EMRs: The Question of the Lady or the Tiger

Here’s a tale which, believe it or not, may be worth discussing on an EMR blog.

In a classic short story by Frank Stockton, published in 1882, readers are asked to make their guesses about human nature and the capacity for self-sabotage, jealousy and fear of the unknown.

As the story, “The Lady, Or The Tiger,” goes, a princess has taken a lover below her social class — and to punish her, the king submits both her and her lover to an ordeal. The lover must enter an arena and choose one of two doors, one with a woman behind it and another with a ferocious killer tiger poised inside to spring.  If he chooses the tiger, he’ll be killed; if he chooses the door where the woman waits, he must marry her.

The princess, as it happens, knows which door poses which threat. But she has a dilemma to face. She doesn’t want her lover dead, but she doesn’t like the idea of his marrying another woman, one whom she actually envies. The question Stockton poses, at the end of the story: “Will the tiger come out of that door, or the lady?”   Nobody knows, since Stockton doesn’t tell us, but it’s food for thought — as a parable for EMR adoption.

Am I crazy to draw such a comparison?  Actually, I don’t think so.

Right now, hospital and physician staff members essentially have their own choice to make — embrace EMRs or dig in their heels and make the transition last as long as possible and cost as much as possible.  Sure, individuals will have more nuanced reactions, but globally, I’d argue that an institution either embraces EMRs or fights them.

So, clinicians and support staffers basically have two doors to choose from, one which generates certain disruption, change and possibly the end of the jobs they know (the tiger). That’s embracing EMRs.  The other door (the lady) comes with requirements of its own but is arguably a much less painful choice.

Which door they choose, fortunately, isn’t completely up to chance.  If there’s a “princess” — OK, the analogy falls apart here, guys — to indicate which door works and give people the guts to open it, things will move more smoothly.  That “princess” leader (in reality, many leaders at many levels) will have to sell people on the value of disruption, change and ultimate benefit, rather than the “lady” door which seems so much less threatening.

But the story, which is more than a century old, reminds us that even the leaders may not be sure where they want to lead if both choices force them to change their lives.   Diminish anxiety, detooth the tiger, and your EMR install may move forward.  Allow people to get hung up on the illusion of having a choice, and you’re out of luck.