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Uncomfortable Questions

why you need to ask why - five times

I saw a post recently on a Facebook group asking about holiday bonuses, wondering how much people got. Maybe you saw it, too. It was an innocent enough question, and I didn’t get the impression that it was meant as any kind of “What grade did YOU get on the test?” kind of question. I got the impression that the real question was more along the lines of “Is it just me?”

The post got hundreds of comments. The distinct minority of those who commented got bonuses; some of them sounded pretty sweet (equivalent of a week’s salary – less taxes, of course). Some were more modest (gift card).

Most commenters got nothing. Nothing.

  • After everything that we have been through for nearly three years.

  • After the time that we have donated to our employers in the form of working extra hours.

  • After doing more with less – for years.

  • After the barrage of messages coming at us from all directions – staff, patients, payers, admin.

  • After being so drained that we are thinking of leaving.

  • After coming back every day.

After all this, nothing. (Not even a pizza?)


There is a root cause analysis tool that can be used to get closer to the real cause of a problem. It’s super simple, and you can use it in any setting for any problem. I love things that are simple, elegant, and effective – and this tool checks all those boxes. All you do is ask why five times. The thinking is that by the time that you get to the fifth why, you’ll be at the cause (or have really narrowed it down). It’s a great technique - you can use it at work, at home, with your kids, with your bosses.

If you are part of the really big club that did not get any kind of thank you for your efforts this year, I suggest you ask why.

You can ask yourself, your colleagues, your employer. Then ask four more times. Then ask yourself how you feel about the answer – good, bad, or furious.

Personally, I have never received a holiday or end of year bonus in any healthcare position I have held. I did work for a nonprofit that had a good year and actually handed out some cash, but that happened once. And I’ve been working for a few decades – that’s a pretty crappy track record.

When I have been in positions to supervise others, I always made a point to thank them – regularly. But especially at the end of the year. It’s a celebratory time for some, a tough time for others. It’s a time of reflection. It’s a good time to say thank you. Even if I had to go into my own pocket, I did it because it was important to me that the people that I worked with (not “my employees,” you might notice) knew that I was grateful for them, and that I could not do what I did without them.

And do you know what? I’m grateful for you. However we ended up being in one another’s orbit (whether you read my book, purchased a time-saving tool, worked with me as a client, or decided to join the bandwagon of those who are working to put their life back into balance), I’m glad that you’re here. I’m glad that you read all the way to the end of this missive. And I’m glad that you are doing what you can to help others and try to make the world a better place.

Thank you.

P.S. If getting through the day in clinic is getting out of hand, let’s talk about how I can help.

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