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  • Writer's pictureEric Knabel

Thoughts From Six Feet Away: Something Old, Something New

Before I start, an idea that struck me as odd earlier this week – has anyone ever stopped and thought about the phrase “the struggle is real?” I’m sure most of us have said it at one time or another, but it occurred to me that I have never once doubted the authenticity of the struggle. I can’t speak for others, but I know I’ve never faked it.


The good old days weren’t always good.

I saw a new patient earlier this week, and they said to me, “I can tell that you’re a bit old school.” I proudly proclaimed that I was, but isn’t it funny how when someone refers to you as “old school,” it’s a compliment, but when they refer to you as “set in your ways” (basically the same thing), it’s an insult? I think it speaks to what aspects of the old ways you choose to embrace; those perceived as positive are filed in the old school category, and those perceived as negative fall into the latter category. Thinking about this on my walk yesterday inspired me to look at my profession. In medicine these days, we are obsessed with innovation and efficiency. It’s extremely corporate in approach, and that’s not necessarily a good thing. Everyone loudly proclaims that medicine is broken, and rightfully so, because it is. Whenever possible, I try to operate within the system as just another patient, and I’m continually surprised at the frequency with which I must use my connections and my influence to get even the simplest of tasks accomplished.

I’ve gotten to the point that I tell my patients that the reason for this is that now, more than ever, there are more people and entities standing between me and the patient. The most obvious of these is the insurance company, and my thoughts on that topic alone could keep you busy reading for the next hour and a half. Suffice it to say, we will just all agree that it’s a HUGE problem and leave it at that. The more interference, the more the difficulty.

This has led the medical think tank to conclude that we need to develop better protocols, to build a better process that handles all scenarios. There are a couple of obvious problems with that line of thinking. The first is that when we innovate in medicine, we tend to throw the baby out with the bathwater. I guess it’s just easier to throw out all old ways without trying to figure out what aspects made the situation unmanageable in the first place. But if we’re being honest, isn’t that kind of lazy? I mean, today’s stale concepts were yesterday’s innovations, so something was obviously working at one point in time. The second problem is that when we develop protocols to do our thinking for us, well, we stop thinking. In our quest to build a process that addresses all scenarios, we’re left with this bulky, unwieldy tool that is not allowed to be questioned, and we often find ourselves doing silly things that no rational person would do. Our intentions are good in the beginning, as they often are, but our “automatic thinking” tends to steer us off course.

While thinking about this topic, I realized that there is an unseen enemy in all our innovative thinking, the foundation of the Socratic method itself. And that is this: our ability to solve problems is directly related to our understanding of the problem itself. Do we understand what the problem is? Are we sure that everyone around us agrees on the actual problem?

Take, for example, what we refer to as “patient access.” To administrators, patient access is defined as the ability to see ANY provider, while to most of the patients I see, they define it as the ability to see THEIR provider. With this misunderstanding, huge protocols are built that don’t successfully solve their problem, leading to mistrust and increased frustration.

There are a couple of truths that need to be confronted here, and everyone has a stake in it. The first is a byproduct of the increasing polarization in this country, and the source of a lot of conflict between generations: the “good old days” weren’t always good, hence the need for change. But to our innovators out there, they also weren’t nearly as bad. How can we learn from the past and embrace what works, while simultaneously being humble enough to admit that some things must change? I’m reminded of the early days of the Internet, when e-commerce was starting to become a reality (hard to believe there was ever any doubt, right?). I heard a speaker during that time who stated that in our quest for “high tech,” we should never forget that there will still be a need for “high touch.” In other words, technology can be cold, and we need the comfort of knowing there’s a human on the other end of the line. I can’t begin to describe how many of my patients express frustration with automated systems and how they “just want to talk to a human!” We’ve all been in that position, yet we continue to view automation as an answer!

The second truth is that an overwhelming majority of the time, we don’t have a ‘process’ problem, we have a ‘principle’ problem. Medicine has lost its way, not because it’s inefficient, but because it has lost its soul, its reason for existence. I hear doctors do nothing but complain about computers, and burnout, and administrative burdens. And if they’re complaining to each other, you can bet they’re complaining to their patients. To my colleagues out there, I have an inconvenient truth for you – your patients Do. Not. Care. And our efforts to scapegoat some administrator to save face actually do more harm than good. And to administrators, you can build the perfect protocol, but it will fail if it’s grounded on a lack of principle. In fact, it will fail so spectacularly that it will make the Titanic look like a bad fishing trip. Figure out a way to fix a rotten culture, and then protocols become largely unnecessary. You can come up with all sorts of ways to get poison out of the water supply, but maybe you should start with stopping the thing that’s poisoning the water in the first place. I devoted some time to principle-based thinking in last week’s blog, and if you’re interested, check it out.

It's important not to be set in our ways, but it’s also important not to lose sight of what works when we make changes to our ways of thinking and doing. I choose to take the path of the traditionalist, recognizing the things that made medicine great when patients were satisfied with their care. But I also layer my process with enough technology and “new ways” to make me appear innovative. Call me “old school” if you want, but I like the slick coolness of the term “retro.” So, with that in mind, remember to be excellent to each other, and…

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