How do we deal with change in medicine?

Early in my career, I learned that keeping my focus on patients would help me define the physician I wanted to be. One of my first offices was in a cell of a repurposed juvenile detention unit with cinder block walls painted pasty white. Occasionally, I had to apologize to my patients as I explained that the smell was sewage from the toilets backing up. In that cold, harsh room, as my patients sat across from me entrusting me with their struggles and crisis, I experienced moments when I knew, with absolute certainty, I was exactly where I wanted to be.

In those moments, the cinder block fell away, the stench faded into the background, and I experienced a connection with the person sitting across from me. Whatever they were there for, I got it. I didn’t get it because I had nailed their diagnosis and saw a clear path to their treatment. In that moment, my focus was completely committed to the person in front of me, and all the other distractions fell away. This is the reason I went into medicine. I pursued medicine not just to help people by “fixing” them, but to help by listening, validating their experiences and letting them know that I am “all in.”

Unfortunately, as Sam Cooke sang, “A change is gonna come.”  So, how do we deal with change in medicine, some of it unacceptable, some of it unavoidable, while maintaining the integrity of our focus? How do we deal with changes in health care that draw our attention away from patients? Whether the distraction is more time-consuming EHRs, increased “encounter targets” by administration, or more documentation required by insurance companies for medication approval, potential distractions will grow in health care.

Sometime during my 20s, I accepted that change can be a beneficial and active process. I learned that when confronted with it, I need to acknowledge its presence, examine it, then decide what must be done. Change always demands that we do something. Even if our response is to step aside, for a moment, as it bulldozes its way into our lives.

However, I’ve learned not to be bullied by change, but to determine how to better understand what it means in my life. Instead of hastily reacting, I can respond with a strategy for my best plan of action. I’ve also learned that change can help me clarify my focus. After a career practicing in community-based settings, I was in a position where change was an inevitable process within my organization, and it was taking focus off my patients. In acknowledging this change, my ultimate decision was to leave in order to practice with greater alignment with my clinical philosophy.

Part of the process of fixing what’s broken in health care is focusing on what’s not. The power behind focusing on the people we are treating has not changed. In fact, all changes in medicine, if they are truly serving patient well-being, should support and enhance this focus. Anything that gets in the way of this connection is destructive and should be consumed by the process of change.

So, I’ve started to wonder if it is more useful to describe medicine as changing, rather than broken. Perhaps if medicine can be seen as changing, then the task of steering that change in a direction that best serves patients is preferable to the generic tagline of “fixing” a broken system. If we become active agents in the ever-changing field of medicine, then doctors can begin to reclaim some control in health care.

Change, where I am an engaged and active agent, I can do that. That allows me to find control and become more empowered. It allows me to bring my focus back into vision. I found this control when I left a faltering nonprofit. I realigned my focus to connecting with patients and allowed that to drive my path. Every physician can center their focus on their patients and then seek the path that will allow that focus to be fully realized. Not everyone has to start with a  major career pivot. We can start with more manageable steps like how many patients we will see a day or how many new patients we’ll accept. We can identify our individual barriers in focusing on our patients and start there.

But here’s the tough part. Change will almost always try to fight back. And sometimes it will win. Your group may not be flexible on accepting new patients. Patient encounter goals are often not up for debate. But, sometimes, change relents. Just maybe, you can extend your new patient appointment time.  You are working towards a goal of creating environment of greater engagement with your patient. This is movement forward and empowerment in change. We are now working towards healing what isn’t working in health care. The disease has not been cured, but symptom relief goes a long way. And now, feeling a bit more empowered and refusing to be deterred from our focus we can begin to imagine how we might tackle the beast.

Tracy Asamoah is a child and adolescent psychiatrist.

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