There’s an old joke about doctors: “Ask any doctor to name three great physicians and they’ll struggle to come up with the other two names.”
Our egos might not be that large, but what makes a joke funny is that it often hits close to the truth.
Doctors at times tend to think they are the smartest person in a room – especially when others are there. (Fortunately that is not the case with me. My physician wife’s knowledge of medicine is far beyond mine. My male ego handles that well.) In part this is because we are by default the leader of the medical care team, and most if not all decisions ultimately rest with us.
So how do you think a doctor feels when he learns that the care he is providing may no longer be the best possible? I’ll tell you – not good.
I have written before about balancing the art of medicine against the cold hard facts of science. I will also tell you that most, if not all, physicians will readily admit that medical knowledge is so far-reaching that no one can know everything in their field. Further complicating matters is when evolving research proves one’s “time-honored” treatments to be no longer valid.
Still … we all like to think we remain at the top of our game and stay abreast of changes. But with the demands of work intersecting with family, personal friendships and spiritual growth, time set aside for learning can be limited. Continuing medical education courses by necessity cannot touch on all the new recommendations. Studies have shown that learning new things becomes more difficult as we age. Plus, as an older physician, I find my quest for learning more and more involves nonmedical topics.
Those of us who have practiced for decades have a fairly good grasp on the art of diagnosis. If we have been lucky enough to stay in one place during our career and have our patients age with us, we feel we know what is best for individual patients. But often times this familiarity leads to roadblocks when attempting to accept evidenced-based medicine that should change the way we practice. We tend to rely on confirmation bias – choosing to accept only those things we already believe in.
We say to ourselves (and others), “That’s the way I’ve always done it,” which is another way of saying, “I’m too old/stubborn/obtuse (choose any) to learn new things.” Or we feel certain our patients prefer things the old way, conveniently ignoring the fact that what our patients want is usually a result of the advice we have given them. And we have a curious habit of randomly choosing what recommendations we follow: We are quick to adapt to new vaccine schedules, for example, but much slower to use a new treatment regimen when the old one(s) seemed to work fine.
Change is hard and slow. It often requires a leap of faith, seemingly with no net to catch us. But if faith is the evidence of things unseen, then when the evidence of how to improve care is right before us, the leap is more of a step in the right direction. It just takes practice and repetition, so our “muscle memory” does not force us back into our old ways. We can’t get bogged down in the realization that others know more than us. Remember, the evidence-based gurus for the most part concentrate on one disease process, while we see dozens of patients and diseases daily.
Novant Health is committed to helping their providers keep up with changes in medical care. Through a collaboration of physicians and other team members, our medical group has created over two dozen care pathways and guidelines that allow a quick and easy reference for the latest in care. We also have access to the most recent information about diseases, drugs, tests, etc., through our electronic health record system, Dimensions. I have learned (and re-learned) a great deal from these resources.
As a final note, I believe that my colleagues are able to tamp down their pride in order to provide the best care possible, even when it means changing established practice ways. I also believe that, no matter where we are in our careers, we revel in the sheer joy of learning. Thirty years on I still find all this new stuff fascinating and fun.
We are never too old to learn, which means we are never too old to admit we are wrong. Even if we were right in the past.
Dr. Stephen J. Ezzo is a pediatrician at Novant Health Matthews Children’s Clinic and immediate past president of the Mecklenburg County Medical Society.
