The Zoom screen flickered and pixelated as our two smiling faces came into focus. Dawn Osborne-Adams and I patiently waited for our audio to connect, and then we launched into excited greetings to begin our meeting, a scheduled one-to-one to learn more about each other. I love that part of my job includes getting to know amazing colleagues across the campus where I work, and Dawn is one of these colleagues. She is the University Ombuds and a lawyer with years of experience in dispute resolution. Those moments of conflict that make so many of us uncomfortable are the moments where she brings her skills to bear and shines. As a primary care doctor and medical educator, I joined the meeting feeling like a sponge, eager to learn as much as possible from Dawn’s experience and perspective. Learning from others with different backgrounds and experiences than my own is a source of joy in my daily work.
As Dawn and I chatted, she asked, “Do we have community at our institution?” We often talk about our university community, our School of Medicine community, and our medical community, but what does that mean? And do we truly have it? Dawn introduced me to a book that had prompted her to consider these questions more closely.
In this book, Community: The Structure of Belonging, author Peter Block takes an action-oriented approach when he defines community as “the collective capacity of citizens to make a difference.” I anticipate that many of us in medicine can relate to this definition, while also recognizing that community can refer to fellowship, coming together, or living in a similar geographic area. Block’s approach is about the power of communities to be a positive force in the world, and he emphasizes that each one of us has the power to influence community. He writes:
"The core idea is that without a shift in trust, social capital, belonging, relatedness — call it what you wish — our capacity to solve problems, organize work effectively, or end the suffering around us is greatly diminished. Our efforts to discover and implement new programs, pilots, and social innovations will make little difference in a context of scarcity and wide relational disparities. This is true regardless of loving and charitable instincts.
"A shift in social capital occurs when we decide that the real transformation is having citizens — strangers up to now — sitting in circles, learning to trust each other, and deciding how to make a place better."
Block affirms that we have to be intentional to build community. Building community requires attention to how we come together, shifting problems (which often creates “us” versus “them”) into possibilities, and recognizing the power of individual accountability, which is our choice to embody. In the space where possibility and accountability overlap exists the potential of what we can create when we come together in true community.
Building community requires attention to how we come together, shifting problems into possibilities, and recognizing the power of individual accountability, which is our choice to embody.
And I’m concerned that what Block puts forward in his book is counter to how we behave in medicine and society at large. I’m going to generalize here — this is not true for everyone — but more often than not, we hold individualism in the highest regard. We search to identify problems that we can fix. We call out people who we perceive are the source of problems, and we advocate for them to change, or we mobilize to outnumber them. We “connect” in virtual spaces only, and we host meetings with a primary goal of checking boxes.
I’m not saying that we should never engage in or value some of these approaches, but when they are primary and creating community is secondary, we damage belonging, and we leave a lot of power on the table. We are most effective when we prioritize community and then mobilize for action.
Recently, a faculty member in another school reached out to me for advice on a conflict she witnessed. I listened, asked questions, and offered to follow up with her again. She said, respectfully, “I will reach out again when I know it will be worth your time.” I asked her not to worry about whether it would be “worth our time.” Substantial value is produced by the act of coming together, not only in the boxes we check.
Block’s book is rich with suggestions for individual action. One, in particular, that stood out to me:
"Citizens become powerful when they choose the context in which they operate. This choosing is difficult because we are seeking an alternative to the received wisdom of the culture. Choosing our own language of context, rather than aligning with the language of the dominant culture, puts the choice in our own hands. It acknowledges that our mindset, even our worldview, is subjective and therefore amenable to change. There is a cost to this — namely, we are subject to doubt and at times loneliness. It is the path of a pioneer."
Do we succumb to the ubiquitous blaming mentality that puts the onus of change on others, or do we take accountability for how we enter shared spaces, even if our approach is atypical? Do we embrace the pervasive “either/or” characterization of popular positions, or forge a creative path of “both/and” that requires curiosity, humility, and that unlocks hidden potential within us and our neighbors, even if this exposes us to criticism? Our decisions may depend on our perceived power in certain spaces, because going against the dominant culture is risky, exposes vulnerability, and can be decidedly lonely. That said, it is less lonely when we forge a path together, in community. I am grateful to Dawn for stretching my perspective on community and encouraging me to join her in collaboration at our institution.
Sarah Smithson, MD, MPH, is the Assistant Dean for Clinical Education at the University of North Carolina School of Medicine, the Director of Relational Leadership @Carolina, and a senior advisor to Intend Health Strategies.
We are most effective when we prioritize community and then mobilize for action. When creating community is not a priority, we damage belonging, and we leave a lot of power on the table.