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Societal change swirls about us. We are reeling under current events, both those that affect society at large and medicine in particular. Just a few years ago, it would have been unthinkable to envision a Berlin Wall thatwas crumbling under the pressure ofhundreds of thousands of East Germans who now pass freely through its gates. In the same time frame, medicine has seen obstetricians leave their practices in the United States, because of the risk, cost, and torment of potential malpractice actions. How many of us would have predicted that Colombia would go to "war" with the drug barons and turn the country into a bloody area in the interest of stemming drug abuse? Which of us would have predicted that a major congressional thrust might result in a change in physician reimbursement that equates payment with effort, irrespective of a procedural component?
These mixed examples cannot be equated in terms of the impact on the world, but they all illustrate that change is inevitable, and the only predictability in our lives is that change will occur. From the time the first bipeds walked the earth, humans have attempted to change the relationships of one individual to another, of one group of individuals to another group, to alter the environment, and to develop ways to fend off harmful elements in that environment. Our capacity to think, make judgments, solve problems, and simply answer questions posed by the world about us, irrespective of the usefulness of the answers, has always resulted in change. Why, then, are we continually surprised by change? Why do we seem unprepared to accept the inevitable? Why do we resist such change until forced to accept it, since it will happen, whether we accept it or not?