Letters to the Editor  |   September 2004
Should DOs Be More Birdbrained?
Author Affiliations
  • Emil Patrick Lesho, DO
    Walter Reed Army Medical Center Washington, DC
    Infectious Diseases Fellow
Article Information
Cardiovascular Disorders / Neuromusculoskeletal Disorders / Being a DO
Letters to the Editor   |   September 2004
Should DOs Be More Birdbrained?
The Journal of the American Osteopathic Association, September 2004, Vol. 104, 366-367. doi:
The Journal of the American Osteopathic Association, September 2004, Vol. 104, 366-367. doi:
To the Editor:  
Hundreds of years ago, Lao Tzu encouraged followers to seek enlightenment by emulating nature. Two hundred years ago, Andrew Taylor Still, MD, DO, incorporated natural processes into a system of medical care that promotes the body's ability to heal itself. Today, zoologists are establishing consulting firms that promote business practices gleaned from studying birds.1 Amid claims that physicians cannot deal with uncertainty and are poor at gauging risk2 and considering the problems threatening healthcare systems,3 one might ask whether medical executives could benefit from using avian behavior as a model. 
Consider Corvidae, nature's most intelligent and adaptable bird family, which include crows, magpies, nuthatches, jays, starlings, rooks, and ravens.4 Thriving in all types of habitats, these Shamanic birds have consistently proven themselves up to the challenge, be it natural or man-made.4 
Medical executives face management decisions akin to those faced by birds; for example, whether to continue operations in the current fashion, which are productive but possibly declining, or to change the method of operation or even to relocate. Corvids' use of food sources— caching, advertising, collaborating, and even sharing scarce nourishment—is biologically unorthodox, providing a rich model for executives. After ravens discover abundant food, rather than returning to that source, they often continue searching farther away, resulting in greater risk but producing long-term sustainability. Another behavior related to management is that while navigating, corvids compensate for constantly changing reference standards as they go.4 
When medical executives cling to what they think is certain, they allow innovations to languish, they inhibit diffusion of major developments,5 and they fail to manage developing challenges to security (eg, increasing burden of chronic illness, shrinking resources, expanding mission requirements, greater expectations from patients and stakeholders, increasing fragmentation of care).3,6,7 
Another avian behavior that has meaning for medical executives is the way in which corvids collaborate with unlikely partners (eg, wolves, dogs, humans) to gain additional energy advantages and opportunities both would miss by operating alone. In healthcare delivery, results of studies show that the care outcomes of patients after myocardial infarction were better when both primary care physicians and subspecialists provided care than when either specialists or primary care physicians alone treated these patients.8,9 
In an attempt to use available tools in more imaginative ways, it is helpful to observe ravens, which are the only members of the Passeriformes (perching birds) order that use their feet and beaks in novel ways: stacking crackers, locking feet and beaks with other ravens while in flight, and even carrying two oversized doughnuts at once. (This is achieved in two ways: (1) the bird hooks one doughnut around its beak and carries the other doughnut between the beak that protrudes, or (2) the bird holds one doughnut horizontally between the beak while another doughnut sits vertically within the horizontal doughnut.) In addition, Pliny observed the phenomenon of ravens dropping stones into a container of water to raise the water level to within drinking reach.10 And, even more impressive is the fact that corvids conserve energy by shrinking and then growing their brain tissue according to need and season, thereby avoiding expensive maintenance of tissue that is not in use.4 
As medical executives face demands associated with the integration and maintenance of new digital systems which are too critical to be left solely to computer experts,11 they need to master information management as do the corvids: In one season a nuthatch caches between 22,000 and 33,000 seeds in more than 7500 places. To survive winter and spring, the nuthatch must invoke mental maps enabling it to quickly recover these reserves. 
Corvids even appear to communicate with humans. When an avid raven watcher in Maine called out to a raven flying overhead, “How's it going?”, the raven turned around, rolled, then resumed course. The raven repeated this when called at again. The observer commented, “I can't prove the displays were for me. I understand the need for the scientific method, but there are times when nature speaks just once, and it is a loss not to listen.”4 
Whitfield J. Zoologists bet CEOs will take hints from birds.Wall Street Journal Europe . January 3-5,2003 : A7.
Goldie S. Calculated risks: how to know when numbers deceive you. N Engl J Med. 2003;348:88-89.
Sandy LG. Homeostasis without reserve—the risk of health system collapse. New Engl J Med. 2002;347:1971-1975.
Heinrich B. Mind of the Raven: Investigations and Adventures With Wolf-birds. New York, NY: HarperCollins Publishers Inc; 2000.
Berwick DM Disseminating innovations in health care. JAMA. 2003;289:1969-1975.
Sox HC. The future of primary care. Ann Intern Med. 2003;138:230-232.
Moore G, Showstack J. Primary care medicine in crisis: toward reconstruction and renewal. Ann Intern Med. 2003;138:244-247.
Ayanian JZ, Landrum MB, Guadagnoli E, Gaccione P. Specialty of ambulatory care physicians and mortality among elderly patients after myocardial infarction. N Engl J Med. 2002;347:1678-1686.
Indridason OS, Coffman CJ, Oddone EZ. Is specialty care associated with improved survival of patients with congestive heart failure? Am Heart J. 2003;145:300-309.
Bostock J, Riley Esq, eds. Pliny the Elder, The Natural History. Available at: Accessed August 13, 2004.
Kilbridge P. Computer crash—lessons from a system failure. New Engl J Med. 2003;348:881-882.