The Elephant’s Chains and Breaking Bad Habits

Doctors, like pachyderms, have a mental block against changing their ways and adopting new habits that could set them free

Tell the truth, didn’t you ever want to run away and join the circus? Perhaps we all had that fantasy at one time. One of the observations that you would have made is 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 an elephant has been conditioned by the chain around its back foot, even the largest 2-3 ton elephants will not try to break loose since the elephant believes he\she is tied to a big stake or large tree.

How many doctors behave as if 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, and how can we break lose of old habits and embrace new ones that make us better doctors?

Bad habits (metaphorical chains and stakes) holding us back

Until recently, only doctors performed procedures or touched patients. Now we have physician assistants and nurse practitioners who are able to do many of the procedures and conduct care on behalf of the doctor, resulting 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 our practice has to open at 8:30 a.m. and that we must stop seeing patients at 5 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 p.m. 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 chain by collecting 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.

Thirty 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 to this antiquated method of managing uncomplicated UTIs in women. Now there is good data to show that a 1-3 days course of antibiotics in selected patients is adequate.

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.