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What I Wish I'd Known When I Started

Posted By Susan McDaniel, Thursday, April 4, 2013

Susan's post is the first
in a 5-part series on
leadership in
collaborative care.


Vision and the Evolution of a Collaborative Leadership Style

I could start this story with my Family of Origin-- my energetic, Ob/Gyn father and my strong-willed, arts activist mother. I also have a competitive and very successful journalist/businesswoman sister. But I’ll spare you the details on all that, and start with 1982. I was 30, and got my first academic job in Family Medicine. It was .35FTE and I was the first female and first non-MD on the U of Rochester Family Medicine faculty. The Chair encouraged me not to "worry about coming to faculty meetings.” Somehow (perhaps because of the structural family therapy training I had complained about as a postdoc) I knew not to listen, and told him I’d be there. First lesson: Try to hone your skills about when to listen to others and when to have the courage of your own convictions. (I was also discouraged from several people about taking a job in Family Medicine as "it’s the stepchild of medicine.” And earlier, the psychologists I worked for during my year as a research assistant after college urged me to go into Law rather than Psychology. I’m sure glad I didn’t listen to them.)

Really, I do seek a lot of advice and I usually take it. But when I really believe in what I’m doing, I take the risk; then at least it’s my fault, not someone else’s, if it doesn’t work out. I just went to a Tribute at the Fort Lauderdale Museum of Art for my mother who died 12/24/12 In addition to comparing her to Scarlett O’Hara, one of the speakers talked repeatedly about her "courage” in advocating for the arts in Fort Lauderdale and across the state. When they broke ground on the big new Museum of Art 25 years ago, there was a photo of 6 men and my mother, all with shovels. I hope I inherited some amount of courage from her, as it’s critical when you’re going against the tide. From a family systems view, I think we’d say that individuation is critical for healthy collaboration.

Family Medicine was and is a wonderful laboratory for someone like me interested in biopsychosocial medicine. I was so fortunate to work with pioneering people like Lyman Wynne (a psychiatrist and father of family therapy) and George Engel (and internist and the father of biopsychosocial medicine) during the first 25 years of my career. They were wonderful mentors--educating, coaching, supporting, and challenging me. Second lesson: Seek out experienced people you respect and ask to work with them, no matter their discipline. The mentoring will come naturally. I learned so much from these two men. Their work forms the foundation of mine. To say I stand on their shoulders would be an understatement.

From the beginning, it was clear to me and many of the faculty and residents in Family Medicine that family therapy has so much to offer patient care and education. The key was really learning about primary care. That took connecting with a key collaborator. For me, it was family physician, Tom Campbell. We were both young and new. (It helps to be idealistic, energetic, and somewhat stupid early on. You see the world with fresh eyes. I just couldn’t understand how medical care could be delivered without attention to psychosocial issues. Actually that’s still true….) In the early 80s, Tom taught me about family medicine ("I don’t care about theory. Just tell me what to do.”), and I taught him about family therapy ("Slow down. I want to know the history and the relationships. Give me a genogram.”) Together we developed a family-oriented curriculum for primary care that eventually became a book. Third lesson: Choose your smartest, healthiest collaborators. This is as important as your marital or life partner. You need many of the same attitudes and skills: respect, communication, conflict management, problem-solving. It’s a very intimate relationship, in the professional sense of the word. I did and do learn a tremendous amount from Tom.

Then through professional meetings, I became close with family therapists, Jeri Hepworth and Bill Doherty, who were (and are) working in Connecticut and Minnesota. The three of us were fortunate to be at a Family Process quadrennial in 1988 in Costa Rica, and we talked once again (a favorite topic of ours) about how we now knew how to teach primary care physicians about psychosocial medicine and family systems, but we were frustrated about how all our mental health colleagues didn’t understand biopsychosocial medicine. It was a one-way street far too often. For some reason, maybe the palm trees or the drink beside the pool, Jeri didn’t join in complaining this time. Rather, she challenged us: why don’t we write a book for mental health professionals about this work? The 3 of us flew together from Costa Rica to the Family Medicine Amelia Island meeting via Nicaragua (where there were soldiers with machine guns outside the plane, but we didn’t stop working). By the time we landed in Jacksonville, we had an outline for the first edition of Medical Family Therapy. Like any good partner, once you find good collaborators, don’t let them go! It took some major arm-twisting at various points to get Bill and Jeri to do the 2nd edition of this book, which will come out this summer. But collaborators that they are, once on board they were fully on board. And what a beautiful product it is!

There were and are many, many challenges to this work. I left out all those stories in order to tell you these. And that brings me to the Final lesson: Persistence! If you have a vision, challenges help clarify what it truly is. Some projects take weeks, others months, still other decades. I’ve often thought persistence may be my strongest talent. For new professionals, having the long view can really help when the inevitable difficulties and hard times arrive. Collaborative care is not yet the dominant paradigm, so challenges are to be expected, endured, even occasionally embraced. And they make the successes that much sweeter.


Susan McDaniel

Dr. McDaniel is the Dr Laurie Sands Distinguished Professor of Families & Health, the Director of the Institute for the Family in the Department of Psychiatry, Associate Chair of the Department of Family Medicine, and the Director of the Patient- and Family-Centered Care Physician Coaching Program at the University of Rochester Medical Center, where she has been since beginning her career in 1980. Her career is dedicated to integrating mental/behavioral health into healthcare. Dr McDaniel is the author of numerous journal articles and 13 books, translated into 8 languages. She was co-editor of Families, Systems & Health for 12 years, and is now an Associate Editor of the American Psychologist. She is very excited about her latest book, co-authored with Bill Doherty and Jeri Hepworth. Medical Family Therapy and Integrated Care, 2nd Edition, is In Press and will be published late this July--21 years after the 1st edition appeared.

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