Doing Good in “Minute Particulars” in Occupational Medicine

First published on Monday, 09 November 2015

Occupational medicine is and should be about helping and protecting people. It is about preventing avoidable injury and illness, helping people live healthier lives, and ensuring fair compensation when we cannot stop bad things from happening. Unfortunately, this is not so easy for us compared to other physicians. We don’t get the same psychic reward as other physicians. The psychic reward for saving a baby’s life is immediate and life-affirming. The reward for patching up an injured worker – not so much. The reward for preventing something bad from happening is nonexistent. The reward for documenting that a claim for compensation has no merit is aggravation. To keep motivated and to stay alert we need to take the big picture, to understand our role in the big scheme of things and to take pride in doing our job well, because if we do everyone wins, even the worker with a non-meritorious claim who thinks that his or her life would be better in motivation-less dependency.


Our leadership comes from doing things well, acting wherever we can in the genuine interests of the worker, and knowing how the system works so that the best and truest outcome is favored, although it is never guaranteed. Leadership in occupational medicine takes place behind the curtain, where it is not often seen. It is the kind of leadership that Ernie Mastromatteo showed, making things better and making occupational medicine stronger.

This notion of making occupational medicine stronger is important. Too often we treat our organizations like ACOEM, OEMAC, SOM, ICOH [if you are in the field, you know what these acronyms mean; if not, it doesn’t really matter], and the Boards as if they existed apart from us and were just there to get in our way or take our money. But these organizations do make things better over time and give our field backbone. Organizations like ACOEM and its component societies provide services like education and networking, of course, but just as importantly they give us the credibility we need to get people to accept difficult decisions, they show solidarity within medicine, and they improve our own practice through peer pressure. They provide the framework for a civil society within the community of occupational medicine practitioners. As a consequence, the state and health of our specialty organizations is a matter of concern to all of us, including those of us in other specialties or out of the civilian world. Here is another dimension of leadership in occupational medicine, the willingness to make things better and advance the state of the art.

If it sounds that I have been talking at least as much about character as I have about leadership, I’d have to say that you are right. The more I see and the longer I live, I have come to believe that character is not set in concrete. I think you can set the conditions for good character, through raising children right and encouraging initiative and self-discipline, but that is not the whole story. A lot of it also has to do with the response to a particular situation, whether a person can overcome a particular fear or feels the cause is worth standing up for. Quiet leadership denies the opportunity for grandstanding and hardly ever requires physical bravery but it is equally about character. It is when nobody is watching and you are still doing what you think is right that your true character becomes evident.

How does this soaring rhetoric square with our day-to-day reality? We grind through our schedules, push paper, see mostly commonplace injuries, sit through endless meetings, and live for the occasional challenging case that uses the full range of our skills and insight. How is this a test of leadership? Is what we do day to day enough to command our attention and commit us to a higher goal than dispatching one case after another? I think so.

I think our commitment to occupational medicine is worthy of leadership and worthy of reflections on character. Because occupational medicine, and occupational health in general, is not really about compliance with regulations, protecting productivity, or reducing losses or compensation. It is about being fair to people and about how we want to live. It is about living in a society that values people who make and do things that we need, just as we as physicians make health and provide services they need. It is about doing what is right in a society that values people and their families.

Now comes the most important message of all: So what do we do about it? How do we lead?

The simple fact is that occupational physicians are always in the role of advisors and consultants, never in a position of authority to make things happen, other than in their own small chain of command in the occupational health service. That means that our leadership cannot come from the authority of power but must come from the authority of persuasion and knowledge.

As I said at the beginning of this talk, your leadership comes from example, mastery, and persuasion. Our field, perhaps more than any other, demonstrates the truth stated poetically in William Blake’s Jerusalem. He wrote:

If we do but our duty….
He who would do good to another must do it in Minute Particulars.
General Good is the plea of the scoundrel, hypocrite, and flatterer;
For Art and Science cannot exist but in minutely organized Particulars,
And not in generalizing….

So, to do good, we must do it in minute particulars. We work in a field with fascinating science, one that is deeply embedded in technology and the economy, and in which every day is different, but in which the most important management problems are often arcane, tedious, and mundane. Our leadership lies in doing what we do well and in knowing full well what we are doing, and why we are doing it. Our leadership lies precisely in minute particulars.