Embrace your team: Small efforts can yield big results

AMA Leader Commentary. By Edward L. Langston, MD, Jan. 7, 2008.

AMA LEADER COMMENTARY

A few words about current events in medical practice

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A message to all physicians from Edward L. Langston, MD, chair of the AMA Board of Trustees.

Change can be difficult. Sometimes change is frightening. Change also can be invigorating and intellectually challenging.

But we should not seek change for change's sake only.

In health care, change needs a strong dose of evaluation and analysis to avoid extremes that put people and populations at risk.

On the other hand, we need to avoid allowing the perfect to be the enemy of the good.

It seems to me that change in health care, and more precisely in medical care, is bimodal. By that I mean, there often seem to be two extremes: change occurs abruptly, at least from a medical perspective, or very slowly.

For instance, I recall that in early interventional coronary artery care, angioplasty without stenting was the predominant methodology of care.

Within two or three years, the ratio of intervention changed from 85% without stenting of the coronary artery versus 15% with, to 95% with stenting versus 5% without.

In medical care, that is a rapid reversal within a short time. Technology and technique advancements can be provocative drivers of rapid change.

However, analyzing the rendering of medical care in a more global perspective, change can be slow.

Many influential leaders and practitioners, for example, have called for a team approach to providing care in certain well-defined circumstances. But there are forces that negatively impact even the opportunity to test, on a broad scale, the utility of this concept.