by Tia Will
As my retirement rapidly approaches, I have had time to reflect on the changes that have occurred in medicine over the course of my career. Since I was first licensed in 1984 there has been a major change in the doctor-patient relationship. Medicine has moved from a model in which the doctor was assumed to know best, was expected to simply tell the patient what to do, and the patient either complied or did not, and improved or did not. Over the years, and with much study and self-reflection a new and more effective model has evolved. It is now nearly universally accepted that the doctor-patient relationship works best and achieves the best outcomes when it is considered as a partnership in which the doctor is the acknowledged expert in the anatomic, biochemical, and pharmaceutical aspects of medical treatment and the patient is considered the expert in the more personal aspects of treatment such as their past experience with various approaches, what is and is not acceptable treatment for them, and how much faith they have that a recommended course of action will be beneficial.
Many studies, and much personal experience confirm that the best outcomes are achieved more rapidly when the goals and values of the doctor, the patient and those critical to the wellbeing of the patient, usually family members, are all in alignment from the very first appointment. The doctors who practiced the paternalistic, doctor-knows-best model were not evil, nor greedy, nor uncaring. They had simply been trained to consider that their model was the best way to provide medical care. As it has evolved, they were wrong. The current model of partnership and mutual respect between doctor and patient is a much more effective.
Earlier this week, while attending a City commission meeting, a broader application of this principle occurred to me. As I was listening to comments from both proponents and opponents to a project being considered, the similarity in attitude and process occurred to me. There were a number of highly effective speakers on both sides. There was no doubt to me that both sides were very sincere in their beliefs and that all believed very strongly in their own position. It also was clear to me that different models of process were being invoked. The developers and investors were doubtless sincere in the belief that their project was good for the entire city and that the potential downsides are miniscule by comparison. Those who object to the project (almost all from the most directly affected neighborhood) do not see their concerns as trivial and believe that there is another, better approach that would be within the current guidelines, would still be profitable for the developers/investors, and would meet the goals of the community in terms of minimizing adverse effects, or to use the medical analogy “side effects”.
From in-person and Vanguard conversations over many months, it appears to me that the issue of development is currently considered as an inevitable struggle between those who propose a project and “push back” from the neighborhood, or the “NIMBYS” as they are derisively called in a shaming process not so different from those who portray all developers as “greedy exploiters” only out for a buck.
I believe that there is a third way that could prove more effective and less costly in terms of time, money, and animosity. I have discussed with some of our local developers the possibility of considering a new model of engagement using mutual respect and acknowledged different areas of “expertise” between those whose project would change a neighborhood in terms of architecture, land use, and the technical aspects of site development (analogous to the doctor) and those who live in close proximity and thus will actually have to live with and be most directly affected by the effects of the project, both positive and negative (analogous to the patient). I feel that a collaboration from the beginning, before the land is purchased, before the design is decided upon and long before it is presented to the community with only the possibility for minor “mitigations” would provide a much less expensive, faster and more civil process that does not pit neighbor against neighbor would result in much better outcomes.
I know that for those who do not want peripheral development, the thought of change to a larger footprint is difficult. And yet there are some who believe that we should definitely move in this direction by ending Measure R. I know that for those who do not want large developments in their small, homey neighborhoods the thought of a large building outside design guidelines is a change that they do not want to see. And yet there are many who argue that since the property is owned by someone else, they should just shut up, and take what they get. This is the way the conversation is sometimes framed.
What I am suggesting is that perhaps the developers/investors might also be willing to consider a change from the way things are classically done in their business. They frequently see change as a good for the community. What I have not yet heard on a wide scale is the embrace of change in their processes to be more inclusive from the onset of the initial project concept to consideration of the preferences of the directly affected community.
I freely admit that the change from a paternalistic model to a partnership model in medicine has been slow and in some cases difficult. Humans tend to be slow to accept change, especially if they are the ones that have to change. However, if it can work for one of the most entrenched, arrogant and condescending groups of people that I have ever met, namely doctors as a whole (not necessarily as individuals) I believe that it is at least worthy of consideration by our experts in the field of city and project planning. A little up front collaboration just might pay off in the long run in terms of quicker project approval, a project that will be universally considered beneficial and freedom from “repeat visits” in the form of contentious meetings both private and public and ultimately the ever present threat of a law suit.
I believe that we can do better than current process and look forward to your thoughts.