Today’s physicians are faced with identifying, evaluating, and applying a huge quantity of medical information. In addition, many stakeholders in health care, from patients to payers, are taking an active role in the previously inviolable process of physician decision making. This is the third paper in a series discussing the concept of information mastery. In the first paper we discussed using the criteria for Patient-Oriented Evidence that Matters (POEMs) to distill clinically relevant information. The second paper in the series focused on techniques for efficiently obtaining this information from the myriad resources available. In this paper we discuss the final step in the process, changing practice habits after finding new information that necessitates it. We discuss managing change, consider barriers, and present ideas to help with the process.
One of the greatest pains to human nature is the pain of a new idea.
Medicine, like most professions, is in danger from a tsunami created by the information explosion of the 1990s. This tidal wave of information, as well as its push-button accessibility, is threatening the basic foundations of the profession. The clinician is no longer considered the exclusive interpreter of medical wisdom and the sole arbiter of what is best for patients. Government agencies, managed care organizations, the news media, and advocacy groups all use medical information to influence patient care. All of these groups are constantly monitoring medical research to determine whether we are changing the way we practice when new and better information comes along.
In this article, we focus on how we learn from this information. From that perspective we will talk about how to change, since change is the ultimate goal of information use.
Why is change so important? The advent of new diagnostic tests, procedures, and medications make it necessary for us to change on a regular basis. Every clinician must change practice habits many times during a career. One can choose either to lead change or be dragged along behind it.
Our article is not about reacting to outside attempts to induce change, the carrots or sticks used by agencies and organizations to motivate us do something different. It is about truly being a master of information rather than its servant.
Information and change: How we learn
At the beginning of life, our minds are like empty shelves in a grocery store. As we learn, we stock them with units of information. Much of our lives are spent filling those shelves with the things we have learned.
Like bread in the grocery store, our information becomes stale and eventually expires. As we continue the lifelong learning process, we replace what has gone stale with fresh units of information. Unfortunately unlike the grocer’s shelves, the information gathered during medical school and in practice does not have an expiration date stamped on it. As a result, we may not know when our existing information has become stale or invalid. And similar to a loaf of stale bread, the information that we store can appear fresh, even though it is past its expiration date.
This lack of expiration labeling makes the job of the information master much more difficult. We need to search continually for new information to discover when our existing information has become outdated.
Think about the information that has become available in the last 10 years: antibiotics for treatment of peptic ulcer disease, the ineffectiveness and possible harm of patching corneal abrasions, therapy of deep venous thrombosis changing from 14 days of hospitalization to at-home treatment, and angiotensin-converting enzyme inhibitors and b-blockers used instead of digoxin as the cornerstone of heart failure therapy. To do what is best for patients, we need to identify new information and assimilate it into daily practice. Maintaining best practices requires change.
In our first paper, we distinguished “data” and “information” from the “knowledge” and “wisdom” that are the results of our brainpower. As a critical prerequisite to change, we must separate our view of ourselves from the information we have. Our value—to individual patients as well as society—is based on our ability to think using the information we accumulate.11,12 Descartes said, “I think, therefore I am,” not “I know a lot, therefore I am.” We can only think best when we have the best information. Information is useless without reflection and questioning.
Too often we get so attached to hard-earned knowledge that we get defensive when it is challenged by new information. We might interpret evidence requiring us to change as an assault on the integrity of our previous education (and so, in some ways, an attack on our very being).