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Change                                                                                      President’s Letter

By Elizabeth B. Moran, MD                                            to cope with the anxiety inherent in dealing with some degree of
                                                                     uncertainty in every decision. Just as we are taught in our training
C hange, as we all know, is inevitable. And over the                 the unique skills to manage this in clinical arena, perhaps this skill
               past few years, much writing about modifications in   is transferrable to other areas of our work and lives.
               the medical profession has focused on the negatives
— physician burnout, the rising costs of practice,                     One way of improving our sense of certainty is via better
                                                                     communication and clarity, Robbins suggests. Although we
a reduction in job security, ever-increasing documentation and       work hard to have clarity in our diagnostic and treatment plans,
                                                                     perhaps we need to strive for greater discussion and clarity
regulations, and an uptick in recertification requirements. These    regarding job security, work environment and the other non-
                                                                     clinical parts of our profession. One example might be to join
all serve to paint a pessimistic picture of the current state of     a committee or take steps toward a leadership role either in our
                                                                     day-to-day practices or in the local or state medical society. This
affairs in medicine. Through this lens, it is difficult to see the   could result in a greater sense of understanding, and ultimately, a
                                                                     sense of control.
positives of what we do. It may be even more difficult to recall
                                                                       Variety in our lives and jobs is another fundamental need. For
Certainty in our           why we started down                       some, continuous variety is a must; for others, too much variety
jobs, within our                                                     can lead to dissatisfaction and anxiety. Patient encounters are
homes and throughout       the path of becoming                      infinitely varied, and it is difficult to see how any physician
                           physicians in the first                   could ever want for more diversity in clinical challenges. Indeed,
                           place. What drove us to                   the trouble often arises from too much variety, which may fall
                           choose this profession?                   outside our individual comfort zone. But, with experience, larger
                           And, has the landscape                    patterns in patient visits may emerge that allow for enough
                                                                     variety to keep the job vibrant and exciting, while also providing
our relationships,         changed so drastically                    a comfort level on a daily basis. Perhaps some self-reflection on
                           that those choices are                    what type of schedule matches our desired need for variety might
                                                                     increase our appreciation for this fundamental quality inherent in
leads to a sense of        no longer viable for our                  our profession. Then we can take active steps, as we are able, to
                           children, for the next                    tailor our day to better suit our need.

control and security.      generation of doctors?                      The third aspect of Robbins’ theory to increase personal
                             With the constancy                      satisfaction, is the need to engage in significant and meaningful
When certainty is                                                    work. This seems self-evident, but recently there has been a shift
lacking, increased         of change in mind, I                      to customer satisfaction forms, documentation requirements,
stress occurs.             recently found myself                     and the increasing pressure of volume. Let us never lose sight of
                           reading about “Human                      the fact that we have dedicated years of our lives and thousands
                           Needs Psychology,” a                      of dollars in tuition for the privilege of making a significant
                           theory developed by                       difference in the lives of those around us. Let’s remind not
                                                                     only ourselves, but also each other, of this fact on a daily basis.
                           well-known leadership                     I believe the simple act of saying “thank you” to a colleague
                                                                     for a consult, for their contribution to the plan of care, for their
                           guru Tony Robbins                         dedication overall, can have an impact so much greater than the
                                                                     effort required to express that gratitude in the first place. Small
(link to his TED talks at the end.) Robbins’ theory, entitled “6     things matter, and within a profession that deals with such large
                                                                     outcomes — life or death — those small things easily get lost in
Core Human Needs,” surmises there are six fundamental needs          the shuffle. A heartfelt compliment from a patient, an expression
                                                                     of gratitude from a colleague and the simplest of kind gestures in
that govern human behavior and happiness. While each of these        a busy day offer us the opportunity to see anew the true meaning
                                                                     and significance of our work.
may have varying significance across individuals, each and
                                                                       Connection also is a fundamental need which feeds human
every person is influenced to some degree by them all. Although      happiness. We are social creatures and, within his theory,

Robbins’ writings on this subject are geared primarily toward

leadership and team development, I see a strong parallel between

medicine as a career and the fulfillment of each human need.

Medicine, as a profession, provides all the necessary ingredients

for human happiness, and I argue this has not changed over time.

The recognition of these core human needs and the ways in which

our work can lead to their attainment is evergreen. Focusing on

the constants, rather than on the relentlessness of change in other

aspects of our profession, can lead to a better understanding of

what we do and a greater satisfaction in doing it.

Robbins espouses the importance of certainty as a fundamental

human need. Certainty in our jobs, within our homes and

throughout our relationships, leads to a sense of control and

security. When certainty is lacking, there’s increased stress.

However, as nothing in medicine — or life for that matter — is

ever 100-percent certain, doctors, as a rule, are uniquely equipped

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