The lobster and the doctor

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It is a challenge to connect the dots to understand the relationship between a lobster and a doctor. This blog will explore the life cycle of the lobster and provide examples of leaving the comfort zone and using the stimulus for innovation that enhances the medical profession.

Let’s start by answering the question: how do lobsters grow? A lobster is a crustacean that lives in a rigid shell. That rigid shell is fixed and does not increase in size as the lobster matures and increases in size. As the lobster grows, their shell becomes confining. The lobster feels under pressure and is uncomfortable in the tight-fitting shell.

The lobster goes under a rock to find protection from predators as it casts off its shell and produces a new one. Eventually, that new shell becomes uncomfortable as the lobster continues to grow. Then it is back again under the rocks, and the lobster achieves a new, larger shell. This cycle repeats itself numerous times.

What is the message of the life cycle events of the lobster compared to the healthcare profession? It is likely the feeling of discomfort that enables the lobster to retreat to safety and then grow. It is the stress of being confined to a small shell that becomes the stimulus for further growth.

Our medical education taught us the exact opposite — we should avoid stress and discomfort wherever possible. As physicians, we learn and experience that stress leads to burnout and often the situation when physicians decide to leave the medical profession.

Now imagine this scenario: If lobsters had doctors, the lobster would never grow! The doctor would prescribe medications to reduce the stress, but the source or the stimulus remains. As a result, the lobster would never cast off their shell and become a better lobster.

I’m not suggesting that stress is a good thing or should be encouraged; far from it. The impact of frequent or extreme stress is well known. Chronic, persistent stress increases cortisol and other stress hormones, decreases the immune system, increases insomnia, increases blood pressure, and causes gastrointestinal disorders. In the long term, chronic stress reduces performance and often becomes debilitating.

Now, back to the lobster--In the case of the lobster, stress is not necessarily a bad thing, but it may lead to positive change. Stress triggers the lobster to retreat under a rock, protect itself from predators, and ultimately grow stronger and become a better lobster. We must realize as physicians that times of stress are signals for growth. If we harness and positively use stress, we can grow through adversity.

Total adversity is unavoidable in a medical practice. We are encouraged to accept the status quo or that the old, tried, and true way is the best way. Healthcare innovators and entrepreneurs often have a difficult path and are likely to meet obstacles along the way. Innovation and finding new and better ways to practice medicine will likely be uncomfortable and stressful. Yet, that is how medicine makes progress.

However, I like that we can recognize stress and discomfort in life and healthcare as a stimulus to protect ourselves and grow stronger.

Seth Godin says, “discomfort brings engagement and change. Discomfort means you’re doing something that others were unlikely to do because they’re hiding out in their comfort zone. When your uncomfortable actions lead to success, the organization rewards you and brings you back for more.”

My take-home message on the growth of the lobster is: Significant growth in medicine often comes from adversity. As an innovator, take time to look inward and focus only on what’s important at that specific moment (i.e., growing a larger and stronger shell).

Growth can often require you to leave your comfort zone, i.e., like an old shell. This process may be uncomfortable and painful.

Whenever you hear of a healthcare success story, you can be sure they’ve been through adversity and growth pains to get there. There are many examples where these lessons have played an essential role in the progress of healthcare innovations.

There are many examples where innovators propose a new idea or treatment against the prevailing dogma. The idea, as well as the doctors who proposed the changes, were vilified, or denounced by their peers. Here are is one examples from the past and an examples from contemporary medicine.

Dr. Ignaz Semmelweis reported in 1847 that pregnant women delivered by doctors in the Vienna hospitals had more puerperal fever with an increased maternal and neonatal death rate, as high as 35%, than women who were cared for by midwives. Semmelweis did not know about bacteria, germs, or hygiene. Still, he did postulate that the doctors who were coming from the hospital were carrying “something” on their hands that the midwives did not have on their hands. Semmelweis suggested that the doctors wash their hands before going into the delivery room so that whatever was causing the lethal condition from the hospital was removed.

Semmelweis published a book of his findings, Etiology, Concept and Prophylaxis of Childbed Fever. Despite various publications of results where handwashing reduced mortality to less than 1%, Semmelweis’ observations conflicted with the scientific and medical opinions of the time, and his ideas were rejected by the medical community. Some doctors were offended at the suggestion that they should wash their hands, and Semmelweis could offer no acceptable scientific explanation for his findings. Semmelweis’ practice earned widespread acceptance only years after his death when Louis Pasteur confirmed the germ theory, and Joseph Lister practiced and operated, using hygienic methods, with great success. In 1865, Semmelweis was committed to a mental hospital, where he died, ironically of septicemia, at age 47.

Second example: Dr. Barry Marshall was a primary care doctor in Australia and noted that the gastric ulcers contained bacteria in the pathology specimens. Marshall proposed that it wasn’t hyperacidity that caused gastric ulcers but that a bacterial infection, Helicobacter pylori, was the culprit. The elite scientists and doctors, who did not believe that any bacteria could live in the acidic environment of the stomach ridiculed his theory.

In 1984, Marshall decided to experiment on himself. He had a baseline gastroscopy performed on himself, followed shortly after that by drinking a solution containing H. pylori. Three days after swallowing the H. pylori solution, he developed nausea, vomiting, and abdominal pain. A repeat endoscopy eight days later showed massive inflammation, and H. pylori was cultured in the gastric juice. On the 14th day after ingesting the H. pylori, a third endoscopy showed the typical gastric ulcer. Marshall’s illness and recovery, based on a culture of organisms extracted from a patient, fulfilled Koch’s postulates for H. pylori and gastritis but not for peptic ulcer. This experiment was published in 1985 in the Medical Journal of Australia. In 2005, the Karolinska Institute in Stockholm awarded the Nobel Prize in Physiology or Medicine to Marshall and Robin Warren, his long-time collaborator, “for their discovery of the bacterium H. pylori and its role in gastritis and peptic ulcer disease.” Once again, it was several years from his identification of the bacterial culprit until the medical establishment accepted that it was an infection that caused ulcers and not increased acid, spicy food, or alcohol that was responsible. Today, gastric ulcers are treated with antibiotics and not surgery.

There are important lessons for both progressive thinkers and innovators. It would be nice to have 20:20 hindsight, but there are also some important lessons for innovators:

• Stay open-minded — the most significant successes and market opportunities are not always obvious
• Perception shifts over time — hindsight or Monday morning quarterbacks are not a lens from which to learn important lessons
• Be humble — healthcare is built on the premise that we can make audacious claims and still be wrong most of the time
• Don’t fear rejection — all the greats experience it
• Have faith — The odds are so stacked against innovators and entrepreneurs that it’s often important to go back in time and remind ourselves how history was created. Outlier successes are not obvious and never easy, but they do happen.

Bottom Line: The odds are stacked against us in the innovation and entrepreneur arena. It’s important to go back in time and remind ourselves how history is created. Just imagine where medicine would be if Semmelweis or Barry Marshall never left their tight fitting shells. Outlier successes are not obvious and never easy, but they do happen. Therefore, let’s relate to the growing lobster, abandon our shells or our comfort zones, and reach out to new horizons and better care and outcomes for our patients.

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.