It’s all well and good to talk about how to work with people who are resisters, but what if you yourself are a resister? What would you say to someone who recognizes and wants to overcome their own resistance to change?

Dale, I’ll be watching your blog.

“Resistance” is rife in my own field of study … physicians and medical personnel are inexorably being herded into the use of electronic media for every aspect of their record keeping, and a vast majority of them are either actively “resisting” or grudgingly accepting the inevitable.

I’m in an interesting position, because I see how the HIT professionals are being trained to implement the change … and I also belong to a large medical blogging community, and am able to see, and understand, why the physicians are “resisting.”

It’s going to be a real social experiment to watch my fellow students rush out into the real world, eager to convert every paper record using medical office they run across into a bright, shiny EMR and CPOE hub. They expect to be welcomed with open arms.

It will be interesting to see what you have to say!

Richard, of the four people who have responded to my request for questions, three (including you) most wanted to know how to deal with their own resistance. I think that’s interesting.

And, yes, I have plenty to say about that.

In fact, the first thinking I did about resistance was about my own resistance to my own good ideas. I wondered: Why don’t I do the things I know I ought to do?

Short answer: We only think we know what we ought to do.

Point to ponder: Consider the difference between “I ought to” and “I want to.”

Doris, I’d love to hear more about what you’re learning. In particular, I have a few questions.

What are the physicians doing or saying that you are thinking of as resistance?

What do you think are the physicians reasons for resisting?

What leads you to think those are their reasons?

I’m intrigued by your comment that your fellow students expect to be welcomed with open arms. That expectation is, in my view, one of the main causes of resistance.

One of my definitions of resistance is any response that violates the change agent’s expectations about how the change will go. So when we expect to be welcomed with open arms, we’re more likely to treat any response other than open-armed welcome as resistance.

If we didn’t have such a strong expectation of being welcomed with open arms (or such a strong hope), then we wouldn’t be thrown for such a loop when people welcomed us only half-heartedly or not at all.

“What are the physicians doing or saying that you are thinking of as resistance?”

Dale, that question brings so many things to mind, that I’m overwhelmed at the thought of trying to give you a comprehensive view.

You know that I belong to a medical blogging community. I follow the blogs of more than 95 medical personnel by RSS feed (Bloglines) … most of them are physicians. Offhand, I can think of only 3 who’ve had anything good to say about electronic medical records, although the subject comes up rather frequently in their blog posts.

During research for one of my HIT classes, I came across the following articles:

Overcoming Barriers to CPOE
Doctors are the main barrier to computerizing records

Ironically, one of the course’s subjects for that week’s discussion was the “popularity of CPOE’s.” Over the ensuing weeks, I began to see that there was a major difference in what we were being taught, and reality …

I posted a question on my blog for my physician friends:

Do Physicians Show Low Levels of Computer Literacy?”

They left me some very interesting and revealing comments … which included, but were not limited to, the following:

1) The startup cost - nearly impossible for a small practice, or a smaller facility.

2) Takes the focus off from the patient - the human to human exchanged is lessened.

3) It adds hours of work for those who are not computer savvy.

4) The added chance (reality) of errors (medical and otherwise) during the transition phase.

5) It’s cut down on once essential staff, and put the detailed work load on the already busy physicians, lessening their time with their patients even more.

… just a tiny, tiny taste of their reasoning.

All of this was reinforced in a telephone interview with a physician who’s healthcare system recently made the swap from paper to electronic record systems. He’s a younger physician - computer savvy, and he says he would drop the electronic records “in a hot minute” although the change was easier for him than for many others.

“What do you think are the physicians reasons for resisting?”

I believe most of the physicians’ reasons for resistance … and take them at face value. There are a few reasons that could be argued against as being a bit disingenuous, but for the most part, the reasons seems believable, even if some would be relatively short term problems.

“What leads you to think those are their reasons?”

This is more difficult for me to answer. My own relatively recent introduction to the world of health care through having developed a serious chronic health problem has given me an idea of what those who are on the clinical side of medicine are up against, with government regulations, insurance companies’ interference in the physician’s care of his patients, and the constant threat of litigation and rising malpractice insurance costs.

Being asked to trade over to this new system, which will impact every aspect of his practice, especially where it deals with the regulatory and financial/legal organizations mentioned above, would be enough to give the best of them an ulcer!

From my side of the fence, I can see that we are being groomed to go out into medical facilities, and save all of these poor fellows from their outmoded, time consuming, bloated paper records … with the exception of my own chronic problem of posting warnings about unwilling and unhappy physicians, my fellow students have no idea what they’re going to be up against when they get out into the field, and try to go about bringing Dr. Dinosaur into electronic medical age.

For myself, I can see that EMR’s are where medicine is going. It’s inevitable. EMR’s … and lots more. The era of house visits from Dr. Murphy are all over … and we’re entering a time which could eventually see us all carrying our medical records underneath our skin in the from of a tiny computer chip.

I would like to find out what would make the transition easier for all of the Dr. Murphy’s … what would cause them to feel more at home with the system … how we could prevent errors during transition phases … how they could save time using the electronic media, without sacrificing the human element of the physician/patient relationship.

Not sure if I’ve answered your question or not … if I haven’t, or if I haven’t been clear, please let me know. I’d be delighted to attack it all from a different direction. You’re talking my language, Dale - both with the records, and with enabling communication in order to turn resistance into cooperation - from both sides of the fence.

—
My view: He who pushes another into resisting, is also resisting, even if all he’s resisting is the resistance. —

I am very interested in any discussion or responses to Doris’ question(s). I am currently implementing an EMR for a large academic medical center, and the only major, almost un-mitigatable problem I face is that of physician resistance to the change.

I am throwing all of my best “change management” tactics at them, and if I am successful at moving the focus from a particular topic, resistance just rears it’s “ugly head” on some other topic.

The primary issues seem to be:
Physicians feel that they are being made into clerks, with lots of typing and system use.

Having to develop their own notes (versus jotting a few lines onto a piece of paper and having a nurse or assistant translate them into the typed chart) takes them more time, and makes their days longer without seeing any more patients

There is a dicotomy - each physician complains they want standards, yet they want the standards to reflect their needs, rather than a amalgam of what is best for the organization.

[…] several people responded to my request for questions about resistance, and several others have talked to me in private about some of their puzzles about resistance. I […]