Conflict Creates Progress–Don’t Let the Unpleasant Get in the Way of “Better”

“The Emperor Has No Clothes!” the child cried while all others marveled at the finery the Emperor was supposed to be wearing.  No one wanted to speak the truth and face the consequences of conflict with the powerful man.  This child’s fairy tale continues to haunt us everyday in so many aspects of our life.  We shy away from conflict especially when new ideas are introduced that collide with our world view or make us feel uncomfortable.

I was reminded of this important truth by a colleague who sent me a story about a woman scientist, Alice Stewart, who in the 1950s observed that children of more affluent mothers were dying from cancer at twice the rate of those who were less affluent.  The cause?  X-ray during pregnancy.  The idea that new technology and the doctors using it could actually make us sick was not well formed at that time.  She engaged a colleague, an epidemiologist , George, to prove her wrong.  Unfortunately, he did not.  And even with her proven theory, two decades would pass before x-rays in pregnancy would be a thing of the past.

What is important about this story is that when a new idea is introduced or an old idea is examined, putting aside one’s strongly held biases (a/k/a opinions or in some cases proven “facts”) is hard to do.  To listen to conflicting ideas that challenge your world view, or even worse, go against your “group” belief, is incredibly difficult.

We have been lured into believing that behavior that “goes along” is better than behavior that challenges.  I do not agree.  If we don’t challenge ourselves and others to question what we do, why we do it and how we do it, then we are stuck in the mistakes of today without the hope of a better tomorrow.

As a surgeon, I have seen this acceptance of what we do as the way it needs to be done, become codified in clinical pathways, guidelines, and unnecessary medical record documentation, all in the name of “quality” which is not measured by how we solve a problem that is in our purview to solve. (Physicians cannot be held responsible for the societal eating, drinking, smoking, etc. habits and the ravages caused to our bodies by the food, energy, media industries).  We are losing seasoned physicians who possess a lifetime of wisdom that is not found in double blind, placebo controlled studies (which are nearly impossible to do for most problems).  They are leaving medicine because of the misguided thinking that electronic medical records, clinical pathways, and “best practices” are the new “emperors” of medicine.

The conundrum is, however, when we speak up, we are called “disruptive” and labelled as having “anger management problems”.  We are sent to psychiatrists.  We are paraded in a national data bank for all to see.  We may even lose our licenses.  New tools to make sure that no one cries out, “the Emperor has no clothes.”  Hospital administrators, the most odious of which are medical officers, fight to keep the peace, even when the peace means less good care.

My advice?  If you can safely stir the pot, and not endanger your voice be silenced forever, then do so.  But we are in danger of losing the voices of doubt, the voices that question, the seekers of “truth.” And so we are doomed to make the same mistakes again and again.  And thus begins the 21st century.