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Your Best Life: Alter Your Paradigms for Radical Change in Your Life

Kelly, John D. IV MD

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Clinical Orthopaedics and Related Research: March 2020 - Volume 478 - Issue 3 - p 473-475
doi: 10.1097/CORR.0000000000001137
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We tend to see others as we are; not as they are [5]. In other words, we project our own inner realities on the world and onto others. In Seven Habits of Highly Effective People [3], author Steven Covey employs a loose definition of “paradigm” to mean how one interprets what one sees. Covey asserts that this perspective is a large determinant of individual growth and happiness. From these paradigms, our attitudes, behaviors, and relationships with others are formed. Covey continues and maintains that how we interpret people and events is inseparable from our character [3].

Each of us sees the world through different lenses, determined largely by our personal experiences and early conditioning by parents or caregivers [9]. Covey states that the closer our paradigms match reality and the time-tested principles of fairness, honesty, diligence, and integrity, the more peace and effectiveness in one’s life will be realized [3].

The term “paradigm” launched into mainstream parlance after Thomas Kuhn’s landmark work, The Structure of Scientific Revolution in 1962 [8]. In this celebrated treatise, Kuhn describes how sizable advances in science occur subsequent to a “paradigm shift” or drastic change in how the world (data) is (are) interpreted by scientific observers [8]. Similarly, each of us can experience substantive growth if we examine and modify our own personal paradigms so that they can become more aligned with what is truly real. Each individual’s paradigms are one’s own, and I do not presume to tell my readers how they should see the world. But professionally, and specifically in my specialty, I have experienced certain inaccurate paradigms that need to be adjusted or properly shifted.

Below are some common, inaccurate paradigms, along with substitute views or fixes for each that align with Covey’s time-tested principles.

Inaccurate Paradigm: The Scarcity Model

The fiercely competitive matching process has undoubtedly fueled a win-lose mentality among many surgeons, where one’s success occurs at another’s expense. Similarly, The Scarcity Model affords no allowance for synergistic relationships. I’ve spoken to colleagues who believe that practicing orthopaedic surgery is a zero-sum game [7], where there are only a finite number of patients in a certain area deserving of surgery. A surgeon ascribing to this paradigm may think: “If Surgeon X operates on 10 patients this week, that’s 10 less available patients for me to treat.”

This thinking creates tension, competition, and sometimes even ill will for neighboring surgeons.

Paradigm Shift: The Abundance Paradigm

The Abundance Paradigm recognizes that there are enough patients to go around [4]. Indeed, all will be well if we simply do our best to live out our vocations treating one patient at a time. An abundance mentality acknowledges (my belief) that we live in a friendly universe that will work for the common good; we simply have to cooperate. There should be no intrinsic competition in a healing vocation [11]. In addition, when we attend to doing the right thing for each patient, we build something that will endure—our character. Patients recognize surgeons with character, and such surgeons attract patients.

Inaccurate Paradigm: I Am My Relative Value Units (RVUs)

With reimbursements dwindling [1], I know of orthopaedic surgeons who feverishly increase their patient volumes to maintain income [2]. While this could benefit the hospital or your private practice’s bottom line, stacking patient appointments on top of one another does little to benefit your own self-worth. The paradigm of seeing one’s worth equated to RVU production can lead to burnout and dissatisfaction [6, 13]. With this inaccurate paradigm, as our productivity goes, so does our worth and self-esteem.

Paradigm Shift: We Are More Than Our Accounts Receivable

A more-appropriate view, and one more-grounded in reality, is that we are all so much more than our accounts receivable. I understand the argument against this paradigm shift: “I can’t help patients if I am losing money or don’t have a job.” There is nothing wrong with ambition and we deserve to be fairly compensated for our work. But we cannot lose sight of why we are working so hard. Each of us has been granted an unusual privilege of caring for others and mitigating suffering. We are called to engage in the noblest of vocations—that of a healer. The privilege we all hold is not to be taken lightly. When we focus on the vocation, rather than the business, patient and surgeon satisfaction soar [11, 13]. A daily mission statement that delineates one’s purpose or “mission” in life can keep us aligned to what we deem as truly important and meaningful. I have spent considerable time in crafting my own and it is paraphrased as follows: “Finding the good in myself, others and the world; to be present and act on inspiration, not judgment, and extend loving compassion to whom all I encounter.”

Inaccurate Paradigm: Our Patients Are “Needy”

Traditional training does precious little to affirm patient dignity. Terms like “dirt bag”, “gomer”, and “druggie” were heard regularly during the course of my training. When we look at patients through the lens of judgment, and see them as needy, we sow the seeds of an unhappy life [10] and generate negative energy. In addition we are less inclined to provide the care our patients deserve [12].

Paradigm Shift: Treat Your Patients with Compassion and Empathy

Empathy and compassion do not imply behavior that condones destructive habits. These virtues simply allow one to understand situations, share suffering, and withhold judgment. Patients who demonstrate aberrant behaviors are simply displaying inner pain projected outward. When we discover that the “druggie” in Bed 3 was raised in foster care after his father who was an alcoholic assaulted his mother who was addicted to opioids, we may begin to understand that patient’s usage of narcotics, and demonstrate empathy and compassion.

A paradigm better aligned with reality holds that patients generally visit orthopaedic surgeons because of pain—whether physical due to an intrinsic joint affliction, or psychic pain, which may manifest in myriad musculoskeletal ways. Self-destructive behavior is a manifestation of the patient’s pain, not an indictment of his or her character.

Judgment leads to anger and frustration. Compassion yields peace. It is our choice.

Tomorrow, Try This

  • Examine your paradigms: Are you a fault finder? A proponent of scarcity over abundance? An RVU chaser or a healer? Recognize faulty paradigms and commit to changing them.
  • Dedicate yourself to honesty, integrity, diligence, and fairness. You will see the world more clearly.
  • Write a personal mission statement that includes the positive person you wish to be.

References

1. Belatti DA, Pugely AJ, Phisitkul P, Amendola A, Callaghan JJ. Total joint arthroplasty: Trends in Medicare reimbursement and implant prices. J Arthroplasty. 2014;29:1539-1544.
2. Bernstein J, Derman P. Paying surgeons less has cost more. Orthopedics. 2012;35:1804-e1806.
3. Covey SR. The 7 Habits Of Highly Effective People: Powerful Lessons In Personal Change. New York, NY: Simon and Schuster; 2013.
4. Escarce JJ. Explaining the association between surgeon supply and utilization. Inquiry. 1992;4:403-415.
5. Fenichel O, Rangell L. The Psychoanalytic Theory of Neurosis. London, UK. 1946.
6. Kelly JD. Your Best Life: Perfectionism—The Bane of Happiness. Clin Orthop Relat Res. 2015;10:3108-3111.
7. Kirchmeyer C. Nonwork participation and work attitudes: A test of scarcity vs. expansion models of personal resources. Human Relations. 1992:45:775-795.
8. Kuhn TS. The Structure of Scientific Revolutions, 3rd edition. Chicago, IL: University of Chicago Press; 1996.
9. LeDoux JE. Brain mechanisms of emotion and emotional learning. Curr Opin Neurobiol. 1992;2:191-197.
10. Pronin E. Perception and misperception of bias in human judgment. Trends Cogn Sci. 2007;11:37-43.
11. Shanafelt TD. Enhancing meaning in work: A prescription for preventing physician burnout and promoting patient-centered care. JAMA. 2009;302:1338-1340.
12. Wen CK, Hudak PL, Hwang SW. Homeless people’s perceptions of welcomeness and unwelcomeness in healthcare encounters. J Gen Intern Med. 2007;22:1011-1017.
13. Wenzel RP. RVU medicine, technology, and physician loneliness. N Engl J Med. 2019;380:305-307.
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