The Executive Suite: What doctors can learn from tying their shoes

Have you ever tied your shoes and found that the bow unraveled, and you almost tripped over your laces? Learning to tie your shoes is a life skills task you learned as a toddler unless you were trained on Velcro straps! You performed the task of tying your shoes daily, believing you were doing it correctly. After viewing a TED talk by Terry Moore, we learned that we were doing this simplest of procedures incorrectly. The three-minute video by Terry Moore demonstrated a more effective way to tie shoes that will not come undone. Try this yourself. Begin by putting the shoe on your foot and throw down the first part with the right hand going in front of the left hand. Then, make the bow but go counterclockwise instead of the more commonly used clockwise creation of the bow. This is a more substantial knot; when any tension is applied to the knot, it becomes tighter and less likely to come undone.

Another example of learning to tie your shoes comes from the legendary coach, John Wooden, who led the UCLA Bruins to 10 NCAA basketball titles during his tenure there from 1948 to 75. The first practice of every season was his legendary lecture on how to put on socks and how to tie shoes. Can you imagine these 18- to 19-year-old basketball stars having to listen to how to wear shocks and tie their shoes? The coach believed that the first step to becoming a champion was learning the fundamentals, not of shooting, jumping, and passing the ball but of putting on socks and shoes! If the socks didn't have every wrinkle out before inserting the foot into the shoe, the player risked getting a blister on his feet. The next part of the lesson was learning to double tie the laces, so there was never a problem with the laces becoming untied and the player tripping or having to burn a precious time out. The coach said, "There's always a danger of becoming untied when you are playing. I may take you out of the game if they become untied."

So, what lessons can physicians learn from Terry Moore and Coach John Wooden? First, small changes can yield large results somewhere else. Second, we must be mindful of the basics and fundamentals.

All doctors struggle with their patients' reluctance or inability to modify behaviors for their health. Still, doctors are prone to stay on the path they're on even if it isn't working or recommended. Let's be honest--we are creatures of habit. We are provided with clinical practice guidelines but often need to pay more attention to the advice when it conflicts with long-held practice patterns.

For example, although one recommendation of the Choosing Wisely campaign* is to forgo routine general health exams for asymptomatic adults, doctors often close each patient encounter with healthy patients by saying, "I'll see you next year."

How often do we order a CBC, CXR, EKG, PT, PTT, or complete metabolic profile for a healthy patient without comorbid conditions before a surgical procedure? How often have we uncovered a condition that caused us to cancel the operation? Probably seldom or never. How often do we act defensively and order all of these tests "just to be sure" or to protect us against deviation from the standard of care? More than we would like to admit.

It has been taught to every physician that they schedule a patient every fifteen minutes. Would it be possible for a patient with diabetes, heart disease, hypertension, obesity, and is on eight medications to be managed in a fifteen-minute appointment? Of course not. Does a patient need a fifteen-minute appointment for a blood pressure check and review of their cholesterol level? Also, no. It is far better to identify the medical problem and the patient's personality and schedule them accordingly. This results in seeing patients on time and will decrease the anxiety level of the staff trying to stay on schedule.

Bottom Line: Doctors are, unfortunately, creatures of habit. Our default is to continue the path we've always walked or were trained to take. If doctors recognize that impulse, it will give us a dose of empathy for our patients, who are struggling with the same challenges regarding changing behavior. If we do so, our shoes can stay tied in the final seconds of the basketball game, and we become effective for ourselves, our team, and our fans.

*The American Board of Internal Medicine Foundation's Choosing Wisely campaign aimed to spark conversations between clinicians and patients about what tests, treatments, and procedures are needed – and which ones are not.

____________________________________

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.