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Adapting to change is never easy, particularly when everything is moving so fast that one has less and less time to devote to thinking about the transition process. We are all rather like white water canoeists: carried on rapid waters in a small and fragile boat — in danger of being either sunk or left on the bank — and, with head over paddle, unable to see very far ahead. The change always seems to be external and it is difficult to answer such questions as what change and for what purpose and even if we knew the answers it is unclear to what extent we are capable of affecting the outcomes. What might be helpful is to examine some of the undercurrents that are propelling us forward, affecting our work and our perceptions of our professional role.