But information only affects our decisions: It does not change our ability to think. The correct decisions of 5, 10, or 20 years ago were based on the best information available at that time. New evidence, however, requires that we change the way we think about things.
Barriers to Change
Humans spend their lives resisting change.
The idea of change seems self-evident: If people want to change, they will. However, it is not that simple. Many smokers want to quit. Many overweight people want to become svelte. There is a large gulf between wanting to change a behavior and actually changing it.
Several barriers get in the way of this process of change. Fear, discomfort with ambiguity, guilt, and loss of control top the list of reasons for resistance to change. The Figure 1 illustrates some of the factors that have an impact on the process of change. Another barrier is a lack of awareness of information. Sometimes, even when information is found, it may not seem trustworthy. We may think that the information is flawed, that our patients are different from those in the study, or that the results are not applicable to a particular patient. Or we may be uncomfortable with straying from the pack. Fear of lawsuits, bowing to authority, and the “we’ve-never-done-it-that-way-before” syndrome can keep us from doing something new and different.
Changing Yourself
For most doctors, change is virtually a routine part of life…. The alternative to controlling the process of change is to be controlled by it, and in dramatic cases, to experience professional or personal collapse.
Taking control of learning requires the prerequisites outlined in the Table 1. The process of change has 5 steps: obtaining new information; deciding, based on that information, that a new approach may be better; deciding to use a new approach; implementing it; and confirming that this change is beneficial. Below are several ideas to make these steps easier.
Become a Reflective Clinician
The process of change begins with reflection in action: thinking about what you are doing while you are doing it. This introspection, often confused with clinical experience, allows you to identify, though not necessarily fix, those aspects of practice you feel uncertain about. The first requirement of change is the identification of tried-and-true, yet not wholly satisfactory, modes of patient management. Ask yourself: What am I doing in my practice, and why am I doing it?
The next step is to open our minds to the idea of change. Our value lies in our analytical skills and our ability to synthesize information, not in being storehouses of facts. We need to work hard to cultivate the talent to question all things, especially our own knowledge.
Once our minds are open, we need to listen. We have to hear what patients are saying between the lines. We have to take the letters from insurance carriers concerning prescribing or referral habits out of the trash and see what they have to say. Find out what is behind their pronouncements, not for argument’s sake, but to analyze and understand the information.
Many of us get defensive when we realize that our practice habits can be improved. We are not used to nonsuccess of any sort. We get embarrassed, feel threatened and then guilty. Anything short of perceived perfection is threatening. Information mastery means realizing there is much we do not know. The first step to knowledge is the confession of ignorance. We need to look for ways to become free of self-deception (take off the rose-colored glasses) by looking beyond the dogma.
Determine Patient-Oriented Outcomes of Importance
There are many questions that have not been answered by the science of medicine. We know much less about the optimal care of patients than most of us care to confess.
Information masters know that there is much work to be done to shore up the science that supports medicine. Recent studies have shown that only approximately half of the best clinical information is based on good evidence. For example, the latest anticoagulation guidelines were developed using the highest quality evidence only 44% of the time.
Nonetheless, everyone needs to figure out the patient-oriented outcomes of importance to their patients. Start with the concept that patients want to live long healthy symptom-free productive lives. What are you willing to do to meet this goal? Independent thinking is a necessary requirement for exploration of new ideas.
Develop Information Skills
There are several skills necessary for becoming an effective information manager. All of us need to develop quick ways of identifying new information and evaluating its validity. We can begin by being discriminating in our sources of information, since the easiest source may not be the best.