The Life of a Salmon Examined: What the Healthcare Profession Can Learn from Fish

Abstract:

Healthcare has looked to various industries, such as airlines, hotels, restaurants, and entertainment, for concepts on how to run our medical practices. We have also embraced the computer industry and have followed closely Microsoft and Apple as we have used their technologies in both our clinical practices and our offices. However, we have only rarely looked at nature to provide us with examples of exemplary behaviors that serve as models for becoming better doctors.

Healthcare has looked to various industries such as airlines, hotels, restaurants, and entertainment for concepts on how to run our medical practices. We have also embraced the computer industry and have followed closely Microsoft and Apple as we have used their technologies both in our clinical practices as well as in our offices. However, we have only rarely looked at nature to provide us with 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.

Many of us in the healthcare profession have had the opportunity to enjoy a delicious meal of salmon at home or in a restaurant. And some physicians have had the incredible opportunity to catch a salmon in a mountain stream and have it prepared for eating just after it comes out of the water.

But let’s look at the lifecycle of this amazing fish. Salmon hatch in the cold river waters of the Pacific Northwest. They become small “frys” and swim hundreds of miles downstream to the Pacific Ocean, where they remain for two years, feasting on the bountiful food in the ocean and growing to adulthood. The mature adult salmon then swim upstream to the very stream where they were born, where the females lay their eggs and the males deposit their sperm on the eggs, and then both the male and female die, having completed their reproductive mission.

Lessons to be Learned from Salmon

Salmon Remember Their Origins

Salmon are born at the origins of streams and rivers in the Pacific Northwest and travel thousands of miles to the ocean and then return two years later to the very same stream where they were hatched. No one knows how this is accomplished. The most widely accepted theory is that they 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 United States and Canada in the spring. These butterflies lay eggs several times along the way, and then die. The new hatchlings continue on the way, and in the fall their progeny then 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 his or her life. These invaluable coaches must be placed in a special category, and the role that they have played in a physician’s life must always be acknowledged. Also, there are physicians who helped us get started and have helped us along the way to our successes, and they also need to have a special place in our lives. Even when these older physicians retire, it is a nice gesture to remain in contact with these mentors who have made our paths so much easier. You can be sure that a note, a phone call, or an e-mail will be sincerely appreciated.

Salmon Do Whatever It Takes to Get It Done

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

Projects that physicians wish to implement are often met with resistance.

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

Projects that physicians wish to implement, whether a program at the hospital, new technology in the office, or a new marketing or public relations program, are often met with resistance. Doctors are creatures of habit, and change takes place slowly. Look at how long it took Ignaz Semmelweis to convince his colleagues that washing their hands before going on the maternity ward would reduce infant and maternal mortality. The same applied to Barry Marshall’s concept that gastric ulcers were secondary to bacteria (Helicobacter pylori) rather than stress and hyperacidity. Change occurs very slowly in healthcare. It takes persistence and a clear focus on reaching the destination that will allow you to achieve your goals and your dreams.

Salmon Are Able to Leave Their Comfort Zone and Venture into Uncharted Waters

The salmon leave the security of the small rivers and streams and swim a great distance to the vast unknown (i.e., the Pacific Ocean).

Physicians also need to leave their comfort zone, such as, for example, leaving the nest of their training and oversight by their professors and teachers and going into practice without supervision. One of us (NHB) clearly recalls leaving residency to go into practice with a group of urologists in Houston, Texas. Not having the confidence to operate 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. This was a major step in my development and gave me the assurance that I could, indeed, operate on my own without handholding from the senior partner.

Salmon Know How to Defer Gratification

Salmon on their way from the ocean to their origins go without any nourishment at all. They will defer all pleasures and enjoyment in order to reach their destination.

Physicians will also have to defer gratification en route to success. There are so many instances where physicians have to forgo enjoyment with family and friends in order to be of service to patients. For most physicians, medicine is a calling. Yes it is a financially lucrative profession, but it is not finances that drive the majority of us to become a physician. As a matter of fact, in 2010, a UPS truck driver starting to work at age 18 would earn more than a physician for nearly 18 years before the physician made more than the truck driver. Incredibly, if the UPS driver worked the same number of hours as a physician (i.e., 60 or more hours a week) and received time-and-half overtime, it would take the physician nearly 24 years to exceed the income of the UPS truck driver!(1) So we don’t do it only for monetary purposes. We practice medicine for the enjoyment and gratification that come from helping others. We practice medicine because we enjoy making a difference in this world.

Salmon Can Make Changes and Shift Gears in Order to be Successful

Male salmon develop a kype (or hooked jaw) during spawning that enables 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.

Doctors can modify what they do and shift gears in order to become more efficient and productive.

Now doctors aren’t going to grow a hooked jaw to ward off competitors. However, doctors can modify what they do and shift gears in order to become more efficient and productive. An example is the electronic medical record. Most middle-aged and older physicians have difficulty making the transition from paper to an electronic record. We have even heard of doctors who have opted to leave medicine rather than learn how to use the computer.

Conclusion

We have discussed various attributes of salmon that are worth emulating. However, there is one example of salmon behavior that we suggest you consider avoiding. Salmon will “give their all” to reach their stream of origin to lay eggs for the next generation; and once this is accomplished, they will die. Too many times 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 they retire. This is not a healthy path for older physicians to follow. We should enjoy our practices, make a contribution 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 see examples that can apply to our practices and our caring for patients. The salmon is one of those exemplars that all of us should consider . . . save the idea of working ourselves to death!

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