Monday, May 21, 2012

A Note to My Younger Colleagues. . .Be Brave

I was searching for a couple of papers by Harlan Krumholz today for another post and came across this piece just published. I found it inspiring. He writes about the difficulties and challenges of standing against the status quo, even when, especially when the vested interests as they mass in opposition seem to brook or tolerate no opposition. A few choice passages (underlined by me):
"Unfortunately, our profession does not often reward those who question dogma. In fact, there are many episodes throughout the history of medicine and science in which truth was resisted and dogmatic beliefs, however poorly supported by evidence, were imposed by those in a position to do so. If we are to accelerate innovation in medicine, eliminate waste- ful practices, and improve the depth and effectiveness of how we care for patients, then there must be room to question traditional approaches and to introduce new and better ways of prevention, diagnosis, and treatment. We are now at that critical juncture.
When I entered medicine, I did not realize that there was such intense pressure to conform. But we learn early on that there is a decorum to medicine, a politeness. A hidden curriculum teaches us not to disturb the status quo. We are trained to defer to authority, not to question it. We depend on powerful individuals and organizations and are taught that success does not often come to those who ask uncomfortable questions or suggest new ways of providing care. 
I have grown to appreciate those who will stand up despite the risks or in the face of efforts to silence them. Promoting the best science and the best advocacy for patients and the public sometimes entails risk. Change does not come easily to a system and there is resistance to those who may seek to make the system safer, more effective, and more patient-centered through new ideas or the articulation of uncomfortable truths." 
He also quotes from Victor Montori, from Mayo Clinic who writes:
"I have struggled with this issue for years. Turns out that this is a common struggle for those who find themselves unable to stay silent in the face of waste, error, low integrity, or abuse.
If you find yourself with some time (not a lot), let me recommend Letters to a Young Contrarian by Hitchens.His argument that clarity emerges from conflict is compelling. And for conflict to emerge, ie for clarity to emerge, someone has to take a position. The question you ask is whether this should be you, now, and at this stage of your career." 
Read it and distribute widely. 

1 comment:

  1. Thank you for this brilliant post.
    The pull of the status quo is strong. I once offered brief examples of courage and conviction to those who, when faced with criticism and resistance, stood their ground and are tirelessly working to improve our delivery system of care that to one that is safe, timely, patient-centered, effective, efficient, equitable and to a system where no one is left out. One amazing example is Maya Yin Lin.

    Maya Yin Lin, was a 20-year-old student from Yale University who faced significant criticism of her design for what has become the most-visited memorial in Washington DC, The Vietnam Veterans Memorial. In the midst of tremendous challenge, Lin remained focused in her vision and after extensive review from several government agencies, her design was chosen… yet Lin wasn't even mentioned at the dedication ceremony.

    "To fly, we have to have resistance" -Maya Ying Lin

    Lin has since gone on to design all over the world. A few examples of her work include the Civil Rights Memorial in Montgomery, Alabama and an Academy Award-winning documentary Maya Lin: A Strong Clear Vision. In 2003, Lin also served on the selection committee for the World Trade Center Site Memorial Competition.