Fear and Change – they don’t always bring out our best qualities, but they give us a chance to re-evaluate ourselves

By  |  January 30, 2011 | 

Change is inevitable, change is necessary, change is often for the good; but change is hard.  Even getting married to our life-partner is considered one of the top ten most stressful life events.  http://www.garlandscience.com/textbooks/0815341571/pdf/supplements/StressfulLifeEvents.pdf

I have hesitated posting in this blog for some time because of all of the changes going on in my hospital – I was waiting for things to settle down.  But, since the settling may take a while, I’ve decided to write about those these changes.

We have been in a transitional stage for over a year, and will be in one, probably, for another year.  Our CEO retired at the end of 2010, not a stellar financial year.  Everyone in the hospital knew change needed to happen.  For months before our CEO left there was anxiety about who would be standing once we had our new chief.  Unanticipated circumstances led us to have a temporary CEO who will be with us for 3-6  months before we get our new permanent chief, so we know we will go through this transition twice.

Fear of change and loss are widespread.  The changes that are needed, and they are needed,  may require all of us to think in a way that we never have.  Alliances that have been in place for decades are broken or may need to be broken.  Things held as sacred, consciously or unconsciously, may no longer be sacred.  Like in “Survivor” (never seen it, but I’ve heard) when resources are scarce its impossible to know how others, or even we ourselves, will behave.  The distribution of authority changes and it’s hard to know exactly how the new chain of command works. Personally, I struggle with needing to protect my group while also needing to protect myself  at a time when I feel vulnerable. When I feel vulnerable it can be hard to make my best decisions.  If I take a step back and look from the outside, I can appreciate that I’m in a deeply uncomfortable yet fascinating social experiment which has played itself out endless times in every business scenario.  But business and medicine make strange bedfellows.

To be a manager by definition means that you are beholden to the institution above you and the employees under  you.  Physicians, especially hospitlalists, spend so much time in the hospital that their colleagues become their second family.  Feelings of protectiveness, jealousy, fear of abandonment, rivalry, love and belonging all exist in the workplace although we may not recognize them as such.

My job now is  to anticipate what change is required and to stay on top of it, to be proactive instead of reactive.  Being reactive, as we all do at times, can lead to misguided and emotional decisions.  I need to be judicious with information yet be as transparent as possible so that  my group can  keep a sense of control over itself.  We need to maintain our primary goal of safe and excellent medical care while trying to maintain  the cohesive and caring community we have built over many years. This is the most difficult challenge I have faced in my career.  I will, however, as the British Government said in WWII,  “keep calm and carry on”.


  1. Troy Ahlstrom February 3, 2011 at 12:09 pm - Reply


    I just have to stop and thank you for saying some things that I often feel. It’s hard to find the courage to write about something that’s intensely personal, in that it might be misinterpreted by our colleagues going through the same situation with us… Aren’t we just inviting more trouble if we show weakness?

    I’m not so sure that’s true. We face lots of pressures and significant consequences in our jobs and medical groups. We’re prone to the same frailties and fallibility as anyone else. And the pressure we’re under just makes us more likely to make mistakes, rather than find workable solutions to the problems that all of us in the hospital care system face.

    The solution is simple in concept, but difficult in practice. We need to work together in our groups to address needed reforms that serve the patient and the system. We have to change in some areas. But, as we do so, we have to remain affable, available, competent, caring providers. If we do those things, our leaders can remain confident that we’re working with them to get to the difficult solutions we all need… “Keep Calm and Carry On.”

    The hardest part is that some of our friends and confidants may decide NOT to change and not to move in a necessary direction. I can’t convince them. I can’t change them. I’ve tried. I’ve had to move on. And, my, that does hurt!

  2. Rachel Lovins February 4, 2011 at 5:31 pm - Reply

    Thanks Troy. It’s really interesting to me, this idea of needing to appear strong and confident at all times as a doctor and an administrator. Bottom line is that everyone makes mistakes, everyone, and I do think it’s worse when you are afraid. But there has to be a healthy mix of confidence and caution. I think about driving a car or putting a central line in – if I’m over confident driving I can do stupid things like drive too fast on ice, but if I’m too afraid I’ll do even more stupid things and drive like my mother used to, slamming the brakes on every 30 seconds. I do believe that the world is a better place, though, if when we make a mistake we admit it to those around us. It also sets a good example of accountability for everyone else. I also believe whole heartedly that, for the most part, if you take the high road and do the best thing and the right thing there’s karmic rewards eventually. If the game gets nasty I don’t want to play.

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About the Author:

Dr. Lovins loves learning about medicine and leadership, sings in a rocking band called the Inflatables and is married to a photographer named Andrew with whom she shares three excellent children and two small dogs.


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