smacc gold final when to change what to believe for slide share
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SMACC Gold talk on how our beliefs are the most important influence on our practice. However, our beliefs are not always rational!TRANSCRIPT
What to believe?
When to change
You
1. We want to do the best for our patients.2. We want to be evidence based practitioners.
3. We want our patients to get the best diagnostics and treatments4. We want to be the sort of clinicians who champion the best care.
What do you believe?
http://lifeinthefastlane.com/ecg-library/basics/inferior-stemi/
….we don’t always know what we think we know…..
….practice is defined by belief as much as evidence….
Lignocaine for VT Betryllium for cardiac arrest
Endotracheal drug use in cardiac arrest.Large volume crystalloid for trauma resuscitation
Steroids in head injurySteroids in spinal injury
Magnesium in acute severe asthmaHypothermia for cardiac arrest.
Half of What We Taught You Is Wrong:The Problem Is We Don't Know Which
Half
We have a necessity for change
Are we good at change?
https://www.mja.com.au/journal/2012/197/2/caretrack-assessing-appropriateness-health-care-delivery-australia
Change is slowIs this important?
Mortality without new treatment
Mort
alit
y
Time
16%% event rate5 years to implement1.5% benefit with txc. 4000 pts/annum
Evidence
Mortality without new treatment
Mort
alit
y
Time
Mort
alit
y
Time
Vs. ??????
Vs.
16%% event rate5 years to implement1.5% benefit with txc. 4000 pts/annum
Vs.
16%% event rate5 years to implement1.5% benefit with txc. 4000 pts/annum
TXA for UK shock patients
Late adopters kill patients
Early adopters kill people
We don’t do what we are supposed to do.
We are slow to change.
Why?
ACP Journal Club March/April 2005 | Volume 142 • Number 2
ACP Journal Club March/April 2005 | Volume 142 • Number 2
….it is the customary fate of new truths to begin as
heresies….
Cognitive Dissonance
1. Change behaviour (belief)
2. Seek exceptions
3. Justify past behaviour
become motivated to change
what needs to change
make the change stick
Is our behaviour consistent?
So what can we do?
change is hard
Do I know my history.
get social
consider all technologies and
therapies
focus on patient related outcomes
final thoughts
There's only one corner of the universe you can be certain of improving, and that's your own
self.
thanks for listening