Unlearning

We are all SO busy. As more patients need our care, it is a challenge to determine how we can provide more care when resources are so scarce.?Instead of trying to do more with less, I’ve been thinking about how to do things differently, which has led me to see examples in both my work and home lives.?

Both of my sons are sports fanatics. In particular they share a love for basketball – both as players and fans. Zach is a high school senior and on the varsity team. My youngest, Noah, a high school freshman, is already taller and a far better athlete than his Dad. He is truly obsessed with basketball and has become really good at driving to the hoop and defense. The one area of his game that needs the most work is his outside shot. When we’ve spoken about it, we often talk about altering his form. For those who golf (I don’t), this is akin to changing your swing after years of swinging “your way.” This concept of learning how to change one’s shot or golf swing is not just about learning something new, but also about “unlearning” the previous way of doing something. As a society, let alone a health system, we often talk about new learning, but we rarely, if ever, hear anyone talking about unlearning old things.?

There are few, if any, fields that require more learning, experience and training than ours. A typical physician does four years of medical school after college and then a minimum of three years in residency training. Also, depending on the specialty and fellowship training required, it could be three to seven more years of training after this. Most clinical disciplines, from nursing to sonography require years of training as well. Even with all of this training, it is often on-the-job experience that cements these bits of knowledge and technical expertise into our brains.?

If that weren’t enough, we also know that information and knowledge in medicine doubles in quantity every 18 months. As we learn new concepts and ideas, what happens to the old ones? I used to joke with my clinical teams that there was finite space in my brain for new information. As something new came into my mind, it required purging something old. While I meant that to be funny, I now realize that, to some extent, this concept is helpful. Like Noah, learning a new form for his outside shot, we have to actively unlearn sometimes too. It might be a standard of care that has changed dramatically due to new research and innovation or new care models. I posit that the act of unlearning cannot be passive, but rather we must consciously work to eliminate old ways of doing things. Just adding something new on to something old doesn’t always work. In my clinical world of cardiology, it took well over a decade for most physicians to transition their qualifying patients to new optimal heart failure medications.?Ironically, based on great recent data from clinical trials, that regimen has changed significantly yet again, and it will likely take physicians and APPs many years to adapt to prescribing the newer medications even though they have been proven to save lives over the older meds.

As we steadily pivot towards value and work to transform our care models, I challenge each of you to think about something that you must intentionally unlearn. Let’s not keep doing things the same way just because it’s what we’ve always done or because it’s easy, fast and familiar. Hopefully, as we become more advanced at innovation, learning and unlearning will become second nature. As for your ?golf swing or outside shot—good luck!