Don’t Take 17 Years to Wash Your Hands

The Greek philosopher, Heraclitus, once said “The only constant is change.” Today, it’s impossible to stay current on the latest smartphone, system software, political dispute, celebrity drama, or research. Of course, there are always the few who are early adopters to everything. But what about the majority of people? Why do humans resist change, and can anything be done to gift wrap that change and welcome its arrival?

What is this resistance to change?

The authors of Intuitive Eating, 4th edition recently shared a historical allegory that may best illustrate resistance to change.¹ In the 1840s, Ignaz Semmelweiss, a Hungarian obstetrician and gynecologist, discovered when doctors moved from an autopsy to delivery, without washing their hands, mothers ended up with “childbed fever” and often died. He developed a handwashing solution that reduced patient infection and death by nearly 75%.² However, most of the medical community rejected and often publicly mocked his idea.

Ignaz’s struggle to change the minds of his peers has become known as the Semmelweiss Reflex: “the rejection of new evidence because it contradicts established norms, beliefs, or paradigms.”³

It is easy to scoff at Ignaz’s colleagues, seeing with 20/20 hindsight, but the resistance to change continues to affect the health care field. Is it surprising to know, on average, it takes 17 years for a new concept to be adopted into a best care practice?³

Why does it take 17 years to turn the ship? Many of the common objections are:

• “More research is needed before it’s considered evidence based”
• “The research is ‘still unproven’ or incomplete”
• “Look at these (cherry picked) studies that prove concept xyz is ‘wrong’”

The medical field is not isolated in the aversion to change. It is logical to assume the nutrition field is affected by the 17-years delay as well.

A handful of Registered Dietitians were informally asked about the resistance to change within the dietetic field. Consider some of their thought-provoking responses:

• “Change depends on many things but particularly if the new evidence challenges industry and corporations.”
• “There are times when good evidence exists, but it just gets ignored since there is no interest group behind it.”
• “Sometimes [the recommendation] has been done forever and nobody bothered to update the science on their protocols.”
• “As RDNs come across hot topics, we need to discuss them with peers and clients, even if research doesn’t support it yet. We need to be a part of the conversation even if the change never manifests.”

Even outside of the nutrition field, there are multiple examples of resistance to change.

• Technology has seen its fair share of resistance. Some have struggled to give up their “land line” and answering machine. Others feel panicky at the idea of switching from cable to streaming TV, and no doubt there’s a large population that had a big learning curve with the introduction of a smart (or not-so-smart) phone.
• More recently, the pandemic has forced the country to change where people work, how groceries are procured, and how to stay in touch with loved ones. Some have adapted well while others continue to dig in their heels.

Some of this resistance is age related and some may be personality style.  Not everyone is an early adopter. Remember the Diffusion of Innovation by Rogers? His research indicated that late adopters and laggards together make up 50% of the population, 34% and 16% respectively.⁵ This would statistically slow any adoption process down.

Why is there resistance to change?

Okay, change is met with resistance, but why? Why do humans struggle with the waves of change? 

1. Consistency and certainty. The earth provides constant rhythms like sunrise and sunset, 4 seasons, gravity, and North and South. They all provide consistently reliable direction. It is also natural to seek out and create personal rhythms (think: your morning routine). It signals what to expect. ADIME notes and nutrition facts panels provide consistency in the delivery of a nutrition message.
2. Human programming. The brain is naturally programmed to perceive change as a threat, as a warning, releasing hormones of fear, fight, or flight.⁶ Any deviation from consistency and certainty is a signal. This response is protection of any potential or perceived threat. An abnormal lab or symptom gives us the same signal.
3. Comfort. When there is certainty in what to expect, comfort usually follows. There is no need to be “on guard.” Comfort can be good, but it can also lend itself to “the way it’s always been.”
4. Fear. Registered dietitians are competent, confident, and perpetually defending their worth. Change can bring up fear of being wrong or different. What if this new research is all wrong? Will employers, patients, and clients lose trust in what I’ve taught? Will there be loss of face to the profession? Those unfamiliar with the newest research may consider dietitians inconsistent or unprofessional. The old is now wrong – are my skills now obsolete? It’s likely Semmelweiss’s counterparts thought the very same things.
5. Overwhelming. The “new” means new possibilities, new problems, and more work. There is a new learning curve. New patient handouts, presentations, and curriculum must be written. Countless forms will have to be redesigned and reprinted with a heavy price tag. It can be overwhelming.

How to approach change?

Looking back, what could have been said to Ignaz’s most ardent opponents to help them receive the change? What if there was a way to be proactive about change? Wouldn’t it take back control, allow a level of certainty, consistency, and comfort as well as drive out the fear and overwhelm?

To elevate the field of dietetics, it is imperative that dietitians are at the helm of the ship, looking for the changes in the horizon. Did you know: the CDR has estimated that the half-life of dietetics education is roughly 3 years.⁷ 3 years! Metaphorically speaking, that means we need to look at the research map regularly.

What better way to navigate the waters and steer the ship than to actively study the upcoming landscape? There is no better way to do that than with regular, fresh, varied continuing education. Here are a few suggestions when navigating education and changes to big ideas:

1. Expand your wheelhouse: Choose continuing education credits that broaden your horizon with new ideas and challenge your current thoughts.
2. Tap into think tanks: join professional groups (in person or online); work with interns, browse periodicals; or have coffee with a dietitian in a different field of expertise. Any and all of these can all bring awareness and warning about ripples in the water.
3. Choose a self-study course: you can take your time, digging deeper into the ideas that seem counter to what you’ve known. You can also process the information without perceived (or real) bias and without sponsorship or group think.

At this very moment, new and mind-boggling research is being generated that will cause a stir. Will it take you 17 years to accept the change? Will it take 17 years for you to wash your hands?

By Alicia Jerome MS, RDN

Resources:

1. Tribole, E., & Resch, E. (2020). Intuitive Eating, 4th edition. [S.l.]: St. Martin’s Publishing Group.
2. Kadar N, Romero R, Papp Z. Ignaz Semmelweis: the “Savior of Mothers”: On the 200^thanniversary of his birth. Am J Obstet Gynecol. 2018;219(6):519-522. doi:10.1016/j.ajog.2018.10.036
3. Gupta VK, Saini C, Oberoi M, Kalra G, Nasir MI. Semmelweis Reflex: An Age-Old Prejudice. World Neurosurg. 2020 Apr; 136:e119- doi: 10.1016/j.wneu.2019.12.012. Epub 2019 Dec 16. PMID: 31837492.
4. Morris ZS, Wooding S, Grant J. The answer is 17 years, what is the question: understanding time lags in translational research. J R Soc Med. 2011 Dec;104(12):510-20. doi: 10.1258/jrsm.2011.110180. PMID: 22179294; PMCID: PMC3241518.
5. Rogers EM. (1962). Diffusion of innovations. New York: Free Press of Glencoe.
6. Baum A, & Grunberg N. (1995). Measurement of stress hormones. Measuring stress: A guide for health and social scientists, 175-192.
7. Commission on Dietetic Registration. Continuing Professional Education Provider Accreditation Handbook and Appendix. https://www.cdrnet.org/vault/2459/web/files/3-6-15%20Accredited%20Provider%20Program%20Handbook%20and%20Appendix.pdf Accessed 1/18/2021