Physicians must cast off grief over change if they're to move forward, anthropologist advises

Jill Rafuse

Canadian Medical Association Journal 1996; 154: 1403-1404

Jill Rafuse is associate editor in CMAJ's news and features section.

In Brief

It's time for physicians to stop grieving over the massive changes occurring in health care and instead create a new vision that will lead them forward into the future, a cultural anthropologist told the CMA's 8th annual Leadership Conference in March. About 175 physicians attended the 2-day conference on regaining the perspective on values in times of change.

En bref

Il est temps que les médecins cessent de pleurer sur les changements qui bouleversent le système de santé et adoptent plutôt une nouvelle perspective qui leur permettra d'aller vers l'avenir, a déclaré une anthropologue de la culture aux participants réunis en mars à l'occasion de la 8e Conférence annuelle de l'AMC sur le leadership. Près de 175 médecins ont assisté à cette conférence de deux jours où l'on a exploré des façons de remettre ses valeurs en perspective en période de changement.

North American physicians are in a state of grief over health care system reforms that have led to radical shifts in power and created a sense of extraordinary personal loss, a cultural anthropologist told the CMA's 8th annual Leadership Conference in March.

And it is inevitable, Dr. Jennifer James said, that this grieving for the past will persist until physicians accept the need for change and reassert their leadership with a new vision and management style.

"Myths about the past hold us down and make it almost impossible to see the changes around us," James told 175 physicians and health care leaders from across Canada. Likening the medical profession to a brotherhood "lodge" that thrives on tradition, ritual and exclusivity, she said many physicians feel that health care and the medical profession are "going to hell in a hand basket" because things are different from the way they used to be.

"The trouble is, we remember the log cabin but we forget the outhouse," James said of this longing for the past.

Many of today's physician-parents say they wouldn't encourage their children to go into medicine because the uncertain future is different from the past. However, James cited a US study that shows today's first- and second-year students entered medicine for altruistic reasons similar to those of medical students 20 years ago. They also have great optimism for the future and see the many challenges and opportunities that medicine will offer them.

Many of today's physicians still cling to the post-WW II expectation of tremendous economic growth, even though this is an economic illusion in the 1990s. James challenged physicians to recognize the importance of accepting change and to develop a new sense of "what you are and what you want to be."

"You can't just shore up the edges and fill in the holes any more," she said, "or the government will run right over you. Physicians must find a whole new model."

Her advice:

Become computer literate. First-grade students are already more computer literate than their teachers, says James, and computer literacy/communication is becoming essential for almost every profession. If physicians don't push themselves into the technologic world, they will never understand power and the ways it is used.
Develop the ability to see and respond to patterns. With the skill level of the workforce rising, physicians cannot cling to lower-level skills that others can also gain. They must grasp for higher skills themselves.
Develop new language skills. Politically correct language is representative of the new "team culture," and although it seems awkward at first, its use does change social consciousness.
Understand the nature of managing. Physicians are used to dealing with patients on a one-on-one basis, but administrators see the larger picture. Lack of knowledge about what other people do "leads to contempt," James said.
Develop communication skills and build relationships with other health care professions because "when communication skills mature, barriers will be broken down."

James said the highest level in the "values hierarchy" is quality of life for everyone, everywhere, and this is the vision the Canadian -- but not the American -- medical system is built upon.

"This is your heritage and history," said James, and it is what physicians should continue to strive for. "If physicians are visionaries, the public will see it the same way."

Roger Mellott, a stress-management expert from Louisiana, examined the personal psychological issues that physicians must deal with when managing stress and coping with change.

Physicians who say "I don't have time" must make a distinction between time and energy, and try to increase their personal energy levels. The greatest waste of personal energy, he said, is dealing with difficult people. He offered three rules of thumb:

Since you cannot enlighten the unconscious, don't waste your energy on people who are not going to hear you - save it for those you can really help.
Communication guarantees nothing: people will only listen if they want to listen.
You cannot get someone to solve a problem they do not own, but you can spend a lot of energy trying to convince someone else that they have a problem.

During the 2-day conference in Ottawa, participants also spent time in small-group sessions. In one group, physicians examined personal stress and discussed strategies that could be used to address stressors they are capable of influencing. In a second session, participants discussed visions of leadership and skills that can assist the leaders of the future.

| CMAJ May 1, 1996 (vol 154, no 9) / JAMC le 1er mai 1996 (vol 154, no 9) |