On the Value of Change

Posted Jun 22, 2017

by Eileen Couture, DO, RN, CCHP-PEileen Couture

Spring is in the air. Each spring as the trees begin to bud and the perennials begin to protrude their green little sprouts from the hard ground, it is amazing how the season changes right before our eyes. Despite the fluctuations in temperature, nature makes its way to a full bloom.

Spring is my “restart time” to evaluate aspects that I may need to change in my personal or professional life. Change can be defined as the act of becoming different. Change is often an uncomfortable thought, but often necessary. It is all around us, and it occurs in our everyday lives. When we are asked to change, we may respond with resistance, especially if the change alters or interferes with our comfort zone.

In one of my roles as the medical director of an addiction program, many of the clients are referred from the court or local jails as an alternative to serving time. Sometimes this may be their second or third time at the center. One of my standing questions during the intake health exam is, “How were you referred?” Although my interest is to determine whether they have any outstanding medical issues from recent hospitalization, the answer frequently is, “It was a better choice to come here than to jail.”

However, a couple of questions often remain: Are they aware of the behavior change they need to make, and is there a desire to change, especially if they have no conscious intention of stopping their behavior? Although the benefits are apparent, the choice to come to the treatment center is a better option than incarceration.

Difficult but Necessary
I recently recommended sending out one of our clients because she was short of breath. Although she denied having difficulty breathing, her exam revealed findings consistent with congestive heart failure. Reluctantly, she went to the hospital for treatment. One week later she returned and her first comment to me was, “You changed my life.” She felt much better physically and offered the conscious decision that her use of alcohol had to change.

As health care providers, we understand that change is very difficult and we witness the difficulty firsthand, especially in correctional health care. Whether the change be in the system, policy or everyday practice, it is often necessary.

Correctional care has evolved significantly over the past four decades, and it has progressed because there were champions who worked to improve the practice to what it has become today. The impact we all have is so important: Whether it is a small change or a significant change, we touch many lives.

Thousands of starfish washed ashore. A little girl began throwing them in the water so they wouldn’t die. “Don’t bother, dear,” her mother said, “it won’t make a difference.” The girl stopped for a moment and looked at the starfish in her hand. “It will make a difference to this one.”


Eileen Couture, DO, RN, CCHP-P, is chair of NCCHC’s board of directors and serves as the American College of Emergency Physicians’ liaison to the board. She is the medical director at the South Suburban Council on Alcoholism and Substance Abuse, Hazel Crest, IL, as well as an attending emergency physician at several Chicago-area hospitals.

[This article first appeared in the Spring 2017 issue of CorrectCare.]