Instead, they tweak the opening and closing paragraphs to their standard road show presentation. ("Hello, Pittsburgh, uh, make that Atlanta.") Last month, in the audience at a conference symposium about diagnostic considerations for the next edition of the DSM, I squirmed through twenty minutes of the head of a national patients' group lecturing - yes, lecturing - the doctors about stigma.


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    Ouch! We blew another opportunity. That really hurts.


    And in a pinch, antipsychiatrists always come in handy. These are your people who would be the first voted off the island in "Survivor." Even Mother Teresa hates antipsychiatrists. As it happens, antipsychiatrists love getting on committees and serving on boards, which they see as golden opportunities to stick it to the man. What the antipsychiatrists are too stupid to figure out is that their antics are nothing more than "I got a library card" with the volume on high. Thank you for sharing.


    Heaven help if a token consumer were to actually take a genuine interest in the discussion at hand. The entire system - top to bottom - is simply not designed for that. Worse still would be the prospect of the token consumer coming up with an original idea. The magnificently inefficient enterprise that we charitably refer to as health care would spontaneously implode. The Rapture, End of Times.


    "You did what??!!" I asked my housemate in disbelief. Paul is an anomaly, a rare combination of someone with intelligent things to say who gets on well with everyone he meets. More rare still, Paul actually listens and pays people respect. So even if it's not in their best interest, the people who set agendas invite Paul to their meetings.


    You know you've made a telling point when you are met with stony silence. That's what happened when Paul dropped our consumer algorithm bunker-buster on this high-powered meeting. Two micro-seconds of stony silence, then onto the next discussion point, with not even a decent thank you for sharing.


    But after the meeting was over, at least two people signaled to Paul that they wanted to learn more.


    So now the ball was in my court. I needed to come up with a position paper and a sample algorithm or two. Why me? No one listens to us.


    Paul and I both know that, of course. Which is why we're going to do these algorithms ourselves. Not just talk about it. Talking will get us something that no one wants ten years from now.


    Naturally, we can use all the help we can get. From personal experience, I have found that we can rely on the good will from the very people who set agendas once we take the initiative. The dynamics instantly change. No more tokenism.


    But doing it involves a lot of hard work. As I said, we can use all the help we can get.

Published On: July 20, 2007