Tuesday, January 9, 2018
Personal civic authority
Key concepts: my experiences and observations on Rose Wilder Lane’s 1943 book, “The Discovery of Freedom”; mutual responsible freedom; the-objective-truth, which can only be discovered; personal authority for civic goodwill; physical and psychological person (human) power; civic morality---mutually just public and private connections; coaching in preparation for experiencing and observing; hierarchical repression of goodwill---tyranny over human personal authority.
In public transactions, most people behave as though they appreciate mutual responsible freedom, or at least act as though they are civil. They understand civilization or social order. However, some people, perhaps 1/3, readily attempt to impose arbitrary authority over the other party. They are dissidents. Some dissidents attribute their behavior to an institution, church, or government. Civic persons do not readily yield to arbitrary authority rather than responsible freedom.
We assert that the human individual has and cannot delegate the authority for mutual responsible freedom, or civic justice. Two parties in a public or private transaction each have the authority to complete their transaction in mutual civic justice. If the two parties require intervention by a higher power, they have missed the opportunity to humanly collaborate.
Some individuals strengthen their personal authority through spiritualism, such as prayer to their personal God. However, spiritualism does not lessen the responsibility for mutual freedom in transactions with others.
In simple terms, if each person realized that they may personally take authority for mutual justice in one-on-one human conversations, things would go better.
This presents a principle for mutual responsible freedom. The application is human-relations training in service industries such as medical-care. The thesis is: Evolution informs humankind that theirs is the species whose each individual has the potential physical and psychological powers to accept the authority to establish mutual responsible freedom. Some people erroneously avoid that personal authority. Some institutions unintentionally discourage that authority.
In the hierarchy of interests to patient and health-care providers, are life rather than death; best possible physical outcome; best possible psychological outcome; and fiscal viability. Medical services accepts the authority and responsibility to preserve life; provide best outcomes, both physical and psychological; maintain availability to both paying patients and safety-first responders carrying injured people. Perhaps in no other human service is management of authority as critical, and the CEO has that responsibility.
The ideal free market involves health care providers and patients. In 2018, I cannot innumerate the “provider’s category.” The contributions of doctors, nurses, medical aids, information workers, and communicators seem lost in the insurance and government aid debates. However, this improvement proposal addresses the one-on-one conversation between direct provider and patient that is found in each contact in a medical care event. We propose that the provider, whatever their role, accept the authority to collaborate for mutual responsible freedom in all conversations. When the patient does not understand responsible freedom, this system incidentally may fail, but most patients understand.
Medical services involve conversation. In all one-on-one human connections, acceptance of the authority to practice responsibility for mutual freedom is critical. Ideally, neither the provider nor the patient imposes coercion or force on the other. To work toward that ideal, providers may choose a system that preserves the patient’s freedom as much as possible; accepting direct provider authority is the system. To accomplish this mutual responsible freedom, the provider must accept the authority and defend that authority with responsible action. If the patient does not reciprocate, the provider accepts that not all humans understand responsible freedom and then calls for help.
Below, I explain this proposal in more detail. If it is interesting, the complete theory may be of interest. It would take a little time to assemble the existing ideas.
Accepting human authority
The way things are, human beings face death, uncertainty, and opportunity, with determinants for each---a triad of controls. Death may come on either exhaustion of positive energy or on fateful event. Uncertainties come from the ever changing environment, including the psychological community and the physical universe. Opportunity comes from preferential use of personal energy. The individual may accept personal human authority. In other words, the individual may accept the opportunity to spend his or her lifetime energy to discover and acquire personal preferences. For example, I am glad to know I prefer both dark chocolate and to never lie.
During his or her lifetime, the individual is subject to the world: physical and psychological evolutions, the market place, governments, the public, family and friends, and personal energy. Just as he or she must work to eat, he or she must work to understand fidelity, to establish and enjoy statutory justice, and to assure economic viability. Statutory justice refers to just written law with just law enforcement; in other words, responsible freedom. Rare is the person who takes the authority to manage these lifetime opportunities.
As cultures evolve most individuals expect and seek authority. Death is coming. Government contends with uncertainty. The individual may struggle to discover personal preferences. Often, the individual subjects to civility under the least repressive tyranny. Options range from democracy, communism, socialism, monarchy, and others to republicanism under statutory justice. There could be a way of life wherein government serves the individual. It could feature public justice with personal privacy---a civic culture.
A civic culture can be created wherein each newborn is both informed about existing knowledge and coached to take personal authority for responsible human connections in both private life and public life. This way of living empowers rather than represses discovery of personal preferences such as vocation, avocations, religion, fine arts, sports, etc. It offers private liberty with civic morality. Therein, the individual who accepts private authority for mutual justice may live at the leading edge of civic morality.
The overall conditions in the world do not seem optimal. The triad of authority may not be serving the individual well, and there may be an achievable, better way of living. The individual may assume authority on all three levels of control. Thus, even though God/fate, government, and personal preferences exist, each individual develops personal authority in all three determinants.
Personal authority is made legitimate according to its fidelity to actual-reality or the-objective-truth. The-objective-truth is discovered rather than constructed; human inventions behave according to the-objective-truth.
In the physical and psychological world that has evolved, one species, the human being has the capability of taking the authority to discover and benefit from the-objective-truth. The corollary is that each person has the responsibility for both personal freedom and civic justice in human connections. “Civic” means behaving for mutual justice in human connections more than conformity to a municipality or doctrine. When or if most inhabitants collaborate to prevent or lessen injustice, misery, and loss, they create and improve a civic culture. I say “most” because history shows there are always dissidents to statutory justice for reasons the dissident may or may not understand.
In a civic culture, collaborating humans enjoy private liberty with civic morality; dissident citizens are constrained by statutory justice (civic laws and law enforcement). Civic citizens look not to tradition but to actual-reality to guide human connections so as to live at the leading edge of civic morality. For example, the British commoners who settled this country vaguely knew that Lords fox hunt for revelry; the American settlers adapted to indigenous peoples’ cultures, hunting for food rather than for revelry. The British purpose for hunting became obsolete for Americans, yet remains the English tradition. A civic culture allows the individual to develop private hopes according to personal preferences. In fidelity, each person, in their daily choices, discovers his or her preferences, and therein his or her person. The dissident is a slave to habit, subjugation, or other tyranny.
No institution should repress the civic person’s quest for self-discovery. To put it another way, cultural evolution that influences people to assign the authority for civic connections (human goodness) to institutions is erroneous. While it may be true that a higher power (God, physics, energy, or other) controls fate, goodwill between two humans is a consequence of mutual civic justice. The erroneous tendency to assign authority for goodwill to institutions can be lessened by collaboration and coaching. The spiritual person errs to neglect personal authority for mutual responsible freedom in transactions.
A hospital is a human collective that takes or accepts the opportunity to preserve life and its benefits. The doctors take responsibility for medical care and supervision of assistants---specialist, nurses, aids, and other direct medical providers. Close to the direct medical-care providers are administrators---record keeping, appointment schedulers, food servers, room janitors, and other people who communicate directly with patients. The administrators coordinate with the direct care providers and all other necessary functions---data, legal, collections, maintenance, etc.
A hospital takes responsibility for the both the patient’s well-being and the risk of causing death. The last thing a hospital wants is to perceive they may have caused the dreaded fate: death. In other words, no civic person serves in a hospital so as to participate in deadly error. Hospitals do all they can to continually discover potentials for error and eliminate them. Application of the theory of human, mutual responsibility for freedom---in other words, accepting civic authority---may be advantageous for hospital-employee training.
The hospital personnel may decide to accept the triad of authority: opportunity, uncertainty, and fate. In every civic connection, the patient rather than institutional authority may be the prime consideration. With common practice, the public would perceive the better relationship and reciprocate---take the authority to preserve mutual appreciation.
An example will help understanding for collaboration on this idea to consider developing it for inclusion in employee training. We choose the doctor’s appointment scheduler (DAS) to illustrate a care-giver who may take civic authority. By DAS, we mean the person who confirms the doctor’s availability, for example, when the hospital’s general appointment scheduler needs assistance from the doctor’s suite or the patient is in the doctor’s suite. In this example, a patient came to the office for an appointment that was interrupted by an emergency. He asked to be called at home when the doctor arrived. The DAS did not feel authorized to say, “Okay.” Explanation of both sides of the conversation will aid comprehension.
The patient seems a candidate for stroke or heart attack. He had 3 stents added to a fourth in the same vessel on August 25. There was another serious concern: In an unrelated subsequent first appointment, regarding a 2.5 cm thyroid-nodule, the endocrinologist would not schedule a needle biopsy because of Plavix. In a subsequent phone call, the cardiologist’s nurse reported that Plavix could not be stopped until a year had passed. The patient was anxious for the December 15 appointment with Dr. Janes.
The patient is a lung-cancer survivor, so his family is very alert to cancer. They are upset with the thyroid uncertainty; the patient not so much, because he considers risks low.
His wife is a Parkinson Disease patient and blood in her urine was confirmed on December 13. The family is very concerned about that and anxious for her to see the urologist on the PCP’s referral. On December 15, he was in the shower when his wife heard a message being recorded on the home phone from the doctor’s office. Soon, the patient, at the phone, dressed in a towel, saw two recordings from physicians, heart physicians at 9:30 and urology physicians at 9:33. He requested his wife’s permission to make an appointment for her (with Dr. McNeal) and did so.
Then he called heart physicians and talked to one person who then dialed another number, I suppose in Dr. Janes’s suite. After several minutes, the family was urging him to get off the phone to avoid being late for the appointment. He hung up and left.
At the office, the ground-floor appointment clerk sent the patient to the ninth floor. There, Dr. Janes’s scheduler presented the options: wait for Dr. Janes’s return, or reschedule for Monday. The patient thought; did not want to risk a Monday appointment; then asked, “I live only five minutes from here: Please call me when you know a time Dr. Janes can see me today.” This kind person had the opportunity to say, “OK,” but did not accept the authority to do so. She is not to blame, because she lives in a culture that represses mutual responsible freedom in favor of hierarchical authority. What’s overlooked is that the patient’s health may be at risk. She would like the opportunity to say “Okay. In other words, without institutional repression, people behave with goodwill.
A few fortunate people take authority and minimize human misery and loss despite institutional constraints. And that’s how this story ends, below.
December 15 morning, Dr. Janes was called to a heart attack situation and the staff kindly wanted to contact me, the patient, to say I could come wait or reschedule for December 18. It was nice of them to try to call. However, as described above, I did not get the message, ran out of time, and drove less than a mile to the appointment. So far, no problem to anyone.
There, facing the options: wait indefinitely from 10:15 AM or reschedule for Monday, interrupting my family-holiday-time, I responded, “I live only five minutes away. Let me go home, and call me when you know the time Dr. Janes can see me.” Unfortunately, the nice person did not feel authorized to respond, “Okay,” as described above.
The next event was typically unhelpful: The person she looked to for authority perhaps did not take the time 1) to understand the simplicity of the request and 2) to consider the reality that they had already called me once that morning. She merely repeated the options offered. In effect, they could call at 9:40 to say Dr. Janes was gone but could not call when he returned. When I was incredulous and stubborn, that person got a third person, who gruffly said, “Come into that office [pointing] and we’ll . . .” (I did not really hear the rest of her sentence.) That unfortunately excited me. When I responded to her “police order” to sit in the hall, I turned to sit down and saw that another customer was in line behind me. The staff knows the other patient could wait in line across the hall. In other words, to me, three care-providers were not considering me their patient; call it the hospital’s patient. The institution did not care that a heart patient was being excited to high blood pressure (see below). The “police” action was, in my opinion, an abuse: My objections were placed on public display.
The above described events are typical of busy work places like hospitals. The first care giver has the first hand conversation but does not perceive authority to respond “Okay”. The second person may have the authority but does not have the first hand conversation---does not really appreciate the simplicity of a second phone call. Any third person becomes mere force without consideration of the patient. The hospital’s freedom is more important than the patient’s freedom, and the patient is paying the bill (paying for the insurance).
Meanwhile, the patient has human energy and psychological power that does not accept care-giver conveniences as legitimate responses. In other words, “we can’t call you,” when they had already called does not compute. The object of this proposal is to change the authority-culture so as to take advantage of the human psychological power to reject nonsense on both sides of a conversation and use it for opportunity for goodwill or civic morality or mutual responsible freedom.
The situation was resolved when Pamela Sharpley was asked to offer care; seated in the hallway between the two doctor’s suite schedulers. (A policeman might imagine that if the patient suffered a stroke it would be best for the public to witness the preceding dialogue. The patient would prefer appreciation as a patient, agitated as he may be.)
Pamela and I patiently spent the time it took to mutually understand the two issues: 1) patient communications including a phone-tree that can leave a patient in indefinite wait and 2) completing the December 15 appointment. She not only reached understanding of both problems, she created a new option for Dr. Janes’s emergency absence: examine me for the vital data so that when Dr. Janes arrived, the appointment could be expedited. Then, Pamela contacted Dr. Green’s nurse at BR Clinic (overcoming my equivocation that he is at OLOL) to clarify the needle-biopsy needs; four days without Plavix. However, my expected blood pressure could not be measured, because the actual data was 160/90. A check at the end of the exam was the same. Dr. Janes knows me and was not concerned with the emotionally elevated blood pressure. On December 20, my blood pressure was 134/72.
The person who made the decision to call me about my cancelled appointment had the patient in mind, but no idea the chaos I, the patient, was calmly handling. When I hung up on the stalled, automated phone-tree, I was only driving less than a mile and would be on time for my appointment. No problem, so far. However, when the same people could not see their way to call me again, things became psychologically challenging to me to the point of emotional blood pressure.
Pamela patiently listened to me suggest a better way. It’s based both on experiences and observations and on reading Rose Wilder Lane’s 1943 book, “The Discovery of Freedom.” Read it in PDF at mises.org/library/discovery-freedom, perhaps on library loan, or consider purchase options at amazon.com/Discovery-Freedom-Struggle-Against-Authority/dp/1503117553.
The point in this example is that when all that matters is human, civic collaboration, as in “I called you before, so I can call you again,” the direct caregiver can and may take authority rather than call in a third party. Pamela took complete authority and the results, which seem unusual by today’s institutional standards, can become the normal, better future at all levels of hospital services.
The message from my reading Lane’s book is this: The hospital’s hierarchy of personnel has direct authority for medical care. The hospital, intending to effect favorable outcome, takes the risk of causing unfortunate fate. Each caretaker in the hospital has human authority to take responsibility for just connections---good will---with patients and visitors. The judge in human connections is mutual responsible freedom---in other words, appreciation by both parties in the connection. When someone responds to one patient’s emergency, the routine patient may also be viewed as a human with the potential for emergency. His/her reasonable request in the face of options he/she deems nonsensical (“I called once but cannot call twice”) ought to be considered by the caregiver. The-objective-truth is that humans are too psychologically powerful to collaborate on nonsense. This principle applies to both parties in the transaction. Just as the patient will not accept nonsense, the care-giver who is not repressed to take authority does not offer nonsense. The psychologically powerful care-giver who nevertheless yields to repression regrets forcing nonsense. This no nonsense civic morality can be taught and coached. As in all things, there will be some bad events outweighed by more good consequences.
If this concept is useful, the actual training principles must be developed. The goal is most providers and patients completing connections with mutual appreciation. With future practice, frequency of mutual appreciation will increase.
A couple went to dinner to celebrate a 48th wedding anniversary. The restaurant was very crowded but so large that they were seated right away. One member of the party needed assistance to maneuver the busy isles and take a seat. The party of four used a spare chair to hold heavy coats and hats. Later, a server demanded the chair, but the waitress intervened. The party of four, by agreement, each ordered what they wanted when they wanted it. One party ordered an entrée later than the rest so as to complete the preliminaries and not overeat. The waitress took complete charge of the extended service, and every need was met. She empowered a celebration that could not have happened without her authoritative approvals of off-menu orders.
I realize that to some waitresses and waiters such service is commonplace, yet I had not expected it. When service is so civic, it demands appreciation.
Copyright©2018 by Phillip R. Beaver. All rights reserved. Permission is hereby granted for the publication of all or portions of this paper as long as this complete copyright notice is included.