It’s been a while since I’ve posted anything here, and now that I’ve started to practice as a licensed Family Physician, there have been numerous things I’ve been musing about. One of those things is change. As a former change management consultant, and someone who has created major change in my own life many times, it isn’t a real surprise that ‘change’ as a concept spurs some reflection. Even though some might consider me to be an expert at ‘change’, it doesn’t mean that I find it easy.Maybe change and transition are top of mind because today marks seven years since my Dad passed. Maybe it’s because I’ve started practicing psychotherapy with a few patients and find myself telling them:
If changing our behaviour was easy, we’d all be the most ideal versions of ourselves already.
Dr. Alanna Martineau
Some of the most substantial changes in my life have been in the last few years. After leaving my consulting career to go to medical school – pretty big change, I moved across the country for residency – also not insignificant. I moved again during residency to be closer to home and to explore other opportunities and locations in Northern Ontario. The moving and constant readjusting were challenging. However, even though it was hard, it led me to a place where I was able to finish residency working with great people and in environments I really enjoyed. My last few months in Kenora, ended up being the easiest time I did during residency and I made some wonderful friends there. You know how the sayings go: without risk, there is no reward; you miss 100% of the shots you don’t take; if it were easy, everyone would do it. . .
Much of primary care in medicine is about helping people change. We advise patients on things they can do to help lower their blood pressure, lower cholesterol, reduce blood sugars, manage anxiety, live with chronic pain, get more active, quit smoking, decrease use of alcohol and recreational drugs, understand prevention measures for airborne viral transmission, etc. Sometimes, receiving health information motivates people, and they make changes and sustain them. Sometimes, people have no interest in changing or are paralyzed by fear of change. Some individuals have all the resources they could possibly need at their disposal but still may not be able to change. Some really want to, and maybe could, but they’re so overwhelmed by grief, pain, anxiety, or financial distress that they can’t even imagine where to begin. Often, people look for a quick fix, when most often, one doesn’t exist. Some people just want ‘easy’ and continually let opportunities for growth or greater fulfillment pass them by.
Lately, there’s been lots of macro discussion on ‘things that need to change in family medicine’. Last month there was a flurry activity around the College of Family Physicians of Canada (CFPC)’s plan to change Family Medicine residencies from two years to three. There has been what I hope was a vocal minority of physicians dismissing the need for education on the Social Determinants of Health (e.g., how racism, colonialism, and many other ‘isms’ affect medical care and health outcomes) saying ‘only the science matters’ and that learning objectives related to this are pushing a ‘woke agenda’. I think, most physicians believe this knowledge is important and that you can integrate it without adding another year of training to Family Medicine. But as far as extending residency training, 96% of those who voted on a motion were opposed. The main argument against the extension was that Family Medicine is already in crisis in this country and extending residency would exacerbate this. It’s true, Family Medicine is in crisis, and little is being done to fix this (see my last post). The Government of Alberta (GoA) announced last week, their latest ‘solution’ to the gaps in primary care would be offering Nurse Practioners (NPs) a salary of $300K annually, plus overhead to open their own primary care clinics. This proposed change created more frustration amongst Family Physicians, who were already feeling undervalued and overworked. There’s also the GoA’s plan to restructure Alberta Health Services (AHS), or as I like to think of it, a make-work project to make it look like you’re doing something while not improving anything.
The thing with change is that sometimes, especially when trying to fix or improve things, we must have some idea about whether we’re treating symptoms or underlying causes (the conflict between Israel and Palestine comes to mind). This is true at individual levels and at organization or geopolitical levels. Sometimes, treating symptoms is all we can do, or all we can do for now. However, if we want to make real improvements and lasting change, that requires understanding the root cause of the issue (or disease). For example, we can treat symptoms caused by a cancer, but this will not eliminate the disease. Accurately diagnosing and eradicating a cancer is the only curative option and we may need to simultaneously manage symptoms or side effects of the disease and the treatment. Most physicians inherently understand this concept and see that the proposed organization changes for AHS for example, might be the equivalent of polishing the brass on the Titanic, prettying up a sinking ship and not actually fixing the things that are broken. Doing primary care well, helps with disease prevention, decreases emergency room visits and hospitalizations and therefore lowers healthcare costs, but governments are resistant to appropriately compensating this work.
Sometimes there has been so much change at individual or organizational levels, that what’s required is in the near term is stability and hitting pause on some things. I found that to be the case personally after these last few years and it led me to rethink my own plans after finishing residency. Sometimes a change, even if it was hard or maybe not quite right, helps provide perspective on what is or was good. I came to appreciate a lot of things about Calgary again by living in various places in Northern Ontario for two years. Balancing rest and reflection with becoming comfortable being uncomfortable (i.e., the unknown and unpredictable), is something we would all likely benefit from. Increasing our psychological flexibility, helps us change and adapt to circumstances either chosen or thrust upon us. It also helps us know when to shift gears, slow down, hold steady or as my Dad used to say, ‘know when to say whoa’, or was it ‘never say whoa in a tough spot’? In other words:
You’ve got to know when to hold em’, know when to fold em, know when to walk away, know when torun.
Kenny Rogers, The Gambler
That might look like asking whether something we’re contemplating doing is aligning with the kind of person we want to be and our goals in life (i.e., our values). It may also mean accepting that something we’ve chosen isn’t aligned long term but allowing it to be because it temporarily satisfies a need. Sometimes it means walking away. This idea reminds me of the question:
How many psychologists (physicians / therapists) does it take to change a light bulb?
Only one, but the lightbulb has to want to change itself.
Change is hard, but we can get better at it and have better outcomes when we understand what we’re trying to change and why. Change, change, change, change. . .
One last point is that obviously changing course is a little easier to manage on an individual level, reversing something for an organization generally takes years.
On a musical note – I wanted to credit the title of this post to Corin Raymond and his pal Taylor Ashton. On his Paper Nickels album, Corin shares an email he got from a venue booker, which wasn’t exactly an appealing invitation to play. When he shared the contents of the email on social media, so many people responded and advised he needed to write a song about it. Taylor informed Corin hours later, that he ‘had it’! He and Corin recorded it live. You can listen to the intro What to Do? (must do) and the song Change here. Both can can also be purchased on Corin’s website. You too can have ongoing laughs for $.99 each. There isn’t any particular symmetry to that song and this post except that I like the chorus. . .change, change, change, change, that being ‘strange’ might be what makes you wonderful, and this line:
If you’re going to ask someone to sellout, you better have more to sellout than fifty bucks and couple of drinks. What do you think?
Corin Raymond and Taylor Ashton
Stay tuned for more ‘Musings on Medicine’ down the road. The header image is a reference to ‘Getting Snow Globed’, what some call it when your life gets shook up.
Alanna Martineau 