Can We Lead Change And Not Resist It?

I decided to post this comment I made recently on our LinkedIn interest group site, Psychiatry Online Lifelong Learning (POLL) because I thought it might be interesting to those who aren’t registered on LinkedIn.

You know, if you’ve had even a cursory look at the Nov.1, 2013 issue of Psychiatric News, you get the impression that collaborative care really is the wave of the future. Dr. Katon’s article here is a point of departure for a larger conversation about new payment models to support the initiative and academic training curricula proposed to disseminate collaborative care models.

Dr. Jurgen Unutzer, MD, MPH is another major figure in collaborative care research and you can read his article.

Early this morning, I sent Dr. Unutzer an email inviting him to comment on this forum. As most of us know, he is associated with the U of Washington, where Dr. Katon also is located.

As I reflect on this discussion (which I hope will soon include more people), I find parallels of conflict with the Maintenance of Certification (MOC) and Maintenance of Licensure (MOL). While the MOL is not a fait accompli, integrated/collaborative care and MOC both seem to be.

Last year’s Academy of Psychosomatic Medicine (APM) meeting in Atlanta seemed as devoted to the integrated care theme as this year’s conference in Tucson. Katon, Unutzer, and many others delivered excellent presentations on this topic. Yet a few psychiatrists in the audience of one symposium I attended were hesitant to support the model, though couldn’t come up with a standard of care with which to compare it when presenters invited them to do so.

I keep thinking of the dictum, “Lead change, don’t resist it.” I think of it every time I write a blog post on how we must keep creating new ways to reform MOC–and resist MOL. So far I’ve not thought of a way to lead change and not resist it simultaneously.

I wonder if this is where I stand on collaborative care as well. Another article in Psychiatric News might be pertinent.

It’s entitled “New Yorkers to find ‘No Wrong Door’ to Public-Health Facilities’.” The abstract mentions “…efforts by a state mental health authority to move toward an accountable and fully integrated public health delivery system.”

And of course that reminded me of Dr. George Dawson’s recent blog post, Real Psychiatry: Accountability – The Last Refuge of a Scoundrel.

And I’m also reminded of what one Iowa Board of Medicine (IBM) member asked me when I presented my opposition to MOL at our Oct. 25, 2013 telephone conference. What would I replace the MOL with in order to ensure that Iowa’s physicians are engaged in lifelong learning and improvement?

At the time, I essentially said that it was not my responsibility to come up with a replacement. But after further reflection, I thought of Dr. Twersky-Kengmana’s idea for this LinkedIn journal club. And as we moved forward with the plan for its launch, it became my second answer to the question.

The reasons for the changes in medical and psychiatric practice resulting in things like collaborative care and MOL are not my fault–but they’re my problems.

So I’ve also sent an email message to the Iowa Psychiatric Society and the Iowa Medical Society, copying the IBM, to join us here on this forum–and also to oppose MOL.

How would we change the collaborative care service delivery model if we’re not persuaded it should be the wave of the future?

Does anyone know how we can both lead change and resist it?

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Comments

  1. Hi Jim,

    I tried to post this earlier and it didn’t work out so here goes again. I think the whole idea of leading change rather than resisting it is a rhetorical device. After all it is implicit that if I don’t like the direction that you are going and head out on my own, I am resisting you at some level no matter what and resisting you completely if you are actually trying to lead me in a direction that I don’t want to go. Sounds like a typical managed care koan to me. Slightly more sophisticated than: “Change is good.”

    I would have no problem coming up with different models to challenge the collaborative care models and the current MOC model. From what I can tell the collaborative care model as it was explained in the recent article in our LinkedIn group would not even require a psychiatrist and it is just a step away from demonstrating that. How difficult would it be to come up with a “scientific” article that demonstrates that a psychiatrist who is not really practicing psychiatry and who doesn’t see patients – has little to add when monitoring a heterogenous population of non-depressed to mildly depressed primary care patients by their PHQ-9 scores.

    Probably not difficult at all.

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