Neil H. Baum, MD, presented “The Elephant and Chains: Adding New Technology” for the Grand Rounds in Urology audience in March 2022.

How to cite: Baum, Neil H. The Elephant and Chains: Adding New Technology.” March 2022. Accessed Jul 2024.

The Elephant and Chains: Adding New Technology

Grand Rounds in Urology Contributing Editor Neil H. Baum, MD, Professor of Urology at Tulane Medical School, argues that medical doctors often become artificially constrained by old practices, comparing them to an elephant whose weak chains only hold it down because it has been conditioned to believe so. Dr. Baum begins by elaborating on this metaphor, explaining that when elephants are babies, they are chained to large posts or trees, and are genuinely held fast. This conditions them not to pull when chained, and therefore, when they are older, they will not attempt to escape even when chained to a small peg they could easily pull out. Dr. Baum argues that perhaps medical doctors are conditioned like elephants, and suggests that they tend to play it safe, practice defensive medicine, take a long time to implement technology, rarely leave their comfort zone, and use old skills and medications. He then looks at some examples of areas where doctors have been slow to implement change and provides evidence for why doctors should embrace these new developments. Dr. Baum begins with the electronic medical record (EMR), which he acknowledges originally made it harder for doctors to focus on patients, but which he believes can be made a lot more palatable with the adoption of voice recognition software. He then looks at delegation of care to physician assistants and nurse practitioners, which he argues improves productivity. Dr. Baum moves on to telemedicine, which he claims the majority of patients have had positive experiences with since the COVID pandemic began. He concludes by looking at artificial intelligence (AI), which can read tests like prostate biopsies more accurately than the majority of general pathologists and which may improve efficiency and reduce costs.

For more commentary on practice management from Dr. Baum, visit his Improving Your Urology Practice page.


Neil H. Baum, MD, is a Clinical Professor of Urology at Tulane Medical School in New Orleans, Louisiana. He is also a retired urologic surgeon. Additionally, Dr. Baum serves as the Medical Advisor to Vanguard Communications Group. Dr. Baum is the author of Marketing Your Clinical Practice - Ethically, Effectively, and Economically, which is in its 4th edition, has sold over 175,000 copies, and has been translated into Spanish. He also wrote The Complete Business Guide to a Successful Medical Practice, which was published in 2015. Dr. Baum was the columnist for American Medical News for more than 25 years. Dr. Baum also wrote the popular column, “The Bottom Line,” for Urology Times for more than 20 years. He is a requested speaker each year to the Practice Management Seminar for the American Urological Association (AUA), where he discusses techniques for making urology practices more efficient and more productive. He has written more than 9 books on practice management and over 250 peer-reviewed articles on various urologic topics. Dr. Baum is also the medical advisor to Vanguard Communications Group.