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The Need for Tall Poppies

Effectuating Change in Healthcare- An Urgent Need for “Tall Poppies” to Advance Evidence-based Medicine

Change is often difficult.  Most people get very set in their routines and do not enjoy making change, particularly if the change may bring about added stress and complexity to their already stressed out lives.  Yet often there can be no improvement without change and therefore change provides the foundation from which to reach our goals, particularly with respect to issues in healthcare. So why are some, and arguably the majority of, clinicians so reluctant to be agents of change when it comes to the implementation of new products, practices, and policies which are so desperately needed to improve our healthcare systems while others are willing to be change makers? Is it fear of the unknown or a lack of resources to implement the change or does healthcare bureaucracy present seemingly insurmountable obstacles?  Is it the potential high cost associated with change or the potential for liability? Or is it just because we are fearful of becoming a Tall Poppy?

In Australia, I learned that to call someone a Tall Poppy can be construed as a derogatory characteristic indicating a person who does not want to be part of a team and/or “sticks out” as being different or who is advocating for something that may differ from what others are doing.  In our healthcare system today, there is a pervasive climate of “wanting to fit in” along with a reluctance to challenge anyone in authority.  Unfortunately, this climate has also led to a marginalization of patient wants and needs as well, with the average patient and clinician more or less just doing what they have been told to do and not “rocking the boat” by becoming a Tall Poppy.  And what they have been told to do is often dependent upon what other similarly situated providers are doing or what may be “customary” in the industry.  In healthcare however, doing what is customary may not necessarily be “reasonable” and there is a dire need for more “Tall Poppies” if changes are to be made which can enable us to meet an evidence-based standard of care. Many clinicians often use the phrase evidence-based medicine or evidence-based standard of care but may not really understand the concept or meet the requirements of the concept in their everyday practice.  The concept is based upon 3 components - clinical judgment or critical thinking, relevant current scientific evidence and patient values and preferences.

Critical thinking requires the provider to use reasonable prudence and not rely solely on professional standards that may be outdated. And sometimes it takes a Tall Poppy to point this out and take a stand for change.

In fact, in many cases, the law will actually protect healthcare innovators and innovative practitioners, so fear of liability may often times be unfounded.  Medical malpractice standards generally evolve because of changes in technology and not because of changes in law and therefore the failure to incorporate or inaugurate change by becoming a Tall Poppy can actually result in malpractice allegations.  In fact, the second component of evidence-based medicine/practice requires the practitioner to stay current and not just do what others are doing - particularly if what others are doing is not the right thing to do and is failing to achieve the results that had been hoped for.  In addition, while randomized control trials are no doubt the gold standard when it comes to evidence-based practice, there is ample case law to support the incorporation of even small-evidence-based studies into practice which will also help to speed up the implementation of needed changes or advancements.

Patient values and preferences comprise the last component of evidence-based practice.  Patients must be educated/informed so that they can be included as a valuable participant in the decision-making process pertaining to their care.  Clinicians must also be educated with the latest research so that they can adequately convey the available evidence-based options to the patient. 

Healthcare policies, practice, and products must be continuously updated to meet the evidence-based standard of care. In response, manufacturers and other innovators often develop solutions to many of the most challenging issues confronting healthcare today. However, without the “Tall Poppy” healthcare practitioner acting as the vehicle facilitating the introduction and implementation of these evidence-based solutions into practice, an evidence-based standard of care may never be achieved and patients may not reap the benefits.

While patients are the ultimate recipients of the healthcare services that are delivered, they are reliant upon the healthcare providers to stand up for them when necessary. As a closing thought, I would challenge clinicians to stand out as a Tall Poppy through advocacy based upon each patient’s unique clinical needs.