Several of you know that it is best to ignore my sarcasm; encourage me and it only gets worse. The rest of you may be waterlogged with ambivalence. There are a lot of other healthcare blogs. You should read those if you are into the opinions of people who are experts at watching water freeze, people who are pinning the tail on the wrong donkey.

If you are in habitué to learn about consumerism from an author whose ideas are presented like a sprinkling of dew on a rose petal, my blog may not be the best choice for you. I don’t sprinkle. Nor can I turn Coke into Pepsi, but I have been known to make rocks cry.

Healthcare consumerism is a walking enigma on stilts.

The fact that I’ve spent my career in consulting may have something to do with how I approach issues. Consultants, for example, are the people in the movie theaters who get dreamy-eyed when the Titanic goes down. I cried, not because I was moved, but because it was such a bad movie. When bad things happen consultants are thinking, I have a PowerPoint somewhere that told you it would sink. And we tend to make that point with all of the generosity, grace, and selflessness of Jack the Ripper.

After all, ships that aren’t likely to sink do not need consultants any more than we need another album by the Village People. Some business leaders wait to glom on to an issue until it has enough cachet. Those are the same people who will tell you that they were only responsible for sinking the lower decks of the Titanic. Getting insight from them is like reading cartoons that do not have captions. They leave the thinking to you.

Unlike HCAHPS, I am not big on nuance. I wouldn’t know a nuance if it hit me in the face. I prefer to keep equivocations about HCAHPS out of my inbox, because if you think you have a fifty-fifty chance of getting it right, there is a ninety percent chance you will get it wrong.

People who believe consumerism is linked to HCAHPS see straws and immediately reach for them. HCAHPS are to patient experience and consumerism what Oliver Stone was to the Kennedy assassination. Only a handful of us has a license to interpret the universe.

For those who think I may be out of my depth when it comes to addressing matters of customer experience in healthcare, customer experience has no depth. At least beyond the mindset of a sixteen-year-old. And that is why I pretend to be the ringmaster when it comes to the circus of egos who are trying to tell you that you are already doing everything possible to understand what your patients expect from your organization.

Healthcare’s consumerism circus has started, and it’s going to be a three-ringer. Maybe I should be wearing a cape. But, I am a consultant; trust me. (You do not need to comment on the oxymoron.)

I find it helpful to present issues using my illusory charm and mythical footwork, and to disperse profundities to both the washed and the unwashed. Maybe that is why consultants have half-lives of fruit flies.

There are those who will tell you that when you fall off the horse, you need to get back on. I disagree. I think you need to learn to walk or to drive.

There are around a hundred and fifty million people in the U.S. who drive. They live among us. We see them driving, and we think we know how they do it. We think we know what they are doing.

I mention that because I am teaching my daughter to be one of those drivers. She has spent about twenty hours practicing, and other than backing out of the driveway, she seems to be getting the hang of it—way to go, Dad!

During yesterday’s driving lesson with her favorite dad ensconced in the passenger’s seat, she told me about a friend of hers who just passed her driving test. And she remarked, “Sally only uses one foot when she drives.” Her statement was so innocuous that I missed it.

A few miles later I asked, “What did you mean about using one foot?”

“She uses the same foot for the gas and the brake.”

By having spent years observing what is commonplace, we think we know everything about that which we observe. I watched my daughter and assumed she was using the same foot for the gas and the brake. She had spent sixteen years watching us drive her. She saw two pedals, knew she had two feet, and put two and two together and got an irrational number. We gave her the keys. It never occurred to us to tell her that even though there are two pedals that you need to use only one foot. And the reverse never occurred to her.

We learned quickly that our assumptions were wrong; mine about how she was driving, hers about how everybody else was driving.

We make the same errors every day when it comes to our knowledge of patients and customers. We assume that if someone needs an appointment, they simply call and get one. Or a refill, or an explanation about their bill, or a referral, or whatever. Only it ain’t that simple. Nothing is. Never was.

But if everyone in your system believes being a patient or a customer is simple, then why would they be concerned about fixing it? We fix things that are broken.

Instead of operating a health system based solely on assumptions, why not ask your patients and customers whether your assumptions are valid.

The real bad news is that assumptions are driven by expectations. And chances are high that nobody in your system has ever asked them about those either. As a matter of fact, health systems and payers probably have not asked their patients and members about much of anything.