Using the laws of physics to enhance your practice

Neil Baum, MD

The following concerns a question in a physics degree exam for students at the University of Copenhagen:

"Describe how to determine the height of a skyscraper using a barometer." One student replied,

"You tie a long piece of string to the neck of the barometer, then lower the barometer from the skyscraper's roof to the ground. The length of the string plus the length of the barometer will equal the height of the building."

This highly original answer so incensed the instructor that the student was failed. The student appealed because his answer was indisputably correct, and the university appointed an independent arbiter to decide the case. The arbiter judged that the answer was correct but did not display knowledge of physics. The judge decided to call the student in and allow him six minutes to provide a verbal answer, which showed at least a minimal familiarity with the principles of physics.

For five minutes, the student sat in silence, his forehead creased in thought. The arbiter reminded him that time was running out, to which the student replied that he had several extremely relevant answers but couldn't decide which to use.

On being advised to hurry up, the student replied as follows,

"Firstly, you could take the barometer up to the skyscraper's roof, drop it over the edge, and measure the time it takes to reach the ground. The height of the building can then be worked out from the formula H = 0.5g x t squared. But bad luck on the barometer."

"Or if the sun is shining, you could measure the height of the barometer, then set it on end and measure the length of its shadow. Then, you measure the length of the skyscraper's shadow. After that, it is a simple matter of proportional arithmetic to work out the skyscraper's height."

"But if you wanted to be highly scientific about it, you could tie a short string to the barometer and swing it like a pendulum, first at ground level and then on the skyscraper's roof. The height is worked out by the difference in the restoring force T = 2 pi sq. root (l /g)."

"Or if the skyscraper has an outside emergency staircase, it would be easier to walk up it and mark off the height of the skyscraper in barometer lengths, then add them up."

"If you merely wanted to be boring and orthodox about it, of course, you could use the barometer to measure the air pressure on the roof of the skyscraper and on the ground and convert the difference in millibars into meters to give the height of the building."

"But since we are constantly being exhorted to exercise independence of mind and apply scientific methods, undoubtedly the best way would be to knock on the janitor's door and say to him, 'If you would like a nice new barometer, I will give you this one if you tell me the height of this skyscraper!'"

That last student was Niels Bohr, the only person from Denmark to win the Nobel Prize for Physics. Niels Bohr's lesson for modern healthcare is that there are more ways than one to find solutions to healthcare problems.

Another scientist, Sir Isaac Newton, made advances before Einstein and Niels Bohr, who also changed the world. Sir Isaac Newton (1642-1727), mathematician and physicist, was the most remarkable scientific intellect of his time. When Newton was only 23, he changed the world with his insights into mathematics, mechanics, astronomy, gravity, and optics.

He searched for and found the universal principles explaining why things act as they do. Some of his most famous work was Newton's Three Laws of Motion. These laws describe the movement of bodies and can be instructive to us all. This blog will discuss how the three laws of motion apply to our medical practices.

Newton's First Law

A body at rest will remain at rest unless acted upon by an unbalanced force.

In physics, the "force" is an outside push or pull. In our medical practices, the assumption is that the physician or office manager may provide this force. That physician-office manager leader provides the motivating force necessary to overcome the inertia of many of our fellow physicians, patients, and employees.

We can translate Newton's first law for managing our practices by implying that employees tend to keep doing what they do unless a new force acts upon them. For example, suppose a doctor is repeatedly 30 or more minutes late each morning for seeing patients in the office. In that case, the schedule is delayed from the beginning of the day. As a result, the doctor and the staff may have to work through lunch; the staff may have to work overtime at the end of the day, and ultimately staff morale decreases. The outside force may be the office manager or the practice's managing partner. She might meet with the doctor and help him be on time for the office patients to avoid the problems that delay causes when she is not ready to see patients at their designated times.

The take-home message of the first law is that anybody who is at rest will remain at rest unless acted upon by a good physician manager. Any bad situation will remain bad unless acted upon by a forceful physician manager, and things need to be pushed along if they are to change.

Newton's Second Law

Force = mass x acceleration.

In physics, this means that the amount of energy needed to move an object is proportional to the object's size or mass times the object's speed.

In our practices, the amount of mental energy needed to create change is equal to the size of the goal multiplied by how quickly you want to reach it.

For example, if your practice wants to implant new technology such as AI, which has met resistance from physicians and their staff, you will have to dedicate a tremendous amount of energy if you plan to accomplish the implementation quickly.

The take-home message on the second law of motion states that if you want to achieve big goals quickly, you must apply large amounts of energy and willpower, especially if you're going to achieve change quickly. However, if you wish to achieve big goals but are willing to take your time, lower energy levels persistently applied for more extended periods will be adequate.

Newton's Third Law

For every action, there is an equal and opposite reaction.

In physics, this means that the direction of the force on the first object is opposite to the direction of the force on the second object. When a bullet is fired from a gun with a particular force (action), an equal and opposite force is exerted on the gun in the backward direction (reaction).

Newton's Third Law might restate that you must initiate the correct actions if you want a specific effect. Don't expect to have a successful practice without effort. You must pay the price to be the first in your community in your particular area of interest and expertise. The law can also be described as stating that if you do not want a certain reaction, don't repeat the behavior. If you don't like the result, stop repeating the same events that cause unwanted outcomes.

I like to think of the third law as the rule that if what you are doing is not acceptable or you are not receiving the result that you wanted, repeating the same behavior and hoping to get a different outcome will not work. The same action will get the same equal and opposite reaction.

For example, if you are trying to improve compliance with patients and their medications and giving them samples is not motivating them to fill their prescriptions, then a new packaging of the samples is not likely to improve compliance. However, if you have a discussion with the patient about the benefits of taking the medication, the risks associated with not taking the medication, and how their disease state will improve after using the medication, then providing them with a FAQ sheet on the use of the medication and finally sending the patient to the pharmacy with a voucher card for a few free samples, this is likely to improve compliance. Agree; this may take a few additional minutes when you are with the patient. However, this will likely improve compliance rather than merely offering sample medications.

The Bottom Line

Medicine has laws and rules that apply to the clinical aspects of patient care, and some laws and principles apply to the business and management facets of healthcare. We can use Niels Bohr's example to show that we need to think outside the box and identify more than one solution to find the best solution to problems in the practice. Finally, we can apply Newton's first three laws of motion to our practices.

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.