Wednesday, September 10, 2014

Case study: "Minimum Effective Dose" applied to world of physician-led entrepreneurship

Tim Ferriss describes the concept of Minimum Effective Dose (MED) as the smallest input needed to produce a desired outcome. For example, if you want to boil water, the MED is 100 C. Increasing the temperature above 100 C will not produce a better result, it will just waste resources.

Many physician entrepeneurs that I know (especially those still in training) often employ this concept to balance their clinical responsibilities with their innovation work (and families) but do so without much rigor or science behind its application.

I recently had a month that really strained my bandwidth and I applied this principle to manage supervising a teaching clinical inpatient service, a busy month for my company, and a Medical Licensing exam (USMLE step 3).

As always, patient care came first. There's very little control of the time demands of patient care. 80 hrs/week is 80 hrs per week (or more). Outside of that, I had to balance my two other priorities of preparing for the medical licensing exam (2 days, 8 hours each) and leading a startup.

MED concept applied to month as ward supervisor, USMLE, and CEO

1) Prioritize what is most importantly personally: family. I sent my wife and child away to stay with grandparents in Baltimore to avoid the unfulfillable promise of ever arriving home on time for dinner. Although it was sad and facetime is not as good as shooting hoops with little man, its set the right low expectations which and no one was disappointed.

2) Prioritize what is most important professionally: my direct patients. I serve patients with my software company as well as clinically. But clinical time is direct patient care so that takes priority.

3) Apply heuristic of important-urgent (IU), important-nonurgent (IN), less important-urgent (LU), and less important-non-urgent (LN). Patient care through my software company was important but not urgent. I had teams managing enterprise customer relationships and staff could put out fires as needed. The usual quality assurance measures were in place. And the company could go into our usual contingency plan in the event of any patient or technological urgency or emergency.

4) Applying the same heuristic, I prioritized my board licensing exam as less important-urgent. Although failing the exam would be a royal annoyance, no patients would be harmed in the process. And that is a key consideration for clinician entrepreneurs. If we take a step back and think about some of the artificial stresses we put on ourselves: remember, you can't violate the Triple Aim for a patient by under-performing on an exam. Certainly, clinical competency is crucial. But acing exams is not a good proxy of good patient care. So, with caution and application of MED, I judiciously prioritized studying for the USMLE 3 below my other work.

Patients of course received gold standard of care. That would never be a compromise. And if any clinician-entrepreneurs think otherwise, you should not be practicing. Just imagine if your child, sibling, spouse or parent were the patient of a clincian that was only half-thinking about their needs. Big no-no.

The company, with the help of very productive and self-directed colleagues who are great communicators, did well during October. We closed a large deal. And we prevented 13 patients from being readmitted to the hospital.

USMLE: passed.

My family returned to Boston from Baltimore, they were forgiving of my commitment to patients, and no one was upset because the right (low) expectations of my availability were set.

Take aways
1) Family and patients first
2) Know your limits
3) Within your limits, apply the MED principle and designate early what is IU, IN, LU, and LN
4) Do your best and be a nice person

Thanks to Tim Ferriss for his writing and approaches to lifehacking!

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