patient relationship management

Patient Relationship Management–lessons from Thumper

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Today it feels like I got a little too befuddled, steered into the skid, and took a left into the dementia cul-de-sac.  I like to dig a little esoteric hole right up front to test myself—hopefully I won’t overshoot.

One billion, two hundred and twenty million. That’s the number of hits on Google for ‘hotel’. A fairly competitive business one could easily surmise. A business in which one would benefit by trying to attract and retain customers, especially loyal customers. Their tagline is, ‘It happens at the Hilton’. You know what they say, ‘It happens’–it certainly does, ‘It’ happened to me. I’m standing at the Hilton Honors desk, checking in to the hotel. I’m in Memphis. Tennessee is one of the friendliest places I’ve ever been. The people are genuine. We go through the niceties of how my flight was, and what I’m doing in Memphis. Yada, yada. I then provide the clerk with my Hilton Honors number.

“I’m afraid you don’t exist, Mr. Roemer.”

I have the right to remain silent; I just don’t have the ability. I can feel it coming. I’m about to have a Roemer-minute. You know the feeling, when the words are going to jump pass the lips before you have the chance to go into lock down mode. I’m a bit of a stickler for English, so I press him to do better with his statement. “Here I am”—I am Sam, Sam I am, I wanted to add, but I didn’t know how up to speed his was with his Green Eggs and Ham reading. “How can I not exist?”

“In the system. You’ve expired—I checked my pulse to make sure I hadn’t—you’ve been deleted.”

“My reservation?”

“No, you. You are no longer an Honors Club member.”

Now I had it. I hadn’t expired, they expired me. Somebody had to think up that little gem of an idea, and somebody else had to approve it. They could have just pretended I was still in their little club and not said anything and everything would have been fine. Bambi 101. Thumper’s mother; ‘If you can’t say something nice, don’t say anything at all.” A clear violation of the rule. As competitive as the hospitality industry seems to be, how smart does one need to be to know that it is not a good idea to expire customers?

I was in the middle of my run today, four miles away from the parking lot.  Next to the dirt trail was a bright orange Igloo water cooler with a hand-written note stating it was provided by a local running store.

What have you done for your patients recently?  What makes you stand out?

saint Paul M. Roemer
Chief Imaginist, Healthcare IT Strategy

1475 Luna Drive, Downingtown, PA 19335
+1 (484) 885-6942
paulroemer@healthcareitstrategy.com

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Patient Relationship Management (PRM)

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Have I mentioned I am an unapologetically type A person, for the most part an off the chart Meyers Briggs INTJ? This morning I awoke feeling no more querulous than usual—that would change rather abruptly. In general, I make it a rule never to learn anything before having my first cup of coffee. Unfortunately, today wasn’t going to be one of those days. In fact, my mood was a direct result of the instrument pictured above.

These days I am using that to make my coffee as my normal espresso maker’s LED screen is displaying a message telling me my grinder is blocked—sounds a little like something two tablespoons of Pepto should be able to fix, doesn’t it? Google was not help—three hits, each instructing me to send it back to the dealer for a $350 repair. Sounds more like a response you’d get regarding a car, not a coffee maker.

I brought this pot home from my work in Madrid. It works using the same principles as a pressure cooker. Water is placed in the bottom; an espresso grind goes above the water.Steam is forced through the grind, past a metal sieve, and into the container where as it cools it is reconstituted as a liquid—coffee. Anyway, as my coffee is cooking, I notice the metal sieve sitting on the counter. It seemed like too much work to turn it off, rinse the pot, regrind the coffee, and wait the additional five minutes. I was too tired for a do-over.

Too bad for me. Now, I’m not sure if what happened next would be found under the topic of fluid mechanics, converting steam into thermal energy, or general explosives, but it would have made for an entertaining physics experiment. In what appeared to play out in slow motion like the Challenger explosion actually occurred in a fraction of a second. It seems that metal sieve does more than strain the grinds from the steam. It also prevents a thermonuclear reaction. Apparently when the pressure passes the fail-safe point, the reaction proceeds to the next logical step. That step, which I observed, involves coffee and grinds exiting the pot so rapidly that before I could blink they covered the walls, counters, and floors as far away as ten feet. (It was actually pretty impressive to watch.) I’ve been informed that once I finish writing I will be attending to the mess.

The scene reminded me of one of the forensic shows on cable. I halfway expected the medical examiner Henry Lee to walk through my door to examine the splatter pattern.

The choice I faced was to do it over, or deal with the consequences. I was in a hurry, consequences be damned—it turns out that it wasn’t the consequences that would be damned. My guess is that I’m looking at at least thirty minutes of cleanup work.

It pays to invest the time to do something right the first time. Sort of like dealing with patients. Let’s say a certain patient call takes nine minutes to handle correctly. As many of you have observed, there are two ways to go about this. You can do it over a period of several four minute calls because your people don’t want to get dinged for exceeding their handle time allotment, or you can allow the people to talk until the patient’s need is solved.

As patients, we know you prefer the first approach. The mere fact that patients have to listen to a recording telling us how important our call is makes us leery. I think everyone who is monitoring calls and call metrics needs to come over to my house for a cup of coffee and let the people do their jobs.

saint Paul M. Roemer
Chief Imaginist, Healthcare IT Strategy

1475 Luna Drive, Downingtown, PA 19335
+1 (484) 885-6942
paulroemer@healthcareitstrategy.com

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Patient Relationship Management (PRM)-why men can’t boil water

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There was a meeting last week of the scions of the Philadelphia business community. The business leaders began to arrive at the suburban enclave at the appointed hour. The industries they represented included medical devices, automotive, retail, pharmaceutical, chemicals, and management consulting. No one at their respective organizations was aware of the clandestine meeting. These men were responsible for managing millions of dollars of assets, overseeing thousands of employees, and the fiduciary responsibility of international conglomerates. Within their ranks they had managed mergers and acquisitions and divestitures. They were group with which to be reckoned and their skills were the envy of many.

They arrived singularly, each bearing gifts. Keenly aware of the etiquette, they removed their shoes and placed them neatly by the door.

The pharmaceutical executive was escorted to the kitchen.

“Did your wife make you bring that?” I asked.

He glanced quickly at the cellophane wrapped cheese ball, and sheepishly nodded. “What are we supposed to do with those?” He asked as he eyeballed the brightly wrapped toothpicks that looked banderillas, the short barbed sticks a matador would use.

“My wife made me put them out,” I replied. “She said we should use these with the hors d’oeuvres.”

He nodded sympathetically; he too had seen it too many times. I went to the front door to admit the next guest. He stood there holding two boxes of wafer thin, whole wheat crackers. Our eyes met, knowingly, as if to say, “Et Tu Brutus”. The gentleman following him was a senior executive in the automotive industry. He carried a plate of freshly baked chocolate chip cookies. And so it went for the next 15 to 20 minutes, industry giants made to look small by the gifts they were forced to carry.

The granite countertop was lined with the accoutrements for the party. “It’s just poker,” I had tried to explain. My explanation had fallen on deaf ears. There is a right way and a wrong way to entertain, I had been informed. Plates, utensils, and napkins were lined up at one end of the counter, followed in quick succession by the crock pot of chili that had been brewing for some eight hours, the cheese tray, a nicely arrayed platter of crackers, assorted fruits, a selection of anti-pastas, cups, ice, and a selection of beverages. In the mind of our wives, independent of what we did for a living and the amount of power and responsibility we each wielded, we were incapable of making it through a four hour card game without their intervention.

I deftly stabbed a gherkin with my tooth pick. “Hey,” I hollered “put a coaster under that glass. Are you trying to get us all in trouble? And you,” I said to Pharmacy Boy, “Get a napkin and wipe up the chili you spilled. She’ll be back here in four hours, and we have to have this place looking just as good as when she left.”  I thought I was having the neighborhood guys over for poker; I was wrong. So were each of the other guys. We had been outwitted by our controllers, our spouses. Nothing is ever as simple as it first appears. We didn’t even recognize we were being managed until they made themselves known.

Who’s managing the show at your hospital, you or the patients?  The answer to that question depends on who owns the relationship, who controls the dialog.  If most of the conversation about your organization originates with them, the best you are doing is reacting to them as they initiate the social media spin, or try to respond once the phone started ringing.  It’s a pretty ineffective way of managing.  It’s as though they dealt the cards, and they know ahead of time that you are holding nothing.

There are times when my manager isn’t home, times when I wear my shoes inside the house—however, I wear little cloth booties over them to make certain I don’t mar the floor.  One time when I decided to push the envelope, I didn’t even separate the darks from the whites when I did the laundry.  We got in an hour of poker before I broke out the mop and vacuum.  One friend tried to light a cigar—he will be out of the cast in a few weeks.

Be afraid. Be very, very afraid.

saint Paul M. Roemer
Chief Imaginist, Healthcare IT Strategy

1475 Luna Drive, Downingtown, PA 19335
+1 (484) 885-6942
paulroemer@healthcareitstrategy.com

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I’d hate to be thought of as superfluous

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If you and I agreed on everything, one of us wouldn’t be needed.

Of the many special things associated with growing up in this country, one is held dearly by every American eight-year old male who owned a flashlight and an AM transistor radio with an earplug. During those long hot summer nights when the adults sat on the back stoop nursing a bottle of Carling and waiting for their window air conditioners to suck out enough of the heat to make the inside of the house bearable, thousands of boys across the country lay under their bed covers, with a flimsy plastic earplug dangling from their ear as they continued to turn the dial to tune in the lone radio station covering the home team. In spite of the static, they faithfully kept score for their favorite baseball team in the back of their black and white Composition notebook.

The scorecard was homemade, carefully drafted using a pencil and something relatively straight to draw the lines that separated each of the nine innings. Unlike today, when the concept of team has given way to the concept of personnel whose loyalty lies with the highest bidder—free agents, the lineup for the home team rarely changed by more than a player, the pitcher, and had been mostly the same for years.

My team was the Baltimore Orioles. Their team pennant hung on my wall, a team photo was on my dresser along with my membership card to the Junior Orioles. Under the blanket with me was my taped-up shoe box containing my collection of baseball trading cards, sorted by team and held together by rubber bands I had removed from the Baltimore Sun. A few hundred stale sticks of the pink powdered bubble gum that came with each five-pack of cards was stacked neatly in one end of the box. The cards for the opposing team were spread before me so I could get the lineup and study their batting statistics.

What made me think of this was that yesterday my son and I went to see a minor league game. Although the grass was just as green, and the hot dogs smelled the same, nothing was the same. Still, it beat a stick in the eye. Things change. Baseball changed, and nobody conferred with me before changing it. I didn’t see a single person keeping a scorecard, let alone a dad teaching his son or daughter how to keep it. The only constant throughout the game was the commercialization, to the point where it made it difficult to simply follow the game.

That’s progress. Or maybe not. Some progress is good. Some progress doesn’t exist even though everybody around it believes that it does. Buying technology doesn’t in and of itself confer progress, it simply means you bought more technology. For those who are so fond of metrics, look up some ten-year old figures and see. See if patient satisfaction has increased. Still not convinced? Add up all the money you’ve spent on improvements and technology during those ten years and divide it by the percentage of decrease or increase of any decent metric. Was it worth it? I bet not.

Ray, people will come Ray. They’ll come to Iowa for reasons they can’t even fathom. They’ll turn up your driveway not knowing for sure why they’re doing it. They’ll arrive at your door as innocent as children, longing for the past. Of course, we won’t mind if you look around, you’ll say. It’s only $20 per person. They’ll pass over the money without even thinking about it: for it is money they have and peace they lack. And they’ll walk out to the bleachers; sit in shirtsleeves on a perfect afternoon. They’ll find they have reserved seats somewhere along one of the baselines, where they sat when they were children and cheered their heroes. And they’ll watch the game and it’ll be as if they dipped themselves in magic waters. The memories will be so thick they’ll have to brush them away from their faces. People will come Ray. The one constant through all the years, Ray, has been baseball. America has rolled by like an army of steamrollers. It has been erased like a blackboard, rebuilt and erased again. But baseball has marked the time. This field, this game: it’s a part of our past, Ray. It reminds of us of all that once was good and it could be again. Oh… people will come Ray. People will most definitely come.
-Terrance Mann in the movie, “Field of Dreams”

saint Paul M. Roemer
Chief Imaginist, Healthcare IT Strategy

1475 Luna Drive, Downingtown, PA 19335
+1 (484) 885-6942
paulroemer@healthcareitstrategy.com

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Abnormal

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I remember the first time I entered their home I was taken aback by the clutter. Spent and wet leaves and small branches were strewn across the floors and furniture. Black Hefty trash bags stood against the walls filled with last year’s leaves. Dozens of bright orange buckets from Home Depot sat beneath the windows. The house always felt cold, very cold. After a while I learned to act normally around the clutter.

There came a time however when I simply had to ask, “Why all the buckets? What’s the deal with the leaves?”

“We try hard to keep the place neat,” she replied.

“Where does it all come from?” I asked.

“The windows.”

I looked at her somewhat askance. “I’m not sure I follow,” I replied as I began to feel uneasy.

“It’s not like we like living this way; the water, the cold, the mess. It costs a fortune to heat this place.

And, the constant bother of emptying the buckets, and the sweeping of the leaves.”

“Why don’t you shut your windows? It seems like that would solve a lot of your problems.”

She looked like I had just tossed her cat in a blender.

When you see something abnormal often enough it becomes normal. Sort of like in the movie The Stepford Wives.  Sort of like Patient Relationship Management (PRM). The normal has been subsumed by the abnormal, and in doing so is slowing devouring the resources of the hospital.

Are you kidding me? I wish. It’s much easier to see this as a consultant than it is if you are drinking the Kool Aid daily. When I talk to people about a statistic that indicates that 500 people called yesterday about their bill, and everyone looks calm and collected, it makes me feel like I must be the only one in the room who doesn’t get it—again with The Stepford Wives.

saint Paul M. Roemer
Chief Imaginist, Healthcare IT Strategy

1475 Luna Drive, Downingtown, PA 19335
+1 (484) 885-6942
paulroemer@healthcareitstrategy.com

My profiles: LinkedInWordPressTwitterMeetupBlog RSS
Contact me: Google Talk/paulroemer Skype/paulroemer Google Wave/paulroemer

If I ask about it they always have an answer.  “Billing calls are usually around 500 a day.”  They say that with a straight face as though they are waiting to see if I will drink the Kool Aid. It’s gotten to the point where no matter how bad things get, as long as they are consistently bad, there not bad at all.

This is the mindset that enables the PRM manager (I know you don’t have one—I am being facetious) to be fooled by their own metrics. When is someone going to understand that repeatedly having thousands of people calling to tell your organization you have a problem, means you have a problem?

It would probably take less than a week to pop something on your web site, and post a YouTube video explaining how to read the bill.  Next week, do the same thing and help patients understand how to file claims and disputes—granted, you may need more than a week for this one.

Patient Relationship Management (PRM): Left Brainers, Right Brainers, and No Brainers

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Sometimes I feel a little like the ambassador from the planet Common Sense, and unfortunately very few of us speak the same language. Let’s see if we can segment the Patient Relationship Management (PRM) population into left brainers, and right brainers. I am wrestling with an issue that I believe is a no-brainer.

One point, upon which both sides seem to agree, is that without the patients, PRM would be superfluous. The breakdown is that for a hospital to flourish in the long term, hospitals should re-engineer their business processes to facilitate the dissolution or substantive reduction of traditional customer service.  This extends beyond the cordial relationship of a nurse or a doctor and their patients in hospital beds.

In many, if not most instances, the very existence of traditional customer service provides a vehicle which acts as an enabler for failure. It gives hospitals permission to be mediocre in dealing with their interactions with their patients and physicians. In effect, traditional customer service is a tacit admission to the employees and the patients, “We don’t always get it right. We don’t always do our best.

Before deciding not to read further, ask yourself a few questions. The purpose of the questions is to try and articulate a quantifiable business goal for customer service, PRM.

1. Does customer service have planned revenue targets
2. Does it have its own P&L?
3. Does it have a measurable ROI?
4. What is the loaded cost for each patient and doctor interaction?
5. Could the costs of those interactions be eliminated by fixing something in operations?

If the answers to 1-3 are no, the answer to 4 is unknown, and the answer to 5 is yes, your hospital inadvertently made the decision to ignore revenues and to incur expenses that provide no value to your organization. I believe this premise can be proved easily.

The careers of many people are directly tied to the need to have customer service and call centers. Big is good. Bigger is better. Software, hardware, telecommunications, networks—more is better. Calls are the lifeblood of every call center. Without those calls, the call center dies. Calls are good, more calls are better.

When was the last time you were in a meeting when someone said something like, “In the last three years our patient call volume has continued to increase,” or, “Calls have gone up by forty percent.” That part may sound familiar. The phrase nobody has heard is, “We can’t continue to add that many calls.” Tenure and capital. That part of the business is managed with the expectation that the number of calls will continue to grow. And guess what? It does. How prophetic is that? Or is it pathetic? You decide.

Given that, how does the typical healthcare provider manage their customer service investment? Play with the numbers. In many organizations, if customer service management can show that patient satisfaction is holding steady, no matter how bad it is, and they can use the numbers to show that some indicator has moved in a favorable direction, other areas of the business are led to believe that customer service is performing well.

Memo to those executives who are authorizing customer service expenditures—I want to make sure there is no mistaking how I view the issue. If that is what you are hearing from your customer service managers, they either don’t understand their responsibility, or they understand it and they don’t want you to understand it.

To be generous, if patient satisfaction with regard to customer service is below ninety-five percent, your customer service is in serious need of a re-think. Just because patient satisfaction is not tanking faster does not mean customer service is functional.

Most executives know how to get numbers to paint whatever picture they need to paint. Beware the sleight of hand. Any time the customer service manager comes to you and says he is improving operations by reducing the average amount of time someone spends on the phone talking to a patient (average handle time), don’t believe anything else he tells you. Allow me to translate. When the customer service budget is tight (too many interactions and too few people with which to interact) the way to make it fit the budget is to make your people end the call quicker. Shorter calls mean more calls per hour. Note—speed buys you nothing, except for more repeat calls, less resolution, less patient satisfaction. It’s a measure of speed—IT IS NOT A MEASURE OF ACCOMPLISHMNET.

I’d be willing to bet that somewhere between twenty-five and fifty percent of calls from your patients and physicians can be addressed better via a combination of social media and the Internet.

saint Paul M. Roemer
Chief Imaginist, Healthcare IT Strategy

1475 Luna Drive, Downingtown, PA 19335
+1 (484) 85-6942
paulroemer@healthcareitstrategy.com

My profiles: LinkedInWordPressTwitterMeetupBlog RSS

A scathing rebuke of EHR

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I encourage anyone with an EHR or thinking of getting an EHR to read this.  I do not think it is a unique story.

I recently spent an hour with my cardiologist.  He is employed by a very large teaching hospital.  After checking my vitals, listening to my heart, and asking a few questions, he moved from the exam table to the keyboard—where he remained.

Click…click…click

The focus of our conversation quickly moved away from me and onto him—more accurately to his Hospital’s three-year-old EHR system.  I learned quickly from him that calling it a system was somewhat optimistic.

Here is what I learned from him about the hospital’s EHR:

  • It is possible to take your most expensive and most trained resource away from what they do and have them spend forty-five minutes of the hour performing a clerical task—data entry.
  • Productivity is down at least thirty percent.
  • He called EHR the “Silent intruder in the room.”
  • “What are the benefits?” I asked.  “It does a great job collecting data for those who may want to use it against us in a law suit.”
  • “What about interoperability?”  “Not in my lifetime,” he replied.
  • “It makes everyone’s job easier but mine and the nurses.”
  • “Did anyone speak to you about what you needed from an EHR?”  He is still laughing.
  • He needed his nurse to help him schedule my next appointment.
  • “How would you react if I asked if what the hospital implemented was nothing more than a hundred million dollar scanner?”  “I would not disagree with that assessment.”

The good news is that he is arranging a meeting for me with the hospital’s CEO to see what I can do to help.

My take?  I was the other intruder in the room.  

Who is minding your patients, your equity?

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Did I mention that I like to sing? No? Don’t tell anyone, but I just downloaded some Tom Jones to my MP3 so I can belt out a rendition of Delilah while I’m running—I only do this when I’m certain nobody is around. This doesn’t quite foot with my college collection of albums from Pink Floyd, Genesis, and Queen.

Then there was the time I was on a date at a roller rink. I was probably dressed in a pair of tight fitting bell-bottoms, an equally tight fitting rayon shirt unbuttoned to who knows where—hold the laughter. My almost shoulder length hair half-hid a puka shell necklace.

It may be important to know that although I had ice skated, I had never roller skated. There are a few not so subtle differences between the two.  Most notably, the sadist who designed the roller skate must have thought it amusing to place a large round rubberized wheel on the front of the skate in much the same position as a car bumper. I have no idea what is supposed to do. What it does do is stop you on a dime, especially when you have no intent of stopping.

Let’s see if we can tie some of this together. I’ve never felt that I actually needed to know how to do something in order to develop my own unsubstantiated delusions of adequacy—that probably explains why I’ve been consulting all these years. Anyway, back at the roller rink.

Barry Manilow’s “I Write the Songs” was being piped overhead through speakers the size of a dishwasher. Feeling much too confident for my abilities, I dragged my date to the floor. We stood side by side. I grasped her hands in a crisscrossed fashion like I had seen skaters do on television. After circling the rink for half a lap—watching my feet the entire way—I thought I should further dazzle her by singing. I should point out that it is difficult to sing and simultaneously watch your feet, a fact I didn’t learn until I was airborne. This takes me back to the rubber wheel on the front of the roller skate. We crashed to the floor and quickly took out the next thirty or so couples who were following us. It looked like a conga line run amuck. For the next hour or so it seemed like everyone in the rink pointed at me as though they were trying to warn others to stay away.

I haven’t sung any Manilow since that fabled night. Maybe it has something to do with the fact that times change and tastes change. Now I listen to groups like Dashboard Confessional and Great Lake Swimmers. I still interface with those closeted Manilow fans. Gone are the bell-bottoms and platform shoes, replaced by micro-fiber trousers, Droids, and Cole Hahns. My collar-length hair has a more monastic cut.

I’ve aged, so has my generation.  Aged to the point where they now have the power. Those people own the decision making process in most hospitals.  They may be the people calling the shots in yours. How can you tell if the person wearing the eighties polyester is one of them? Walk past her humming a few bars of Mandy or Copacabana, or something from The Captain and Tennille, and see if she hums back.

Is your Patient Equity Management (PEM) strategy is as dated as the double knits?  Or did I get ahead of myself; does your hospital even have a PEM strategy?  Odds are that there is no PEM strategy, no PEM group or executive.

Hospitals are quite good at managing their assets.  I bet your hospital has someone who can tell you how many chairs, televisions, beds and bed pans you have.  Assets.  We count them because we don’t want to lose them.  That is how businesses are managed.

In today’s dollars over their lifetime the average person in the US will spend more than $600,000 on healthcare.  Patients.  Assets.  They are a big part of your hospital’s equity base.

Who is minding your patients, your equity?  I don’t mean the doctors and nurses.  Who is responsible for making sure discharged patients return to you the next time they need a hospital?  Who manages that relationship for the hundreds of days between hospital visits?  Probably nobody; at least nobody in your organization.  Wanna’ bet somebody in the hospital on the other side of town is studying how to turn that $600,000 patient into one of theirs?

In case you’re wondering, the episode at the skating rink was our last date.

Patient Relationship Management & Patient Equity Management

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Here’s a link to my deck on the above. I’d like to read your thoughts.

http://www.slideshare.net/paulroemer/good-CEM-deck

In accordance with the prophecy

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Counting me, there were six of us; college spies. Maybe that is a grammatical error; we were spies who happened to be in college. Well, maybe that’s a half-truth. We were co-op students with rather high security clearances, working at a place in the DC area which made the type of things of which Nancy Pelosi would deny having any knowledge. I was a mathematics intern—not a bad step on the rungs of the career ladder given that the dean of my math department had tried on more than one occasion to get me to change majors. Everyone I worked with had at least a PhD in math. At least I had enough firing synapses to know I would never be their intellectual peer.

During the summers, we six would report at one of the complex’s gates, flash our badges at the marine guards, make our way past the military weapons testing facilities, and head to our basement offices. At lunch time we’d break out our briefcases, and take out our tools of the trade—Frisbees, bag lunch, sun tan oil (this was in the days before anyone could spell SPF, pure Hawaiian Tropic.) Within minutes we’d be stripped down to our cutoffs, running across the field where the helicopters landed, and dripping with sweat. After lunch we’d help draft differential equations whose aim was to read target signatures sent from one of our missiles at a Soviet or Chinese aircraft. Not a bad gig if you can get it.

That was then. Now we are aging adolescents clinging woefully to rapidly fading images of summers past, whose idea of getting wasted is drinking multiple espressos. Gone are the days where we could abnegate responsibility. We matured, at least a lot of us. We’ve learned pretending you know what you’re doing is almost the same as knowing what you are doing. We’ve accepted it to the extent that we act like we know what we’re doing even if we don’t and, we do it.

Pretending is a skill. Guys do it all the time, secretly hoping no one will notice. People who answer your hospital phones do it too. Sometimes patients will settle for an answer; any answer. It’s sort of like bluffing in Trivial Pursuit—if you bluff with enough confidence, your opponent may not even check your answer. For some patient questions, there are three states of being; not knowing, action and completion. The goal is to move as rapidly as possible from the first state to the third. If the patient proves to be a problem, the patient care rep should finish each sentence with the phrase, “In accordance with the prophecy.”

Of course, if face-to-face interaction proves to be too much, you can always tighten up the dialog. For example;

RING …RING …

*click*

Welcome to the Patient Care Hotline.

If you are obsessive-compulsive, please press 1 repeatedly.

If you are codependent, please ask someone to press 2.

If you have multiple personalities, please press 3, 4, 5 and 6.

If you are paranoid-delusional, we know who you are and what you want.

If you are schizophrenic, listen carefully to the little voice until it tells you which number to press.

If you are manic-depressive, it doesn’t matter which number you press. No one will answer.

If you are delusional and hallucinate, please be aware that the thing you are holding on the side of your head is alive and about to bite off your ear.

Thanks for calling.