Richard M. DeBowes, DVM, MS, DACVS
Our world is defined in large measure by our belief systems. Those belief systems or paradigms are quite simply, the way in which we see the world. As such they constitute our reality. All of our actions, our personal life choices, our professional and our medical practice decisions are heavily influenced and at times, strongly directed by our personal paradigms. Paradigms are functionally like blinders. They direct where we look and what we actually see. Every exchange, every interaction, every communication and every experience in an examination room with our clients or our health care team members contributes to our growing repository of life experience. Our paradigms set us up to see certain things because we expect to see them. As such many of our experiences underscore our native expectations, a form of confirmation bias. It is from these many experiences that we come to believe we can make medical diagnoses, operate our businesses and know what our clients want when they come into to our hospitals, even without asking them. Our paradigms form our own unique personal vision of reality and we live them out every day.
How far does the influence of paradigms stretch? Literally they impact every corner of our lives. Social, spiritual, marital, academic, recreational, scientific and financial paradigms exist for each of us. Nearly every part of our life is shaped by a host of core beliefs that define our own personal reality and guide our approach to future opportunities and interactions. This is in many ways good... because it keeps us safe, informed and on track in many parts of our life where consistency is important. That we have a paradigm for gravity and it is well known to us is good because when we are on a rooftop or up on a ladder, it helps keep us aware of the risk and safe.
Joel Barker, a well published futurist and change specialist noted that paradigms always do two things: First, they set the edge or boundaries of the paradigm and second, they provide the rules for how we must work within the paradigm if we are to achieve success within that paradigm. This is good because paradigms provide us with a clear frame of reference and a set of rules to work by. The utility of this is obvious given that throughout our lives, we will attempt to resolve countless unknowns in the world around us (including those in our exam rooms) and our paradigms will reliably give us some basis from which to attempt to resolve these unknowns.
There are however ways in which our paradigms can limit our growth, success, fulfillment or advancement. Consider that most established paradigms represent the dominant thinking about a topic and as such, are seldom questioned. These belief systems are passed from parent to child, teacher to student or colleague to mentee almost without question. As such, they often appear as an expression of "how we do things here." Consider how you learned to engage clients or recognize a patient with parvovirus. While this may be comforting at some level, it does not account for the changing needs of the world around us and as such, our very own paradigms may work in opposition to our success by misleading us or constraining our thinking, reducing our professional agility and even limit our openness to responding to evolving challenges that result from changes in the world around us.
This condition of being limited by our beliefs is often referred to as paradigm paralysis and is classically described as a reluctance to abandon our comfortably familiar and well known paradigms for the less comfortable and very uncertain world of the "new" paradigm. Joel tells us that many a business, an individual or a culture has been set back by their aversion to change, even when it was obvious that their current paradigm was not working. You see there is one other truism about paradigms, they tend to change. Consider the progress we have seen in imaging sciences, from old style cathode ray discharge tubes of the 1940's to what we have today in practices where digital radiography, spiral CT and MRI are readily available in referral hospitals.
Veterinary medicine is no exception to the existence and influence of paradigms. The author believes that many veterinary practices are under-whelming or mediocre for just this reason...a basic reluctance to change.
Consider that the way in which we promote our practices, market our services, work up our cases, attend to our patients and handle our money have all been done in a relatively common and traditional way for many years. These operational conventions (paradigms) have been conveyed to succeeding generations by demonstration, daily practice and direct experience. Our practice paradigms are easy to spot and are often difficult to change, even when there is a compelling medical or business case to do otherwise. Yes, sadly it's true, paradigm paralysis will in some cases appear as a terminal disease of certainty that can most assuredly limit and even kill a veterinary practice just as quickly as it can a corporation.
The good news according to Joel Barker is that paradigms can be changed. Humans are not hardwired or genetically encoded to operate in only one paradigm. All that is required is a healthy dose of open-mindedness and a willingness to consider how other approaches might have a more positive outcome. When changes do occur and paradigms shift, these changes are often mitigated by people and forces from the edge or even from outside of the extant paradigm and are promoted by persons who operate far from the center of "conventional thinking" within the dominant but outdated paradigm.
Those agents of change, those shifters of paradigms are not usually welcomed by those who are prominent in the existing paradigm. Change often means a loss of power, advantage or influence and the impact of that is painfully obvious for those in power when a new paradigm becomes available. Individuals will have worked hard to establish themselves within the existing (default) paradigm and they will have much to lose if the existing paradigm were to change. This is why change can be so incredibly difficult...we are very reluctant to part with the comfortable and the known, even though it may be suboptimal when compared to what is new and different. Considerable fortitude is required for the paradigm pioneer for they will undoubtedly encounter considerable resistance. It is for this reason that Schopenhauer (1862) was quoted as saying, "All truth goes through three phases: First it is ridiculed; then it is violently opposed; finally it is accepted as always having been thus." The paradigm pioneer must have great internal strength and resilience when suggesting to their peers that there might be a different, even better way.
Consider the paradigms shifts which have changed veterinary medicine in the past 100 years. We have moved from working primarily with agricultural animals to working with small domesticated companion animal. Dogs have moved from sleeping in a dog house to sleeping in their master's bedroom, often on the bed or under the covers. Pets play a greater role than ever in our lives, participating in family holidays, vacations and momentous personal events such as weddings, birthdays, holidays and retirement parties. In 2010, nearly 15% of Halloween revelers dressed up their pet in a Halloween costume according to a survey in USA Today! There has been a massive shift in the gender demographic of the veterinary profession from primarily male doctors to primarily female doctors. Postoperative animals are now dispensed analgesic medication to control pain after surgery.
Digitization has allowed for image and information sharing like never before and paperless medical records have made their way onto the private practice scene. Our profession has moved from one comprised primarily of generalists to one heavily populated by specialists. In the last 5 years, we have slowly begun to recognize that preventative medical practice may replace high-end interventional medicine as we seek to be more effective in protecting the health of those pets entrusted to our care. Paradigm shifts abound in our profession and rarely without a healthy dose of angst.
So the critical question today is, how many of us are currently held in check by paradigm paralysis? How many of us are not operating at our peak of health, competence, or happiness because our own, deeply ensconced reluctance to change?
Of even greater interest may be the question of when and where will a veterinary paradigm shift again? All paradigms have a life span during which they are dominant, setting the edges of the paradigm and the rules for thriving within the paradigm. Likewise, almost all paradigms eventually undergo a paradigm shift and change. Imagine how impactful you could be if you could anticipate a shift in the paradigm, predict that wave of change and surf that wave into the future? You can most certainly get some insights on paradigms by watching their apparently period of dominance play out.
The life of any paradigm can be represented as an S-shaped curve on an x-y axes graph, where the x, (horizontal) axis is the passage of time and the y, (vertical) axis is the number of problems solved utilizing the current paradigm. The S-shaped curve will vary in dimensions for each paradigm, but there are three distinct components to every paradigm curve. The initial segment can be found on the lower, left-hand side of the curve, where the new paradigm does not solve problems very fast, or very well. This is when the paradigm is very new, not fully adopted, even resisted by many practitioners of the old paradigm. In the second phase of the curve, the slope dramatically turns upward because most people are involved with the new paradigm and understand how best to use its power and utility. Dramatic results begin to occur as the paradigm is accepted as the norm and considerable advancement ensues. The third phase can be found at the far right side of the S-shape curve where the slope begins to flatten. It is here where the paradigm is "less useful" and its efficacy in addressing issues is increasingly limited because of other changes that render the aging paradigm irrelevant or less effective. It is in this third phase where danger lurks because of our natural tendency to cling to the known paradigm.
In point of fact, we should be looking to potential new paradigms back in the later aspects of Phase two while the existing paradigm is still useful. We don't however because it's difficult to abandon something that feels like it is working so well. As Adam Smith notes in The Power of the Mind, "When we are in the middle of a paradigm, it is difficult to think of any other paradigm."
We should also be thinking about progress and paradigm shifts during phase two because when we encounter the obvious paradigm relevance crisis that awaits us in phase three, it is difficult to think clearly under pressure.
Planning ahead works well in many settings and most certainly this is true when considering paradigms. The best advice we can give is, "Don't wait to get sick to get better!" Prevent paradigm paralysis by always looking ahead. That next shift is just around the corner.
Will you be ready?
Adam Smith: The Power of the Mind
Willis Harmon: An Incomplete Guide to the Future
Joel A. Barker: Paradigms, The Business of Discovering the Future