Like many of us, when I was 18 I didn’t intend to become a physician. I wanted to join the Foreign Service. My first jobs (prior to college) were in Washington, D.C. Then I fell in love with medicine, but I ultimately found value in some D.C. lessons learned as a teenager.
My first position in the winter and spring of 1968—the last year of the Johnson administration—was as a congressional intern. House staffs were much smaller back then, and I did everything from conducting Capitol Hill tours for select constituents to drafting correspondence to reviewing proposed legislation. In Congress there were about 20 interns, and we would have a scheduled weekly tutorial in the evening from senior administration officials, cabinet officers, and senators. I witnessed Washington’s response to the killings of both Bobby Kennedy and Martin Luther King.
I also learned a little bit about how Washington actually functioned behind the curtain. The congressman for whom I worked had breakfast every week with the speaker of the House—a rarity. When I asked him why he rated this experience, the congressman said, “I’m the House racquetball champion. Most of us play racquetball. The speaker and I go over upcoming important committee and floor votes and whose votes we need. When possible, I will challenge them to a racquetball game, and then I’ll have their attention one-on-one for over an hour.”
Washington still works like this. It’s all about relationships and access. And on Capitol Hill, young staffers (as I was) wield considerable influence in this regard. The 116th Congress considered over 16,000 pieces of legislation. Some run over 1,000 pages in length. No individual member of Congress can read each piece of legislation let alone become an expert on the subject. Staff take on that role. (And this is one reason why I never turn down an opportunity to lobby an important staffer rather than the member of Congress.)
In the first year of the Nixon administration, I accepted a position in the U.S. Department of State. It required a top-level security clearance that took months and multiple FBI interviews to attain. Part of my work involved communications with counterinsurgency operatives around the world, and part of it involved preparing an assistant secretary of state for congressional testimony. I learned about potential international conflicts days before they were reported, and I discovered others that were secretly averted. My writing skills improved, and I learned what happened if you forgot to burn your typewriter ribbon at the end of each day. (You received a nasty lecture from a military officer.)
Another important lesson pertained not only to Washington but is applicable elsewhere. After spending a week preparing his briefing materials, I accompanied the assistant secretary of state for Senate testimony. At one point, a key senator asked an anticipated question to which I had prepared a detailed response. My boss replied to the senator, “That’s a great question, senator. I wish I had the answer for you, but I will get it to you by the end of the day.” When we returned to the office, I asked the assistant secretary of state why he hadn’t given my prepared response (thinking that perhaps I had made an error). I’ve never forgotten what he told me: “Son, if I gave the senator the answer, I looked good. This way, he made points for a good, tough question, and I will make a point by delivering the answer this afternoon. This way, everyone wins.”
At first, I thought his response was purely cheesy and duplicitous. Much later I realized its true value. It helped to create and nurture necessary relationships.
It seems to me now, a half-century later, that the (calculated) graciousness displayed in that Senate testimony has become less common as there is less focus on building relationships for future value and more emphasis on short-term, transactional wins. As Academy staff and ophthalmologist volunteers engage in critical issues of health policy and economics, sound data and arguments are essential. But without access to congressional offices and personal relationships, their potential impact is muted. Obtaining that access and nurturing those relationships is a responsibility we all share.