Expecting Different Results

Today's post is a reflection on an old saying that goes, "One definition of mental illness is making the same choices over and over and expecting different results". Another way of looking at this decision making process is to suggest that it is "rut" thinking and we all need to be cognizant when we practice it. Dr. William Osler, father of the diagnostic thought process, cautioned young physicians against treating each disease presentation like the last one they'd seen. Yet, with all of our technological prowess and availability, we still tend to have "tunnel vision and thinking" and make decisions based on the way we've always done things. I've spent a good portion of the last 25 years working in and for hospitals. Though there are more than 6000 hospitals in the United States, it is a true statement that "when you've seen one hospital, you've seen one hospital". Even those that are part of larger organizations (religious affiliations, hospital systems, corporations) still operate with their own ethos and institutional memory and practice. Time and again I"ve come to a new hospital that is wanting to improve what they do, only to be beset by the thought process of "that will never work here" or "my patients are different than those large national guidelines" or "you just don't understand how things work around here". :-) They say that they want to change, but they want to keep doing things the same way they always have. Yes, our healthcare system - and really much of our institutional behavior is quite flawed in its thinking and operation. Even when presented with data from their own institution, data that their own people have generated, I've had leaders tell me that the data don't represent what's really happening! Errors occur and are perptuated in systems that don't learn - that don't evolve. We have reached (or maybe have passed) the point where we can continue with healthcare as usual. Medicines and technologies continue to evolve and create new possibilities, yet they operate within a healthcare system that is woefully behind in its ability to integrate and understand them. New practitioners come out each year having been exposed to wonderful new ways of thinking and treating, yet they go into practice in environments that are antiquated and dysfunctional. Is it really any wonder that we have less than optimal healthcare when we keep making the same decisions?! This week I'd ask you to spend some time learning about some aspect of new technology that could revolutionize your healthcare. Look at websites such as the Society for Participatory Medicine and other empowering sites that are promoting a new and healthier relationship between providers and patients. Learn and grow and advocate for a healthier system to care for you and for those that come after. Peace for the journey, Dan