Physicians must be part of the change process

Change causes distress for most people. In medicine we have a hierarchy that disdains most change. Medical students, residents, attending physicians all seemingly reject change. Practicing physicians dislike change. Yet change occurs and is necessary. I learned a great deal about change from my mother. This anecdote may help put change into perspective.

Many years ago, we lived in a 3 bedroom house. In the evening we all sat in the family room watching our small TV. One evening, as my father sat in his chair, and my sister and I sat on the floor, my mother comes into the room and announces that a couch would look good against one of the walls. I remember my father rolling his eyes and mumbling something about another campaign. Nine months later he gladly bought a couch.

My mother understood patience. My father was not ready for change, so she started a campaign to change minds.

Many years later, I was a new internal medicine program director. I was full of ideas, but quickly learned that my ideas were often way ahead of the program. Once we had to rethink our clinic schedules. I had the idea of having interns come to clinic in the morning and residents in the afternoon. This plan allow someone from the team to always be around during the day. This plan would take interns out of rounds 1 day each week — making a strong statement about the importance of outpatient training. When I first presented this plan, it was roundly rejected. Over the next few months I gently made the case to reconsider this strategy. Eventually, the chair had this great idea of having interns in morning clinic. The idea triumphed after enough time for everyone to accept the logic.

Too often change in medicine occurs without involving those affected. Too often students or physicians reject well meaning change because they were not involved in the process.

Change challenges us. We become used to the status quo. But we must change at times.

When we advocate change, we need to carefully understand the consequences and especially the unintended consequences. We cannot ignore those whom the change impacts. They must be part of the change process, or else the resistance will grow and grow.

Leaders forget these principles too often. We have seen many changes imposed on physicians without a clear understanding of how those changes will impact practice and their lives. They forget these principles and cause great angst.

Robert Centor is an internal medicine physician who blogs at DB’s Medical Rants.

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  • SteveCaley

    I note and disagree, really:
    “Medical students, residents, attending physicians all seemingly reject change. Practicing physicians dislike change.”
    This is the old saw propagated by the “modernist” movement to steamroller over physicians’ objections. If someone is a Luddite, or anti-change, then modernism claims the compelling right to make them do what they are told, in the name of progress.
    I hear that blacks in the Jim Crow South were very fearful of sudden change, as sudden surprises were rarely to their benefit. When people infer that societal improvement mandates my removal, that’s not “progress” – that’s terrorism.

  • ErnieG

    I agree with SteveCaley. There is a tendency to discount opponents of any change as fearful of change. While there are people who fear change, I don’t think physicians “fear” change. Change occurs in medical knowledge which impacts what we bring to patients, which affects our practice. This is part of what we knew when we started training. The changes in “health care” occurring today have very little to do with knowledge of medicine, nor “progress.” There are very real, profound consequences to the practice of medicine which started in the past with Stark laws and insurance/government as direct payers of medical care (the first weakened the financial strength of physicians and gave them to third company providers who have no professional obligations; the latter took monies away from patients and directed how these are spent) and is heading towards physician employment by large organizations interested in population health, treated by pharmaceuticals, with money managed by government. Never mind upper middle management is making out big denying services, while government food/agriculture laws feed the fatty masses into chronic diseases treated by meds, all they while making individual physicians liable for outcomes (on a side note, not until either physicians unionize or class action suit is brought against insurance company will liability shift). This is not about individual medical professionals diagnosing, treating, and advising patients; this is about “controlling costs” in guise of expansion of corporate interests. It is a shame that ACP can’t see this.

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