Thursday, November 20, 2008

Part Five Officially Underway

With 48 hours of no drugs and a renewed interest in getting back to my to-do lists (not to mention my ramping-up de-cluttering drive), we have declared Part Five officially under way. To be pain-free, or nearly pain free—certainly nothing requiring constant analgesics or narcotics—and having completed the seizure-preventing course of meds, this feels like a big step. Slow Hare speed monitoring is on high alert.

Recent mention of customer service experiences pushed a lot of buttons. In addition to David’s story about his service ticket being closed because he wasn’t home when the appropriate technician called two days after his extensive span on the phone with the first-level call center, other stories poured in. The technique of “closing your ticket because you weren’t there,” not because the problem was solved, seems be a particular company favorite. The most frequently mentioned variation was “you didn’t respond” within an arbitrary (and undisclosed) time window. What on earth gives these folks the idea that this is a sensible way to conduct a business? Do parents not teach about penny-wise and pound-foolish any more? Or have we jettisoned that bit of wisdom along the way in our drive to be modern and trendy?

Kearney’s post about “person or product?” also stimulated a lot of comment. In a conversation with a physician, the take was very different: it’s critical, in that view, for verification of identity to occur before even a greeting, so it is never, never overlooked. On the other hand, J, a social worker, made observations about the (unintended) effects of evidence-based medicine over time in recruiting social workers and nurses. I might not be summarizing well, but the gist is how, at the beginning of her career, the ability to connect was paramount in assessing applicants, as opposed to now when those attributes are disregarded, or at least dramatically reduced in importance, in favor of the ability to implement assessment procedures, etc. As is so often the case, it seems to me that a sensible balance is required. It’s hard to achieve the balance with human beings infesting our system, and nonetheless should always be our goal.

My view is heavily influenced by my work teaching “soft” skills, like communication, professionalism, conflict resolution, management/leadership, ethics, etc. There’s nothing that gets attention when addressing a medical audience like empirical evidence revealing that the physicians who get sued for malpractice are not those with poor technical skills, but those with poor communication and connection skills. That stimulates unbelievable, immediate changes in body language, focus and respect. Anecdotally, med mal lawyers I know talk about the people in their offices saying “I know it was Dr. Smith who cut off the wrong leg, but don’t sue him because he was so nice to my mother and wife. Sue all those other jerks who were involved, but don’t include him.” While we can be pushed by events into suing people we like, the threshold for what it takes is very high. One interesting study in the medical field shows that many families never even considered suing until sky-high bills they couldn’t pay started arriving for their dead or birth-damaged babies. Some medical centers have modified their procedures in cases with “adverse outcomes” (the label of choice) to stop all billing procedures until the facts and responsibility have been sorted out.

At the other extreme, Bob Sutton has introduced a lovely concept called TCA (“total cost of assholes”) in the workplace, and generated an incomplete list of costs that can arise from tolerating truly disruptive personalities in the workplace: distraction from tasks; climate costs (fear of making suggestions, reluctance to take risks, inability to learn from failures, damage to forthright discussion), loss of motivation and energy; stress-induced effects and costs (absences illness, etc); turnover, lost clients, etc.

We’re not suggesting that not greeting patients moves medical staff into the "costly" category, though we are asking whether the cumulative toll on relationships has been considered. Surely there must be another way to maintain rigor in patient identification without sacrificing common courtesies in greeting and relationships?

The to-do list beckons, including occupational therapy and my new mentee at the middle school. Not to mention the piles of grading and other work—and the speed traps of my own devising and those in my environment that are monitoring the pace. See? Back to the need for a healthy balance in all things. Happy Thursday to all. Keep those notes coming. Your ideas and questions are a wonderful tonic in this medical adventure of ours.

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