Blog | Friday, March 4, 2016

This is why pushing for change is tough for physicians

Physicians are an interesting and eclectic bunch of people who have sacrificed a lot to get to where they are. Just getting into medical school alone is an academic achievement to be proud of. And that's just the start of the journey. What follows is one of the most rigorous courses of study in existence. Test after test, exam after exam. And when you're finally done with medical school and have earned the right to be called “doctor” (often a childhood dream)—you find yourself at the bottom of yet another career ladder as you slog your way through residency! Going through such an intense process means that most doctors are by their nature incredibly hardworking, mentally tough, independent-natured and freethinking.

We are of course also at a time in health care when all physicians, no matter what our specialty, are feeling the full force of change in almost everything we do. Some of these things are great, others not so much—for our patients too.

Over the last several months I've written about a number of issues that are pertinent to the practice of frontline medicine. These range from how we can improve patient satisfaction and the health care experience, suboptimal information technology systems, to more subtle changes in the way that physicians work and are perceived by their counterparts and society at large. The response to these articles has been highly interesting to observe, and underscores a wider phenomenon in how physicians in particular, as opposed to many other professions, think and organize themselves.

Take for instance a series of articles expressing dismay at the fact that physicians are no longer being addressed by their true job title, but by the word ”provider“ instead. This culminated in an open letter to the American Medical Association and all State Medical Boards that was widely circulated online. The response to this letter ranged from full-fledged support, to almost as many comments and responses from physicians dismissing the idea—instead trying to divert attention to “more pressing” matters.

Then there's the issue of healthcare information technology. If you were to ask any frontline physician (or nurse) almost anywhere in the United States, what their biggest daily frustrations are, health care IT will be at or near top of the list. Clearly there's a problem that needs to be addressed. However, several articles that have sought to bring attention to this, written by many other colleagues too, have been met with a shrug of the shoulders. They have attracted comments from physicians along the lines of; “It's never going to change, so stop talking about it” and “Discussing this is laughable”. Worse still, they often border on personal attacks on the author. I'm all for open discussion and am quite thick skinned, but it's sad when we reduce ourselves to this level, especially when there's probable large-scale agreement on most points.

Perhaps the internet as a whole is more adept at giving a platform to the voices of the cynics and pessimists, neglecting the silent majority. When browsing through the comments sections of articles from a wide variety of different perspectives, some of the more bizarre opinions expressed are from supposedly experienced doctors who, quite frankly, should know better. The article on being called a “provider” was rejected by some physicians for being “last on the list of concerns compared to other problems”. While there is no doubt that other such pressing matters may indeed be very pertinent and higher in priority, an issue such as being called a “provider” is a highly symbolic one, which is actually very low hanging fruit to change.

In real-life realms too, when discussing any problems that health care is facing, my experience has been that as exceptionally intelligent and often times refreshingly rebellious individuals, physicians don't align themselves easily with any given cause without picking holes in an argument and highlighting other unrelated problems. This is not necessarily an advantageous thing to do when it comes to getting things done.

With any agenda or argument that may have broad support, wherever and whoever it comes from, physicians would do well to remember 3 golden rules of affecting any kind of positive change. Firstly, change happens in small steps. Rome wasn't built in a day, and neither will moving healthcare in a better direction happen overnight. Secondly, on any particular issue—never, ever make the perfect the enemy of the good. Even a tiny change in the right direction is better than no change at all. And thirdly, when you are seeking consensus and allies for your cause, someone who is 90% your friend is not 10% your enemy.

Suneel Dhand, MD, ACP Member, is a practicing physician in Massachusetts. He has published numerous articles in clinical medicine, covering a wide range of specialty areas including; pulmonology, cardiology, endocrinology, hematology, and infectious disease. He has also authored chapters in the prestigious "5-Minute Clinical Consult" medical textbook. His other clinical interests include quality improvement, hospital safety, hospital utilization, and the use of technology in health care. This post originally appeared at his blog.