-Bend easy without breaking.
-The ability to be easily modified.
-Willingness to change or compromise.
Social media physician leader Dr. Bryan Vartabedian wrote a post last week in which he called flexibility a necessary skill of the 21st century doctor. He got the idea from another physician leader, Dr. Eric Topol.
Iâ€™ve been thinking a lot about the idea of bending easy and not breaking. How willing have I been to accept change or compromise? Could flexibility be the key to surviving the ongoing disruptive changes in healthcare? I counsel heart patients that how they handle stress impacts their outcome. So…How well am I (and my colleagues) handling the stress that comes with change?
I was speaking recently with a respected surgeon about the turmoil in healthcare reform. She and I had served together on the hospitalâ€™s board as physician leaders a couple of years ago. At that time, the hospital was awash in money, most physicians were independent, and there were many fewer regulatory policies. Itâ€™s much different now.
â€œWe are in the thick of it.â€ I said.
â€œWhat?â€ She asked.
â€œItâ€™s going to hit the fan.â€ She replied.
Iâ€™ve written before that itâ€™s a tough time for caregivers. We are in the crosshairs of change. Inflammation is everywhere. Consider just one source of our angst: The complexity of medical care has risen dramatically. We now know that so much of what we did in the name of helping people doesnâ€™t actually help, and may in fact cause harm.
Thatâ€™s a tough one because it redefines our sense of productivity. Being a productive cardiologist in the past meant doing tests, placing stents, installing cardiac devices and medicating to surrogate markers, like cholesterol. Now we understand that these things help people much less than we had thought.
Explaining such medical reversals, and aligning preference-sensitive decisions with the goals of our patients requires more face time with patients. That we have more time with white screens and forms filled with checkboxes is stressful.
Here is where Dr. Vâ€™s post has me thinking. He urges physicians to adjust the way we see our place in the world.
â€œWhere weâ€™re going may not be what you signed up for. The sooner we get over that, the sooner we can be can find our new place and begin to fashion the solutions necessary for progress. We can fashion those solutions, or we can sit back and let someone else do it.
Okay. Dr V is right. What we signed up for in medical school is clearly not what is happening now. Thatâ€™s crystal clear. There arenâ€™t endless resources. Thereâ€™s emerging evidence of over-diagnosis and over-treatment. We are in a similar situation as teachers: we want the quality of our doctoring to be measured and rewarded accordingly. But the way we measure good doctoring is deeply flawed. Finally, and perhaps most stressful of all: Thereâ€™s a new boss in town, and it is not the doctor.
The doctorâ€™s role in the care of people is on a new course. The ride that used to turn right just turned left. No one in the US has been on this road before. Itâ€™s scary.
My imaginary friend and I have been chatting about all this:
- I really love being a doctor. Using my skills to help people feels good. I want to keep doing it. But how I do it in the future is going to change.
- Iâ€™ve got to make the best of this new course. Who knows, it might be a better route. That happens in cycling; it might also happen in healthcare.
- Complaining and longing for what was, doesnâ€™t help. For instance, EMR, bad as it is, is here to stay. I’ve got to make it work better.
Flexibility isnâ€™t my strong suit. Itâ€™s going to require hard work. But that’s okay too, because hard work seems to agree with me–as it does to most of the doctors that I hang with.
The thing that gives me hope is that even if health care does less, and it surely will, it doesnâ€™t mean patients will do worse.