• Change Isn't Optional, but Making Progress Is

    Change is hard. Whether on a personal, local or national scale, transformation requires effort and patience. This truth plays out in the world around us each day.

    Last week, the Supreme Court upheld the right of all people to marry whom they please. Earlier this month, discussions about race relations nationwide were fueled by a racially motivated shooting that resulted in the deaths of nine people in Charleston, S.C. Meanwhile, the overweight diabetic patient I saw this morning struggles daily with appetite control and making healthy eating choices. Life is all about change. It rarely is easy, but the results often more than offset the difficulty.

    In medicine, change is constant. New scientific inquiry leads to better understanding of basic principles. Understanding, in turn, leads to better implementation of care strategies. We get better at prevention and treatment, and at the same time, we learn which questions need further investigation. It’s a never-ending cycle.

    In the mid-1800s, English physician John Snow (not to be confused with the George R.R. Martin character Jon Snow) explored the link between a cholera outbreak and local water usage patterns, and recommended removing a few water pump handles from contaminated wells. The resulting changes in sanitation practices eventually created a revolution in public health. But changes based on evolving understanding aren’t limited to history. Changes in how we understand the world around us, and how we do our jobs, affect us every day.

    Take, for example, the debates about prostate and breast cancer screening. No matter what your personal feelings are about the screening intervals -- or about whether to screen for prostate cancer at all in low-risk groups -- changes to the U.S. Preventive Services Task Force recommendations for screening continue to spark debate years later.

    The changes we face as new physicians aren't limited to science. In my previous post, I wrote of the changes in medical records and the associated headaches and benefits. In most health care circles, the transition to ICD-10 continues to provoke heated debate, even with the increased specificity in diagnosis reporting it promises. Still, ready or not, implementation of ICD-10 codes is set for Oct. 1.

    Every facet of our lives and medical careers is subject to change. Maintenance of certification, reviled by many as unnecessarily complicated, is undergoing significant changes for many specialties -- ours among them. Debate still rages over the changing scope of practice in family medicine and primary care. And practice models and payment methodologies are in flux as we adjust to a health care system that doesn't involve the Medicare sustainable growth rate.

    We're told that change is inevitable but progress is optional. As new physicians, we will face numerous changes both at work and at home. How we face those change will determine who we are and how we practice. We get to choose which changes we embrace -- where we will progress, regress or stay the same. But we must choose.

    My encouragement at this stage is simple. Gather information. Readily admit when you don’t know something. Learn as much about as many things as you can. Make informed decisions.

    Accept that there are still scientific truths to be found. Go out and help find them.

    Change is hard, but even small changes can make a huge impact. Don't fear change, but don't change merely for the sake of change. Make the changes that make you better, healthier and more well-rounded, and help your patients do the same.

    Gerry Tolbert, M.D., is a board-certified family physician who practices in northern Kentucky. A lifelong technophile, his interests include the intersection of medicine and technology. You can follow him on Twitter @DrTolbert.


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