RESPONSE: Adapting to Change in a Time of Uncertainty.
Michael J. Mack M.D.
Mack, M. J. (2019). “RESPONSE: Adapting to Change in a Time of Uncertainty.” J Am Coll Cardiol 74(6): 816-817.
Historically, the specialty of thoracic surgery has always been, as Han states, one of “paradigm shifts” or, as euphemistically referred to within the specialty, “staying one operation ahead of extinction.” To wit, the specialty began as one to treat tuberculosis until the introduction of sulfa drugs greatly diminished the role of surgery for that disease. The specialty then evolved to the management of rheumatic heart disease for which surgery was a mainstay of treatment until penicillin dramatically reduced the incidence of the disease in developed countries. Next, the central role of surgical coronary revascularization in the treatment of coronary artery disease was significantly modulated by the introduction of percutaneous coronary intervention. Furthermore, many other procedures began as thoracic and cardiac surgical procedures, including bronchoscopy, esophagoscopy, permanent pacemaker, defibrillator implantation, and insertion of intra-aortic balloon pumps, only to have those procedures move to other specialties as the devices become smaller and more easily implanted without general anesthesia. Despite the evolution in the core treatments delivered by our specialty in different eras, we have not become extinct, nor has the specialty diminished; rather, it has survived and thrived . . . As I reflect on the types of operations I was performing when I finished training in 1982, they bear little resemblance to the procedures being performed today. However, that offers little solace to the trainee whose sands are now shifting beneath her/his feet. As the Greek philosopher Heraclitus stated, “the only constant is change.” You cannot worry too much that you chose the wrong career path or succumb to the fear that you will be left behind. Rather, embrace what you love to do and be cognizant of the changes in the ecosystem in which you work. Learn to lead change, embrace that which is currently good, have the vision to determine what needs to change, and have the wisdom to know the difference. To paraphrase Charles Darwin, it’s not the strongest of a species that survives, or the most intelligent, but the one most responsive to change. (Excerpts from text, p. 816-817.)