Humor In Medicine: “What Are You Doing On My Bridge”

bridgeThe temperature was in the mid-nineties and the humidity was not far behind.  Nine miles into my run I was approaching the crest of the two-mile long bridge that crossed the bay that separated the mainland from the island, and I was leaning over the guardrail to catch my breath. I was dog-tired, dehydrated, and my feet felt like they had swollen to twice their normal size.  (Getting older sucks, but it’s better than the alternative.)

To my surprise, a New Jersey state policeman, kitted out smartly in his pressed uniform and wide-brimmed hat, pulled alongside me. “What are you doing on my bridge?”  He asked from the cool confinement of his air-conditioned patrol car.  There was an undisguised tone of concern in his voice. To hear what he was saying I removed one of my earbuds.

I saw my face reflected in his Ray Ban Aviator sunglasses.  Since I was trying to cross the bridge, I thought about asking him if his question was like why did the chicken cross the road, but he did not look like a why did chicken try to cross the road kind of guy.


“Are you okay?” He asked.  “You don’t look okay.”

“I’m fine. Why did you pull me over?” I asked. “Was I running too fast?” He did not look like a was I running too fast kind of guy.  I just heard on the radio a news report saying a guy looks like he may be ready to jump off a bridge.

“I got several calls about a guy on the bridge who looked depressed. Are you thinking of jumping?”

“Am I thinking of jumping what?”

“Jumping off the bridge. Are you sure you are okay? You look depressed.”

“I think I look like I just ran nine miles.” I placed my right leg on the top of the guardrail to stretch my hamstring.

Eighty feet below me a small armada of boats had dropped anchor and the boaters appeared to be having impromptu tailgate parties in the middle of the bay.  Everyone was looking up at me, and some appeared to be filming, so I waved. I could hear a few of the boaters yelling for me to jump.

I could hear the thwump-thwump of a television news helicopter as is hovered overhead, its parabolic microphone pointed in my direction. (I embellished my story a little to make for a better blog, but it’s my blog.)

“Take your leg off the bridge, and back up slowly,” the officer commanded as he slowly approached me. “I was about to call for a police helicopter and rescue divers. Are you sure you are okay?”

To me, the entire dialog was starting to sound like the Bridge of Death scene from ‘Monty Python and the Holy Grail’.

Bridgekeeper: Hee hee heh. Stop. What… is your name?

King Arthur: It is ‘Arthur’, King of the Britons.

Bridgekeeper: What… is your quest?

King Arthur: To seek the Holy Grail.

Bridgekeeper: What… is the air-speed velocity of an unladen swallow?

King Arthur: What do you mean? An African or European swallow?

Bridgekeeper: Huh? I… I don’t know that.

[he is thrown over]

Bridgekeeper: Auuuuuuuugh.

Sir Bedevere: How do know so much about swallows?

King Arthur: Well, you have to know these things when you’re a king, you know.

I was going to ask him if his helicopter would give me a ride back to our house in Ocean City, but he didn’t look like a give me a ride back kind of guy. If I continued across the bridge, the home was only two miles away.  If he did not let me cross the bridge I had to double-back those same nine miles. “May I continue across?”

“No, you can’t do that from here.”

An interesting statement, You can’t do that from here.

I was analyzing a hospital’s website. There was a link on the homepage stating that if I clicked it I would be able to schedule an appointment. (It was right next to the link telling me that if I clicked it three times I could continue across the bridge and go home.)

I clicked the scheduling link. The next webpage told me how much they wanted to help me schedule an appointment and how important my health was to them. The following webpage told me about all the services I could schedule. The final webpage told me that if I wanted to schedule an appointment I should call the hospital Monday through Friday between eight A.M. and five P.M.

The website’s scheduling web page should have included a 24-point, bold disclaimer stating, You can’t do that from here.

Like trying to cross the bridge.

Healthcare’s ‘Honey Do List’

There are a variety of ways for guys to prevent your spouse from adding things to the ‘Honey Do List.” I may have just created a new one.

We have several large, black exterior lights whose color has faded because of their exposure to the sun. Those faded black lights are attached to white boards, which are, in turn, attached to the home’s white stucco exterior.

I should have known better. I was trying to be helpful. Trying to do something without being asked. And so I went to the hardware store and purchased a few cans of black spray paint. Did I mention that the color of the paint is black?

The exterior lights protrude from the side of the house by about a foot. Someone smarter than me might have approached spray-painting the lights with a little more preparation. They may have approached the problem with a roll of duct tape and sheets of plastic to cover the white boards and the white stucco. Did I mention that the color of the boards and the stucco is white?

It would be easy for me to tell you that a sudden gust of gale force wind was responsible for changing the intended path of the spray paint as it left the can. But, there was no wind. The lights are once again black, but

The lights are once again black, but so are the boards and the surrounding stucco.  The refurbished lights look very good. High gloss black accentuated against a white background. Or, as it turned out, a background that is now white-ish.

Trip number two to the hardware store to buy two cans of white spray paint. White boards and white stucco, as I learned after I tried to touch up my overspray of the black paint, becomes a tad less white after ten years. So, try to picture my current dilemma. Black lights. Off-white boards and stucco. And a bright white repair job wedged between two of my new favorite colors; black and off-white. As I look at the results of my work, I am reminded of the Doctor Seuss book, The Cat In The Hat Comes Back, when the pink stain that spreads across everything confronts them.

Enough about cats.

Would you think less of me if I tell you about the voices? I was having trouble sleeping. The sheep-counting thing wasn’t working for me, so I decided to listen to the voices in my head. They gave me a choice between two tasks before they would allow me to sleep; listen to an entire Celine Dion CD, or tie together four disparate facts in a way that made sense. I opted for the facts.

Fact One: Marie Osmond’s never-ending commercial for weight loss. “I’m Marie, and I lost 50 pounds on Nutri-System.” Marie must have been really big.

Fact Two: The never-ending commercial about Mario Perillo advertising trips to Italy. “You may remember my father.”

Fact Three: The spam emails I get from someone named Olga who wants to meet me.

Fact Four: The spam emails I get from Mr. Mumbagi telling me that my uncle left me a large inheritance

And this is what I came up with.

“Can’t wait to meet you, Olga,” I replied. But I wanted to lose weight before I met Olga, so I called Marie, and asked her to tell me about her weight loss secret. Then I emailed Olga, and I suggested that she meet me in Italy. But I didn’t know anything about getting to Italy, so I called Mario Perillo’s son to find out what it cost to go to Italy—it isn’t cheap, even if you bring your own Chianti.   And that left me with no other choice than to reply to Mr. Mumbagi’s email to ask him to expedite the payment of my uncle’s inheritance.

Sooner or later, all the facts make sense. The circle of life.

The circle of life plays out pretty much the same way in healthcare. Examine these four facts—they happened to the same person who was spray-painting his exterior lights.

Fact One: A patient goes online to try to find the date and time of his appointment

Fact Two: A patient calls his health system to find out what day his appointment is. However, he does not remember the name of his doctor at the specialty practice.

Fact Three: A patient arrives for his hand surgery only to discover that the surgery does not take place at the doctor’s office.

Fact Four: A patient calls the health system to ask where he is supposed to be for surgery.

But what if our friend, the spray-painter with the bad hand, had an interactive solution from the health system that would have made facts 1-4 irrelevant? What would have happened if the interactive solution had sent him, or me, a reminder of his appointment that included the date and time and location and a map?

What would have happened is that the surgeon, after asking why my hand was covered with patches of black and white spray paint, would have performed the surgery. And the poor patient would have returned home with his hand wrapped in bandages. And the patient’s wife, who wanted to chastise him for having spray-painted the white boards and stucco black, would have seen the bandages, and she would have been sympathetic to the patient instead of asking why the stucco was black. She would have directed him to his favorite chair, put his feet up on the ottoman, turned on Fox News, and brought him a glass of kale juice.

But there was no interactive app. There was no way for the patient to learn the location of his surgery. And so, the patient returned home only to discover that a team of contractors had constructed scaffolding around his entire house, and had removed all the stucco.

Healthcare’s circle of life.

Design an interactive solution.

Save a husband.


The 5 Pages That Define DIgital Patient Access & Engagement

This is how patients and consumers want to access and engage with their healthcare. You’ll notice, it does not involve a call center.

The EMR does not pass the test of being both necessary and sufficient as it is not accessible to new patients, family members, or caregivers.

How Can You Recast Real-Time Patient Engagement?

Most days I feel like I am Alan Turing’s ghost. The reason I do what I do is to entice companies to do what they cannot imagine, and most times I do not have to apologize for that because they have not taken the time to imagine it.

I look at healthcare through puce-colored glasses. Healthcare services are a world-class, 2.0 industry. No other nation can provide the services we provide. However, the business of healthcare, how we run it, is a 0.2 industry. Providing world-class services without being able to make it easy for people to acquire those services is ridiculous. Isn’t it?

Running any business well comes down to doing a few basic tasks extremely well every time. Being successful requires that tasks are executed at a level above and beyond how others execute those same tasks, and it requires that your customers believe that you can do that again and again.

Once patients and consumers believe a provider is not capable of performing at that level, nobody is going to award that provider a do-over.

Several formerly grand firms missed their opportunity; Blockbuster, Radio Shack, and Sears provide grim reminders. Barnes and Noble seemed to have just realized that their boat sailed and left them tied to the dock. NPR announced that the former bookstore behemoth is considering turning their stores into wine bars. Maybe their business strategy is that after millions of their former customers buy books on Amazon that they will come to Barnes and Noble to read their books and enjoy a nice pinot noir with fava beans.

Each of those dinosaurs failed to recognize that people want to conduct their business electronically. Firms need to go from bricks to clicks.  Healthcare consumerism operates a bricks to bricks model.

CVS’s Minute Clinic has redefined healthcare consumerism.  CVS recognized that for issues that are not emergencies, people do not care who is behind Door Number 1, as long as the person behind the door can help them.  CVS designed healthcare’s Easy Button.  And CVS will make getting care even easier by launching telemedicine.

To try competing, health systems, and others launched urgent care facilities.  Even the name ‘urgent care’ needs to be reimagined.  Providers market it as ‘urgent’ care.  People, however, use it as an urgentish care facility. Or when they want to be seen by a doctor, instead of nurse or nurse practitioner.  Or when they don’t have the time to wait until their PCP can see them.  Urgent care offers a doctor—to be named later—at a facility that is open 130% more hours than the average PCP.  That’s real-time patient engagement. Patient engagement when the patient wants it, not just when your office happens to be open.

Urgentish care allows people to be seen by a doctor—whomever is working—at a facility that is open 130% more hours than their primary care provider.  What you want when you want–like TiVo for healthcare.  Can’t watch 60 Minutes Sunday at 7 p.m.?  TiVO it and watch it when you want.  Your PCP doesn’t have an open appointment today, or it has one at 3 p.m. when you have a business meeting–no problem.  The urgentish care facility two miles from your home is open until 10 p.m.

That’s real-time patient engagement. Patient engagement when the patient wants it.

CVS even let’s people reserve an appointment online. Most urgentish care facilities do not offer that feature. For those who may be interested in adding online urgent care scheduling on an app, it should look like this:

real time engagement

I cannot think of a single entity that has managed to put the toothpaste back into the tube after having missed their industry’s defining moment.

Healthcare consumerism’s defining moment is now. Or, never.

Consumerism today is a 0.2 business model. It relies on call centers which are open half as many hours as Comcast’s call centers. It relies on PCP facilities open M-F from 8 a.m. until 5 p.m.  The healthcare consumerism model needs to leapfrog itself. Executives can try to multiply the model by 10 to get it to 2.0, or they can develop a customer-friendly consumerism strategy.

Consumerism 2.0 is:

  • Easy
  • Convenient
  • Mobile
  • Interactive
  • Cognitive (Understand, Reason, Learn…URL)
  • Cloud-based
  • 24 X 7

If healthcare executives are confused about going to consumerism 2.0, that’s okay.  Their competitors are not confused.


Customer Experience: June Cleaver, Get Smart & Robespierre

If you happen to follow last week’s news, many of you will have noticed that most news organizations lead with the story that the guy with the bad haircut launched an ICBM.

Eschewing that, CNN led with the story of a gif that was posted on Reddit.  We report, you decide.  Maybe the guy with the bad haircut hacked CNN.  Viva la Revolución!—I do not know how to write it in North Korean.

I know some of you are thinking I am attitudinally challenged.

If you have extra time in 2020, consider visiting the Telephone Museum. People will come to see the phones.  It will be standing room only.  There will be a guy at the door issuing tickets and bathroom passes.

It will be like walking into a world that was rotating at 33 1/3 RMPs.  Attached to the museum’s walls will be hundreds of diverse types of telephones.  Wires will be coming out of those phones, like intravenous feeding tubes, and there will not be any explanation about what purpose those wires served.

You will see a tall, windowed box.  A box big enough to hold a person, or a dozen people if you happened to be a member of a fraternity in the 1960’s.  Inside the box will be a smaller metal box attached to the wall.  That box will have slots where people apparently inserted money.  It looks like a slot machine.  At the bottom is a small metal receptacle.  Maybe that was where the slot’s winnings were paid.

A metal wire conduit will connect the phone to the thing people used to hold to their ear. Another metal wire will be connected to a large yellow book so people had something to read while they were playing the slots.

Next to it is a red, tall windowed box that looks the same as the first box.  The sign on it reads, “British Phone Booth.”  There was no explanation about how and why people would want to talk to anyone from inside a box.  Maybe two people would enter the box together and talk to each other in private—sort of like the Cone of Silence in Get Smart.

There are pictures of people holding these devices to their ears, people who appear to be tethered to the walls of their homes and offices.  One of the photos will be of a woman who looks a lot like June Cleaver.  She will appear to be highly educated, and someone with great elocution and diction.  Someone who was well-mannered and behaved.  A human version of a French poodle.

I recently visited the inner sanctum of the health system’s large call center.  One wall contained dozens of gray metal boxes with multiple coils of wire spilling from their tops and bottoms—just like in the phone museum.  Several large monitors were affixed to the back wall, each one streaming lines of data about the number of callers, the average wait time, the average talk time, and the day’s featured cafeteria entree.

Thirty years ago, a call center was a technological marvel.  Today call centers are technological dinosaurs.

People conduct, and prefer to conduct, all their business electronically.  A phone that needs to be plugged into a power outlet does not count as conducting business electronically.

Health systems and payers keep building call centers, and yet, nobody wants to call them.  People call because they have no other choice. Patients and consumers want to conduct their business electronically.

But they can’t.

Healthcare talks about improving customer experience.  They have customer experience committees.  Somebody will bring a cardboard box of coffee to the committee meeting.  The attendees will be hungry.  They will look at one another, the way lions look when there’s only one carcass to go around.  If the meeting was called by an executive, attendees may be provided with a fruit plate and parfaits served in decorative glasses.

Nothing will be decided; at least nothing useful.  In big organizations, every idea must be run up the flagpole before anyone knows what they are supposed to think.  The committee members will have protracted debates about where to put the comma in the meeting minutes.

Organizations are the casus belli of bad customer experience.  Robespierre said, “On ne peut pas faire d’omelette sans casser des oeufs.”  You can’t make an omelet without breaking a few eggs.  Healthcare’s patients and customers are waiting for healthcare to break a few eggs.

How about forming a committee whose singular charter is to let patients and consumers conduct their business electronically.


How To Win The Patient Scheduling Lottery

Observation 1: The Bible has numerous stories of the sick and infirmed being healed.  There are no stories of the sick and infirmed being asked to provide their health insurance information prior to being healed.

Observation 2: Health insurance has become so expensive that it may be cheaper to use the health benefits included in your driving insurance or to rely on the health benefits of the individual who ran into you.

Observation 3: With all of the innovations in healthcare and medical devices, can anyone explain why nobody has thought to bring that same innovation to the design of hospital gowns.


The sign above the call center door: “Now open 24 hours…but not in a row.’

Many call centers came about because of a brainstorming session.  (Kumbaya moment.  “No idea is a bad idea.”)  Trust me on this, the idea to have a call center disproved the ‘bad idea’ premise.  (Sorry if telling you that makes you feel like you felt when you discovered that Santa wasn’t real.)  The last thing providers and payers need is having patients planning an Ocean’s Eleven style siege of your call center.  The patient/call center relationship is like House of Cards—we crush our enemies.

And it’s no wonder your callers feel that way.  I think people look at scheduling an appointment through your call center in the same way they look at trying to correctly pick all the winners in the NCAA Basketball Tournament.

Try this exercise with the blank bracket pasted below.  At the far left and right insert sixty-four names of people who are all trying to schedule the only available appointment with one of your specialists.  Assume each pair of callers is routed to a different call center agent and that each caller is placed on hold for some amount of time.  In round one of their calling, some of the calls are answered before other calls.  For example, if the first four names you enter are Bill, Nancy, Donald—not the Donald, and Becky.  If Bill’s call is answered before Nancy’s, Nancy is eliminated from getting that appointment.  If Donald gets tired of waiting and hangs up, he is eliminated.  Therefore, Bill and Becky move on to the second round.  And so forth, and so on, until only two callers remain, both of whom have a fifty-fifty chance of getting the appointment.

Fifty-fifty does not seem like bad odds.  However, when viewed from the perspective of sixty-four callers each vying for the same appointment, the chance of a specific individual getting the appointment is one in 9.2 quintillion.  That’s how it feels to callers trying to win the scheduling lottery.

If they had the option of online scheduling whenever they wanted to schedule, their chances of getting an appointment are one hundred percent.


How To Know A Bad Experience When You See It

For those people who have a tough time knowing whether an experience was good or bad, may I share an example with you?

Flying.  Bad experience.  ‘Nuff’ said.  The blog could end here.  Healthcare reform could end here.  Neither one will happen.

Most airlines offer two types of seats; first class and no first class – steerage.

First class exists for only one reason—to let the rest of us know that we are not in it.  Airlines hang a shower curtain between first class and coach.  They do this to make it clear to those of us in the bleacher seats that everything beyond the curtain is off limits.  But they do make passengers flying coach walk through first class to get to their seats.  Now each coach passenger has a barometer to measure just how bad their experience is.

“Don’t even think about storing your bag there,” she notifies me.  “This bin is reserved for our first-class passengers!”  Blocking me with her body, the flight attendant turns to the person in seat 2A and asks “May I hang your jacket, sir?  Would you mind if I refill your Crown Royal?  Be sure to leave room for dinner—we’re serving steak and lobster tonight.”  I wished I had purchased the thirty-dollar bag of Gummy Bears.

The bad experiences of coach class are particularly bad simply because first-class exists.  If there were no first class, flying coach would not be so a bad because we all suffer together. Southwest Airlines figured that out.  They do not offer first class.  And despite that, they are always among the highest rated airlines for customer experience.

Healthcare patient and customer experience.  How good was yours?  The scoring is binary —a 1 or a 0.  You either sat in first class or you sat behind the shower curtain.  Did your healthcare experience compare to having surf-and-turf, or did it make you wish you had bought the Gummy Bears?

Bad customer experiences are not insoluble.  Very little is.  For most companies, bad customer experiences are simply a failure of imagination.  For providers, their failure of imagination comes at a high price: poor care management, lost patient acquisition, and poor patient retention. And if that is not a real mess, it will do until the real mess comes along.

Just so you know, none of us likes flying coach.