Lessons doctors can learn from fish

© Jakub Rutkiewicz - stock.adobe.com

Health care has looked to various industries such as airlines, hotels, restaurants, and entertainment for concepts on how to run our medical practices. We have embraced the computer industry and followed Microsoft and Apple closely as doctors have used their technologies in our clinical practices and offices. However, we have only rarely looked at nature to provide examples of exemplary behaviors that serve as models for becoming better doctors. In this article, we will look in detail at the lifecycle of the Pacific Coast salmon and how they can influence our medical careers.

Most of us in the health care profession, save the real vegans, have had the opportunity to enjoy an entre of salmon at home or in a restaurant. Perhaps a few physicians have gone to the West Coast and had the incredible opportunity to fly fish in a mountain stream, catch a salmon, and have it prepared for eating just as it comes out of the stream. We can't imagine that eating in heaven with the angels would taste any better!

But let's look at the lifecycle of this amazing fish. Although I am not an ichthyologist, a brief description of the lifecycle of the salmon is in order. The salmon hatch in the cold river waters of the Northwest. They become small fries (singular fry) and swim hundreds of miles downstream to the Pacific Ocean, where they will remain for two years feasting on the bountiful food in the ocean and become adult salmon. The mature adult salmon will then swim upstream to the same stream where they were born, and the female will lay her eggs, or the male will deposit his sperm on the eggs, and then both the male and female will die having completed their reproductive mission.

Messages to be learned from salmon

Salmon remember their origins

The salmon are born at the origins of streams and rivers in the Northwest. They will travel thousands of miles to the ocean and then return to the same stream where they were born two years earlier. No one knows with any degree of certainty how this occurs. The most accepted theory is related to the stream's odor where they were born and can retrace the route from the stream to the ocean and back to the stream through their sense of smell.

Another hypothesis is that the salmon has inherited memory like the Monarch butterfly, which winters in the mountains of Mexico and then migrates to the northern U.S. and Canada in the spring. It will lay eggs several times along the way, die, and the hatchlings will continue, and in the fall, their progeny will return unerringly to the same Mexican mountain top from which their ancestors left.

Physicians would do well to learn from the salmon about never forgetting their origins or where they came from. Most physicians have had a mentor or teacher who made a significant difference in their lives. These invaluable coaches are in a special category and are recognized for the role that they have played in a physician's life. Also, some physicians have helped us get started and have helped us along the way to our successes. These physicians also need to have a special place in our lives. Even when these older physicians retire, it is such a nice gesture to remain in contact with these helpful doctors who have made our paths so much easier. You can be sure that a note, a phone call, or an Email to one of these older physicians will mean so much to them and will be so very appreciated.

Salmon do whatever it takes to get it done

The trip from the ocean back to the river to lay their eggs is an arduous upstream journey. They swim against the current, jump over rocks and falls, and do it without eating or consuming any calories. They are focused on their mission to lay those eggs regardless of the obstacles.

Physicians often face similar obstacles to success. It takes nearly 10,000 hours of training to become a doctor. This length of training is approximately the same number of hours that an athlete must dedicate to become an Olympic champion. Not only does it take dedication, but every physician has deprived him\herself and deferred gratification, often putting family and friends secondary to their commitment to their practices and their patients.

Doctors are creatures of habit, and change takes place slowly. Any project that a physician wishes to implement, whether a program at the hospital, new technology in the office, or a new marketing or public relations program, is often met with resistance. Look at how long it took Semmelweis to convince his colleagues that washing their hands before going to the maternity ward would reduce infant and maternal mortality. The same applied to Dr. Barry Marshall's concept that gastric ulcers were secondary to bacteria (helicobacter pylori) rather than stress and hyperacidity.

Change occurs very slowly in health care. It takes persistence and a clear focus on reaching the destination that will allow you to achieve your goals and your dreams.

Salmon leave their comfort zone and venture to uncharted waters. The salmon leave the security of the small river streams and swim a great distance to the vast unknown or the Pacific Ocean.

Physicians also need to leave their comfort zone, such as leaving the nest of their professors and teachers' training and oversight and going into practice without supervision. I recall leaving residency to go into practice with a group of urologists in Houston, Texas. Not having the confidence of operating alone, I always asked a senior partner who was a skilled surgeon to assist me in my early procedures. After several months of imposing on my senior partner, the senior physician told me to do the case by myself and that he would be in the hospital and be available if I needed him. I did the case alone with the nurse, and this was a major step in my development and gave me the self-assurance that I could, indeed, operate on my own without the handholding of the senior partner. This act on the part of the senior physician was akin to the mother bird pushing the young hatchings out of the nest and forcing them to learn to fly.

On their route from the ocean to the origins, salmon will go without any nourishment or eating. They will defer all pleasures and enjoyment to reach their destination. Salmon know how to postpone gratification.

Physicians will also have to defer gratification in their route to success. There are many instances where physicians must forgo enjoyment with family and friends to be of service to patients. For most physicians, medicine is a calling. Yes, it is a financially lucrative profession, but for all the hard work and deferred gratification, it is not finances that drive the majority of us to become a physician. A United Parcel Service truck driver starting to work at age 18 will earn more than a physician for nearly 18 years before the physician makes more than the truck driver. If the UPS driver worked the same number of hours as a physician, i.e., 60+ hours a week plus time-and-half for overtime, it would take the physician nearly 24 years to exceed the income of the UPS truck driver! (This was previously described in greater detail in a blog, Physicians vs. UPS Truck Drivers, in Physicians Practice) So we don't do it only for monetary purposes. We practice medicine for the enjoyment and gratification of helping others. We practice medicine because we enjoy making a difference in this world.

Salmon can make changes and shift gears to be successful, i.e., lay and fertilize eggs to create the next generation of salmon. Male salmon will develop a kype or hooked jaw during spawning. Their kypes enable them to nip and bite at other male fish to keep them away from the females. This way, unwanted fish will not be able to spawn with those females or fertilize their eggs. This natural selection process gives male salmon an extraordinary advantage over younger, smaller fish.

Now doctors aren't going to grow their proboscises to ward off competitors. However, doctors can modify what they do and shift gears to become more efficient and productive.

An example is the EMR

Most middle-aged and older physicians have difficulty transitioning from paper to electronic medical records. We have heard of doctors who have opted to leave medicine rather than learn how to use the computer.

We have discussed various attributes of salmon that are worth emulating. However, we believe one example of salmon behavior is that we suggest you consider avoiding and not following. Salmon will "give their all" to reach their stream of origin to lay eggs for the next generation, and once accomplished, they will die. Too often, we have seen physicians work in their medical practices until they become ill, become incompetent, or lose their interest in caring for patients and then retire. This behavior of working until "death do us part" is probably not a healthy path for older physicians to follow. We should enjoy our practices, contribute to our profession, and then know when it is time to gracefully walk away through the front door with our heads held high. We know this isn't the way of the salmon, but it probably does lead to healthier retirement!

Bottom Line: We can learn a great deal from looking at nature and seeing examples that can apply to our practices and care for patients. The salmon is one of those exemplars that all of us should consider: save the idea of working ourselves to death!

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.