When I finished my training in the early 2000s, my first job took me to Ashland, a small town in northern Wisconsin.
When I first arrived, I spent a few weeks driving around and getting to know the streets. One day, I saw a building with two words on the front that caught my eye —”Medical Arts.”
The building had a few therapist offices. I heard it used to have doctors’ offices, too. There was nothing unusual about a place where people went to get care.
What stood out to me was the name. Someone had chosen to call the whole place Medical Arts.
I had never seen that before. And I loved it.
What Made the Medical Arts Building Unusual
My favorite teachers in medical school used to say, “Medicine is a science and an art.”
They meant it as a caution. The science part is what you can measure. The labs, the scans, the guidelines. The art is everything the science can’t reach. Reading a face. Knowing when to push and when to wait. Sitting with a frightened person and choosing the one sentence that helps. Or just holding their hand and saying nothing at all.
Both are important.
But before Ashland, I’d never seen anyone say it so openly, as that building did. Most of medicine keeps the art hidden. We record the science and keep the art private. But this town put the word Arts right on the building, proud for everyone to see.
After I noticed it, I started seeing Medical Arts buildings in towns all over the state.
Medicine is a science of uncertainty and an art of probability.
— Sir William Osler
The Third Dimension of Medicine
My teachers told me that medicine was an art and a science. They never told me it was also a business.
That silence was no accident. Most of my teachers came from a time when doctors could open an office, work every day, and soon have as many patients as they wanted. They didn’t have to worry about money every night. They knew it would come. By the time I started, that world was already fading.
If you drive through small towns in northern Wisconsin now, you’ll see many of those “Medical Arts” buildings have new names or are gone. The independent practices that used to fill them have joined bigger health systems. The word Arts comes down, and the building becomes something else or disappears.
In Ashland, the Medical Arts building lost its name and was converted into apartments.
I’m not saying this just to look back with regret. Consolidation did bring some real benefits. But something important disappeared with those signs.
Why They Sold
My clinic in Ashland was once owned by the physicians who worked there. A few years before I arrived, they sold it to a large system based out of Duluth, Minnesota. By the time I walked in, they were employees. Same as me.
They did not sell because they were greedy or tired of medicine. They sold because they were drowning.
Insurance became more complicated every year. Nearly a third of their patients were on Medicaid, which paid very little for a lot of work. They spent their evenings worrying about things like payroll, billing, and contracts — the kinds of things no one goes to medical school to do.
So, when the Duluth system offered to take all of that off their plate, they said yes. I understand that choice completely. I might have, too.
But here is the part they did not see coming.
They thought they were just giving up the paperwork. But they were also giving up their place at the table where decisions are made.
They assumed that even without owning the practice, they would still have a say. They knew the town and the patients, so they thought the new owners would listen to them.
They did not. And the complaints began.
Two Complaints, Spoken as One
Over time, I heard my colleagues voice two very different complaints. Often in the same breath.
The first went like this: We used to run this place. Now nobody listens to us. We don’t have a say anymore.
The second went like this: They are making calls about our patients that we know are wrong. They don’t understand who we’re caring for out here.
Think about those for a moment. They aren’t the same complaint, even though they sound similar.
The first complaint is about control. It’s the feeling of someone who used to be in charge and misses it. I understand that feeling, but honestly, it’s the weaker complaint. If you sell the store, you don’t set the hours or decide what’s sold there. Anyone who’s left a business they started knows that pain. It’s real, but it’s not a reason for others to act.
The second complaint is something else entirely.
My colleagues knew these patients better than anyone in Duluth ever could. They knew which families couldn’t drive two hours to see a specialist. They knew which ones would skip a prescription to keep the lights on. That knowledge did not live in a spreadsheet in Duluth. It lived in the people who had practiced there for twenty years.
The system owed them a chance to be heard. Not because they owned the place, but because they knew the patients.
That’s not just about employee satisfaction. It’s about a duty. If you’re making decisions for a community you don’t know, and there are people who do, you must listen to them. You don’t have to agree, but you should ask real questions and take their answers seriously.
That was the strong complaint. That was the one that really mattered.
The secret of the care of the patient is in caring for the patient.
— Francis W. Peabody
The Trap They Fell Into
And here’s the sad part.
My colleagues buried the strong complaint under the weak one.
Picture an administrator in Duluth. Several times a year, versions of “the Ashland doctors are unhappy” land on the desk. Sometimes it is about a scheduling change. Sometimes it’s about a new hire. Sometimes it is about a real patient-safety concern. But it all arrives in the same tone, from the same wounded place, wrapped in the same “you never listen to us.”
After a while, that administrator stops sorting one from the other. It all gets filed under the same label. The Ashland folks didn’t like losing control.
The grievance covered up the real concern. The one warning that should have stopped a decision — this is bad for our patients — got lost in all the noise the doctors were making.
Nobody here is the villain. That is the part worth holding onto.
The system failed, but not in an obvious way. It failed because it never created a way to distinguish a patient-safety and quality-of-care warning from a morale complaint. When you buy a practice, you’re also getting the people with local knowledge. You owe them a real way to be heard, not just a suggestion box.
My colleagues made mistakes too. They made a strong point, but they mixed it with their weakest. Then they were surprised when no one could tell the difference.
Keep Them in Separate Sentences
A communication lesson is buried in the Ashland clinic story.
When you carry a strong point and a sore spot into the same conversation, keep them in separate sentences.
The moment you bundle “this decision is hurting patients” together with “and anyway, you people never listen to us,” you have handed the other side permission to dismiss both. They will hear the grievance, sigh, and file it away. Your best argument dies next to your worst one.
This is hard because the sore spot is real, too. Being sidelined hurts. But the skill of leadership, especially leadership without authority, is the discipline to let your strongest concern stand on its own two feet, unburdened by your wounded ones.
What the Business Couldn’t Take, but Was Still Lost
For a long time, I thought the lesson of that Ashland building’s story was simple. The business of medicine wins. The art loses. The sign comes down.
I don’t believe it is that simple anymore.
The buildings are disappearing, and that’s mostly beyond any one doctor’s control. When my colleagues sold their practice, they gave up their ownership voice, their seat, their vote, and their final say. It was a fair trade. They knew the cost and accepted it. At least, at the time.
But there’s another kind of voice that business can’t buy, because it was never for sale. It’s the voice that comes from truly knowing your patients, your town, and your community better than anyone at the headquarters ever could. That’s the art the sign was always about. No one took it from my colleagues. They always had it. They just never learned to use it separately from their complaints. So it faded.
The word Arts came off the building.
The One Practice
Before your next hard conversation with someone who outranks you, take out a sheet of paper and draw a line down the middle.
On the left, write what this is about for the patient, the team, the mission — the part that would matter even if you felt fine.
On the right, write what this is about for you — the slight, the loss, the frustration.
Then, when you speak, lead with the left side. Say it plainly and let it stand. The right side can come later, quietly, or not at all.
Keep them separate. The most important thing you have to say deserves to be heard on its own, not hidden under everything else you’re still upset about.
If you are the one running a health system, learn to distinguish the morale complaint from the true patient safety and quality-of-care concern. This is as much on you as on those raising those complaints and concerns. You owe this to your customers — the patients.
P.S — A Note of Thanks
Dear reader,
My father passed away a few weeks ago after living with terminal cancer for two and a half years. I took a short break from everything except for the bare essentials of living and loving my family. That break included a break from this blog.
I am very grateful that you kept reading this blog and spreading the word while I was silent.
I am even more grateful for the thoughtful condolence messages you sent me. They mean a lot during the most intense phase of grief.
I am back now and look forward to your continuing engagement with my weekly posts.
Once again — thanks a million!