DOI: 10.1097/01.COT.0000295123.87087.16

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Issn Print: 0276-2234

Publication Date: 2006/10/10


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Dealing with Change in Oncology

Joseph V. Simone

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I have a long-standing interest in how we physicians deal with change, especially changes in our working environment. This discourse will eventually make a point relevant to the oncology environment. But before that, I will describe my observations of how many practicing physicians, community and academic, respond to change.
All, some, or none of these observations may apply to you and your practice. At the very least, I am certain you will recognize others in these examples.
Facing change in the nature of our practices that is threatened or caused by outside forces is inevitable. When we are young and just starting out, we accept impending change more readily because we have little invested in the status quo and because we don't know any better. We accept change without a great deal of thought.
This was brought home to me by observing my daughter and son-in-law. Both are physicians who completed their training in the early 1990s and entered a medical world consumed with the threat of managed care. But they seemed immune to all the doomsday talk and hand-wringing. They had no history to compare with the proposed or actual changes and even if they were inclined to do so, no power to modify them. So they just motored on.
In mid-career, we are still somewhat connected to our training, do some clinical trials, and are more or less up to date. We still go to annual meetings and read articles in JCO or Blood. We accept change selectively and try to be proactive, if we have the time, but a growing practice and family consume almost all of our energy.
In the final third of our careers, we have become well-established professionally and domestically. We find it much harder to change in either sphere because there is much more at stake. We may not be up to date scientifically, but we usually know the latest indications for therapy. Whether the new medications are used appropriately depends on who is the judge.
We may look at some of the abstracts in JCO, or maybe just the table of contents, or skip it altogether. Our experience is vast and our judgment excellent, we tell ourselves. Our patterns of care and referral conduits are entrenched. We have bought the second home in the Berkshires, the 32-foot sailboat, the BMW. And if we weren't already, we probably became Red-Staters along the way.
We have it pretty good, so we don't really want anything to change, least of all our practices, and will fight like hell to keep things as they are.
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