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.

About the author

Anne Zieger

Anne Zieger

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.


  • Amazing and very apt anology; hats off to you. I agree that the leaders in organizations have to make the decision and move ahead; there are choices in terms of EHR, which one fits the practice requirements. But other than that I don’t see much choice and the demand of the future will be from the consumers/patients and that will be hard to ignore. Its a great time to establish the competitive advantage.

  • Interesting story. I love analogies as a way to learn and look at something from a different angle. I think you could extend the analogy a bit more. Reminds me a little bit of the movie How to Train a Dragon. Instead of certain death from the Tiger, there’s another option that you get the skill to train the Tiger and then not only do you survive, but you enjoy the company of a new friend and helper. Sounds like spending the time to find the right EMR, learning how to use it well and then enjoying the real benefits of implementing an EMR properly.

    Of course, I think you can extend the analogy that if you have a forced marriage to the woman, it rarely ends well. There are a few cases, but being forced to do something rarely leads to a good result. The same is true for EMR.

    Now, most people will only see those 2 choices. In fact, that sounds like a lot of practices that I talk to. Instead, I think there’s a 3rd option. Kick against the King, grab the princess and go against tradition. Sounds a bit like those who are choosing alternative care models that are facilitated by an EMR, or even those who are leaving Medicare behind so they can use the EMR of their choice regardless of whether it’s certified or not or meets MU or not.

    I like the analogy a lot.

Click here to post a comment