You are confined only by the walls you build yourself

Chester “Trip” Buckenmaier III, MD,
COL (ret.), MC, USA

“You are confined only by the walls you build yourself.” ―Professor Andrew Murphy

The free, efficient and unobstructed flow of information is critical both in business and medicine. Groups or departments within a larger organization are unflatteringly labeled with the euphemism “silo” when they are of a mindset to internalize processes and not share information. This tendency of departments within an immature organization to jealously guard information unique to their activities leads to wasted resources and “turf” wars, which can be devastating to the company overall. Although this concept originated in the business world, it is rare not to hear this same lament about the silos in medicine that slow progress to the detriment of the health system and the patients. A brief internet search using the terms “medicine” and “silo” reveals a host of commentary on the topic. 

For anyone in the healthcare profession, the tribalism inherent to medicine is no secret. In my own world of pain medicine, the factions are too numerous to count, and the different national pain organizations―all with different agendas―can be overwhelming. It seems to be deeply rooted in the human condition for individuals or small groups to seek and define how they are different and special from larger organizations. Admittedly, there is value in this innate need to be unique, in that this human drive motivates innovation and new thinking. Individuals or groups daring to be different should be encouraged and even cultivated, but only to the point where these differences become counterproductive to larger organizational and collective goals. Individual or small group differences that help the larger organization change and adapt to new challenges is positive for everyone. In contrast, being different for personal aggrandizement or reward at the expense of the overall mission and vision of the organization rarely ends well for the individual or the group. I think the following experience illustrates my point.

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