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what's so special about new?

We are obsessed with everything new.

Aren't we? New clothes, new shoes, new movies, new electronic gadgets, new medical procedures, new drugs.  Now we are obsessed with the New Year. As I write this, on New Year's Eve day, 2011, I wonder why we are so obsessed. The newspaper is full of retrospectives, and all over the airwaves you can catch the "ten best" or "hundred best" songs, stunts, crimes, etc of 2011. Following the retrospectives are the predictions for 2012-- the next big trends in healthcare, in social media, in toys, in the economy.

Is it necessary that we get so excited about the next NEW year?

Objectively, the answer is probably "no." But objectivity has little to do with understanding  human behavior. I believe there is value to acknowledging the passage of one period of time and the beginning of another. The fact that we tend to do this on Jan 1 is immaterial. What is important is taking stock through REFLECTION.

Reflection is important.

Whether that reflection occurs during a formal performance review or as part of your daily activities it is necessary to inform your future actions. By reflection I DO  NOT mean judging. I DO NOT mean looking back at decisions you made  or actions you took last year and trying to recreate them in your head, criticizing yourself for choices that didn't turn out as you had envisioned. What good does that do? What is helpful about reflecting is using the experiences of the past to inform the decisions or actions you may face in the future.

The good thing about reflection is that is can be used by everyone in every situation.

So, as a mother of a chronically ill child, you may feel that every decision you make is fraught with the danger of being the WRONG thing. Sometimes, even the most well-thought-out decisions result in undesired outcomes. Does that mean you made the WRONG decision? No, you made the best decision you could at the time. The value of reflecting instead of judging based on the outcome is to look at how you came to your decision, and how you will approach the next decision point along the way. The point is to learn. Use the feedback from this decision to inform the next. Are you relying  upon the right people for advice? Are you finding the best information that exists? Are you so convinced about a single right way that you don't see all the options available to you?

Likewise, we, as physicians, make choices all the time. What test to order, what treatment course to initiate. Hopefully, we are doing this in conversation with our patients and their families. However, as collaborative as we may want to be in this process, it is still our role (I believe--others may not agree) to provide the patient and family with the benefit of our knowledge and experience, and therefore guide the process. We are not always right. We make mistakes.

Some doctors are devastated by any mistake they might make. Others never admit they made a mistake.

Both of these approaches are unhelpful to becoming better. Reflection is now being taught as a tool for physicians and other health care providers to understand how they process information, and where they may have gone wrong in the past so they can prevent themselves from making a similar error in the future.

What do I mean? Is this just the process of amassing more facts than they had before, so they KNOW more?


No one can possibly know everything.

I mean they need to reflect on how they process information, they need to interrogate their system for assessing and amassing information so they avoid some very common processing errors. (In the future I will discuss some of the specific problems doctors are known to face as they try to make a diagnosis or initiate a treatment regimen).

In the past I discussed a mistake I made that led to a very bad outcome for a child. Not all judgment errors are that bad, so that sometimes we may not notice them right away. But doctors (as most of us) have a tendency to see what they expect to see, as well as to ignore things that do not "fit" into a picture we carry in our head of what our patient has.

Let's take the example of a young infant who comes to the emergency room wheezing for the first time. Most of the time a baby who wheezes has a viral infection that is in the lungs, that may need to be treated with inhaled medication, and will generally get better with the passage of a few days. But not always. About one in every thousand babies might be wheezing because they have a problem with their heart. I have seen doctors so convinced that the problem fits neatly into the first category, that they may not notice some of the warning signs that this particular infant fits into the second category. Those signs are usually not subtle and would be a large heart on the Chest XRay, an enlarged liver on physical exam, and worsening instead of improvement with the usual breathing treatments. Yet, sometimes we have become so close-minded to the "one-in-a-thousand" possibility that we just don't see it.

That is where reflection really helps. It is not that the doctor didn't KNOW about the possibility of a heart problem, but the heart problem didn't fit into his or her assessment of the child as having a respiratory viral infection. If the treatment wasn't working he may have simply thought he hadn't given enough. But she rarely thinks: "Maybe I made the wrong diagnosis."

By reflecting upon his approach to decision-making, he can learn, in the future, a lesson that will work with other types of problems. She learns to be a non-linear thinker so that she can place in proper perspective data that doesn't otherwise fit. He learns he has to be open-minded, and that in fact he can be wrong. This helps every new patient he sees in the future. The best doctors are always trying to keep their minds open.

So, whether you are a mother, a doctor, a business leader (or all of the above) please take some time to look back and REFLECT at the end of this year. DO NOT judge, do not criticize. LEARN, OPEN YOUR MIND, and look forward to a new year full of wonderful possibilities and personal growth.


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