The simultaneously most powerful and dangerous word in all of history is the word “should.” But that’s exactly the business that the Congress of Delegates is in- defining the way things “should” be.
As family physicians, our days are filled with decisions based on “should”- whether aimed at us or our patient. We “should” order a certain test or screening and our patients should perform certain activities or follow certain recommendations. It turns out that “should” seems to occupy the vast majority of our days- but “should” alone is ineffective with a resulting action. That you should quit smoking, you should lose weight, or you should exercise more have no impact on the health of our patients- it’s what they do that really matters. But family physicians aren’t immune: how often have you been told you should meet an RVU threshold, should tolerate a broken system, or should just keep your head down and work harder. We probably know better than most the challenge of someone else telling us what we “should” do or “should” be.
History has shown us how powerful and dangerous this word can be when wielded in the wrong hands. Revolutions have been sparked, wars have been fought, and entire cultures oppressed because of what certain people believed others should be, should believe, or should do. Should can be a tool of oppression when it’s used to force conformity or to punish difference or it can be a unifying vision that allows us to look past our differences of opinions. But what does this consideration of seeming semantics have to do with the reason we are all in Phoenix? We are here to define the “should” so that out Academy can convert it from “should” to “will” to “has.”
As you read the resolutions submitted to this Congress, and the written testimony provided to our virtual reference committees, the idea of “should” permeates them. What are the policies of the AAFP? This is the body that determines that. However, the more important aspect of our process is the “should” that we create with our framework of policies. That comes from considered reflection and discussion. As our number of resolutions has increased, we are trialing a hybrid reference committee approach this year. It’s not in an effort to increase the number of resolutions that we hear, but is instead about making sure that we have the time to truly discuss and consider the ones where we don’t have immediate broad approval. If we all agree that we “should,” we don’t require extensive discussions about why. But when our colleagues identify potential challenges, we owe the time for consideration- not in an effort to galvanize supporters of different positions, but to understand, and hopefully address, the concerns of our well-intended colleagues on both sides of the discussion. If we can’t find that compromise, we must recognize that sometimes a bad “should” is worse than no “should.” We can celebrate that our Congress has a long history of coming to the right answer, even if it requires multiple Congresses to find it. That We as a Congress, and not just some small subgroup, come to and own the “should” is just as important as the idea.
As we listen to our inaugural class of Nominating Committee identified candidates, consider the “should” of our process of identifying and selecting our academy’s leaders. Did they get it right, or are there additional “should” that we need so that their output more closely matches the Congress’ expectations? It is only through communication and a willingness to adapt longstanding rules to a rapidly changing world that will allow us to be successful as a Congress.
It remains a privilege to serve you and I look forward to your understanding as we all work together over the next few days to define our vision of “should”.