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     I have been asked to forward this article from the British Medical
Journal regarding the difficulty that doctors, and for that matter, the
rest of us, have in dealing with new ideas and information. I have to
admit I have been guilty of almost every example listed. I hope this is
useful to those of you who are always seeking to do better for the
horses in your care.  Bruce Weary

1473 BMJ VOLUME 329 18-25 DECEMBER 2004 bmj.com

Easy ways to resist change in medicine

Allen F Shaughnessy, David C Slawson


These time honoured techniques will help doctors resist the forces that
prevail on them to change their ways of taking care of patients.
Numerous forces have been imposed on physicians to make them change
their practice behaviours. Under the guise of "quality improvement,"
managed care organisations, accrediting bodies, and the government are
meddling in medicine. Even continuing medical education, previously a
form of intellectual entertainment or a forum for much needed sleep, has
refocused its efforts towards improving the care of patients

Techniques to resist change

Techniques are available, however, that will allow doctors to practise
unimpeded by new information that should induce change. To avoid
succumbing to both the inner and outer forces prompting change, we offer
the following techniques and methods.

Don't pay attention

Get so busy with your practice that you do not have the time to read,
attend meetings, understand your own practice, or observe the practice
of colleagues. Forget about Stephen Covey's seventh habit of "sharpening
the saw."    Create your own habit of sawing harder and harder, with a
dull saw.

Attack the data

When provided with new information that may require a change in practice:

*   Firstly , diss the source. No one expects you really to believe
information from sources outside your specialty or geographical area.

* Secondly, question the validity of the information. Every study or
report contains some loophole in its fabric, however small, that can be
snagged and used to unravel the validity of the whole study. Use the
common logical ploy that holds that if any aspect of the study is
imperfect, the entire study results must be wrong.

* Thirdly, question the applicability to your patients. Studies are done
"out there" and can't possibly reflect the unique nature of your
practice. This technique is especially useful when data from large
studies contradict our impressions gleaned from personal experience with
a few patients.


Maintain absolute confidence

Remember all the smart professors you had and realize that everything
you need to know to practise good medicine was taught in medical school.
Instead of worrying about this newfangled "evidence based" medicine,
stick with "belief based medicine" and organize your thoughts.


Follow the pack

Stay far back, waiting for all your colleagues to change before you
(reluctantly) join them. Of course, if you practise skill # 1 correctly,
you will never know what your colleagues are doing.


Defer to experts

Be sure not to make any independent decisions. An expert is always
available somewhere to support your death grip on the status quo.




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