Slow to Change – Part 1

I was reading the Journal of Hospital Medicine the other day, and after enjoying the Things We Do For No Reason column again (which is one of my very favorite things to read, given an unfortunate contrarian bias I have), I began to look at all of the previous columns.  I was amazed by how many of them there are at first (more than 40 so far), and then as I thought about it more, I realized that this is not surprising at all.  Physician practice is very slow to change.  There is a great deal of weight and inertia with decades of practice rolling along (funnily enough, when you look at the definition of inertia, remaining unchanged is now the first definition, with the physics definition second).

in·er·tia /iˈnərSHə/

noun

  1. a tendency to do nothing or to remain unchanged.

“the bureaucratic inertia of government”

synonyms: inactivity, inaction, inactiveness, inertness, passivity, apathy, accidie, malaise, stagnation, dullness, enervation, sluggishness, lethargy, languor, languidness, listlessness, torpor, torpidity, idleness, indolence, laziness, sloth, slothfulness; More

  1. PHYSICS

a property of matter by which it continues in its existing state of rest or uniform motion in a straight line, unless that state is changed by an external force.

This got me thinking that it would be worth taking a longer look at this issue.  Over the course of the next few posts, we’ll dig deeper into this issue, and look at what the literature can tell us.  Why is physician practice so slow to change – why is there so much inertia?  How long does it take medicine to change?  What are the costs (personal and financial) of this inertia? How can we, as physician leaders propel change in our organizations to improve outcomes for our patients?

In the meanwhile, make sure you always check your assumptions.  Make sure there’s good evidence to support the things that you do.  And make sure you leave some time for learning new things.  Like decreasing use of contact precautions, or stopping thickened liquids for dysphagia, or not giving Colace for constipation, or . . .