Change: Are You Ready for Uncertainty?

  • Lucas, Shawn, MD
| Jun 11, 2015

As I’ve gone through my career I’ve come to realize that, as an anesthesiologist, I was not trained for the sort of decisions I need to make today. I don’t mean the clinical decisions, I mean the non-clinical ones. Our specialty, and all of medicine, is going through a time of tremendous change, one with significant uncertainty about our role and our future. Unfortunately, medical training does not focus on how to deal with uncertainty; it focuses on how to deal with probability.

Our anesthesia group has been in the same situation as many other anesthesia and medical groups. Over the past few years we were forced by circumstance to learn how to deal with the uncertainty of the future of our practice (and the anxiety that is a natural byproduct of uncertainty).

Here are some of the lessons we learned.

First, we got comfortable with the difference between uncertainty and probability. We make clinical decisions every day where we weigh the likelihood of various events in order to choose the path with the chance of the best results. While there is some unavoidable uncertainty in the treatment of illness or the practice of anesthesia, we are sometimes able to base our decisions on clinical research, or evidence-based outcomes.  This lets us know, if we choose to do “X,” we have a smaller chance of a poor outcome than if we choose “Y.” That is working with probability.

One example of dealing with probability is the ASA recommendations for surgery in patients with cardiac stents. In January 2009, the ASA Committee on Standards and Practice Parameters published a "Practice Alert for the Perioperative Management of Patients with Coronary Artery Stents".   It is a good example of how we use probabilities to weigh potential risks, such as the risk of coronary vessel re-occlusion, the risks caused by postponing the surgery, and other risks, to determine the best perioperative management for each patient.

These sorts of clinical decisions, however, are not what we, as individuals and groups of anesthesiologists, are currently making about our practices and our careers. The non-clinical decisions we are faced with often cannot be adequately studied; there is either no data, or not enough data to determine the “right” answer.

The decisions we make in these circumstances require stepping out into the unknown. In order to move forward into that unknown, we have to get comfortable with uncertainty, making a decision when we don’t know the probabilities… and never will.

So how can we move forward when there is so much uncertainty facing our practice?

In my own practice group, once we learned to recognize the uncertainty in our situation, we also had to learn to recognize where we are experts, where we are not, and to get help from those who could explain and educate us on the business, political, economic, and legal issues involved in making a major change in our business.

Using resources from the ASA, such as the ASA Practice Management Conference and CSA Practice Resources were important first steps. After exploring those resources, we felt additional help was required. We spoke with various consulting firms to see which one would be the best fit to assist us through the process of a change in our business model and structure.

Choosing the firm that would help us weigh the options for this decision was important. We took our time to explore the various consultants. Being thorough was important, because we worked closely for months with the firm we eventually chose, and they helped us accomplish an important second step: coming to an agreement on our values, and making sure our goals were based on those values.

We saw that whatever decision we made about our strategy, it would be founded on the values and goals of our group. Making sure that the physicians in the group were aligned behind the same values and goals kept the individuals in the organization moving together.

Finally, we explored a broad list of possibilities for our practice to pursue with outside experts to help with the analysis. As part of this, we learned to come to grips with the fact that not making a decision is actually deciding to keep the status quo. It is a legitimate choice, and needs to be considered. So, as we went though the process of weighing our strategic options, “not doing anything” had to be one of those options.

It is not easy to deal with uncertainty. I wish I could always make a choice from a short list of options and get instant feedback as to whether I was “correct,” but life is not a multiple-choice test. Instead, I, and the anesthesia group with whom I have the pleasure of working, spent a significant amount of time and effort learning the lessons of how to examine and manage uncertainty, so we could be proactive in creating solutions for our future.

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