Breaking old habits -The elephant metaphor

Breaking the chains of habit and tradition can have a positive impact on your practice and wellbeing.

If you ever go backstage at the circus you will see that large, two-three ton elephants are tethered to a small stake with a small chain around the ankle of one of their hind legs.This tiny wooden stake driven into the ground could be pulled up in a nanosecond and the elephant could be free and run away.But the elephant never pulls on the stake and just rocks back and forth peacefully eating hay and drinking water.Have you ever wondered why the elephant is so passive with the chain around his\her ankle, which is attached to such a small stake driven into the ground?Elephant trainers have learned that when a baby elephant is first being trained it is staked to a large log or a big tree and cannot possibly extricate itself from the chain around its ankle.The baby elephant will pull on the chain and the large log or tree will not move and eventually the baby elephant gives up and knows that the chain around his\her ankle means that he\she cannot become free.Once the elephant has been conditioned by the chain around its back foot, the elephant, even the largest two-three-ton elephants, will not try to break loose or break free since the elephant believes he\she is tied to a big stake or large tree.How many doctors believe that they are like elephants and are conditioned by habits that they learned years ago and will not break free or will not leave their comfort zones?They don’t take risks and challenge the boundaries of something new.Instead, they become creatures of habit and perform their craft with the skills and behaviors that were learned many years earlier.So, what are the chains and stakes that are holding us back?This blog will provide some examples of chains and stakes that are preventing us from reaching new heights and offer suggestion on what we can do to leave our comfort zones and break lose of old habits and embrace new ones that make us better doctors.

Examples of metaphorical chains and stakes that are holding us back include:

Until recently, only doctors performed procedures or touched patients.Now we have physicians’ assistants and nurse practioners who can do many of the procedures and conduct care on behalf of the doctor that results in improved efficiency and ultimately in improved productivity of the practice.Another example is having assistants removing sutures or changing a dressing.These are just a few of the examples when we could delegate tasks to others.We need to break the chain of doctors doing everything and move into an area where doctors should do only what doctors can do and allow others with training to do other aspects of care.In other words, we have to practice at the top of our license.

There is nothing in the Hippocratic Oath that states that our practice has to open at 8:30 A.M. and that we must stop seeing patients at 5:00 P.M.You can break the chain of traditional office hours, by having office hours earlier in the morning, 7-9, or later in the day, 6-8 PM.This will make your practice very attractive to those wishing to see doctors before they go to work or at the end of their workday.

Traditionally, doctors’ offices give a patient a bill at the end of the doctor-patient encounter.Instead of billing patients for our services after we have provided the service, you can break the collect the co-pay and balances before the patient is seen by the doctor.This can be accomplished by using touchscreen technology in the reception area.

30 years ago, I clearly remember prescribing a course of antibiotics 10-14 days for women with uncomplicated cystitis\UTIs.Those were the chains holding me back from this antiquated method of managing uncomplicated UTIs in women.Now there is good data to show that a 1-3 day course of antibiotics in selected patients is adequate.1

Bottom Line: Doctors have numerous chains that hold us back and prevent us from being more efficient, more productive, and more profitable.Let’s not forget that as doctors we are always learning and growing.What we learned in medical school and during our residency and fellowship training years may not be applicable to today’s patients.Try cutting a few of those chains.In the next issue I will write about the status quo.

  1. Brusch JL, Bronze MS. Urinary Tract Infection (UTI) and Cystitis (Bladder Infection) in Females. Medscape, October 2017. https://emedicine.medscape.com/article/233101-overview?pa=WkveGI0Z30ShkgjqWI1Jy%2Be42l6mCvQSIM%2BFnniNfhxHa8%2FSFS%2B68S%2FV1A8SL%2FNfVrJxKJt4DRD8mxYr6kYfOw%3D%3D

Neil Baum, MD, a Professor of Clinical Urology at Tulane University in New Orleans, LA. Dr. Baum is the author of several books, including the best-selling book, Marketing Your Medical Practice-Ethically, Effectively, and Economically, which has sold over 225,000 copies and has been translated into Spanish. He contributes a weekly video for Medical Economics on practical ideas to enhance productivity and efficiency in medical practices.  His 5–7-minute videos and short articles provide practical ideas that can be easily implemented and incorporated into any medical practice. Dr. Baum can be reached at doctorwhiz@gmail.com.