Manage the Unavoidable Avoid the Unmanageable

Relevant educational questions are being asked:

Who should learn how to treat vein disease?

Who should be teaching others about venous disease?

What are the educational requirements to teach others about venous disease?

What are the standards to assess adequate venous education?

Who should really be treating venous disease?

These questions are being asked with increasing regularity by an increasing number of people. Unfortunately, this has lead to increasing polarization for some and increasing consensus by others. The Chinese warrior Sun Tzu writes in The Art of War that most successful battles are won before they even start. He also states, “One should never begin a battle that cannot be won.” Assess the situation, and as Thomas Friedman, a columnist for the New York Times recently stated so eloquently on the MSNBC program, “Morning Joe,” “Manage the unavoidable and avoid the unmanageable.”

This outlook could also be applied to many aspects of our current thoughts about venous education. Some of the aspects of venous education that are
currently in the “unmanageable” column and thus should be avoided are:

We cannot decide which specialty of physicians we will educate and which ones we won’t educate.

We cannot tell industry who they should reach out to regarding offering venous education courses.

We cannot tell those physicians already treating venous disease that they can’t just because of the primary specialty they were trained in.

We cannot tell those finishing training in a particular specialty that they are automatically specialists in venous disease.

We cannot be exclusionary.

I suggest that we don’t get mired in the “unmanageable.” Sun Tzu would laugh at our arrogance and ignorance in these efforts. In the global discussion of venous education, our initial thoughts should be to avoid the unmanageable and manage the unavoidable. This is a more productive mindset. Meaningful progress in venous education can only be achieved by managing the unavoidable, such as:

Many different specialties want to be educated in the management of venous disease.

Each specialty brings its own set of educational challenges; we need to address these and manage them.

Vein disease is an incurable disease. We are going to need welleducated physicians to treat it.

Industry is needed as a partner in venous education.

We need to manage its focus and balance its desire to support education and the need to sell product.

Multiple academic societies overlap regarding venous education. Together, all societies need to manage core content and core educational values.

We cannot be exclusionary in venous education. It is an unavoidable fact that cooperation costs less, makes friends and leads to quicker consensual progress.

Some venous leaders are still on their high horses. We need to help them get off those horses.

Some practitioners don’t get the necessary venous education before they begin caring for patients. We need to set standards of education to manage good patient outcomes.

It is an unavoidable fact that some vein care practitioners are not doing a good job or are doing procedures for the wrong reasons. We need to mange this unavoidable problem with remedial education.

It is also unavoidable that some physicians should not be treating venous disease. We need to manage this unavoidable fact for the good of patients.

In the big scheme of things, venous education is the first step in appropriate patient care and good patient outcomes. We need to not be encumbered by the unmanageable issues.

These are the ones to avoid as they distract our focus from the unavoidable issues which need to be managed. Managing the unavoidable issues will lead to meaningful progress. We need to leave our egos at the door during these discussions, all of us—educational leaders, societal leaders and industry leaders. Most of the key players have already done this. We need to manage the unavoidable fact that there are a few key holdouts. To them we give the warning: “We are our only saviors.”

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