Surveys and other time-wasters

In case you don’t read the papers or listen to the news, good for you! And here’s an executive summary of the last two weeks.

Health care “stakeholders” pack congressional hearing rooms; embarrassing picture taken, reminding ordinary people that no one is lobbying for them. President Obama promises a nice raise for primary care physicians, and cuts for everyone else. Procedurists scream like stuck pigs. Congressional Budget Office scores health care proposals; looks like no raises for anybody. Rep. Charlie Rangel solves scoring dilemma: tax surcharge on everyone making over $350,000. Procedurists scream like stuck pigs.

That’s the news for the last fortnight, and good luck to you if you’re counting on the politicians to save us. So, in the meantime, lets talk about something practical. Like surveys.

Surveys are big right now. If you want to be a “medical home,” you’re going to need to survey your patients. You’re going to ask them to respond (on a scale of one to five, with five being “strongly agree”) to items like “I can get an appointment with Dr. Iliff quickly,” or “Dr. Iliff spends enough time with me at our office visits.”

You know the drill. And if you’re in a big group, you’ll have to grin and bear it. Even solo physicians like myself are periodically exposed to patient surveys by insurers, although I don’t have to waste any personal time participating.

Then will come the results. You’ll find that when it comes to waiting for appointments, you rate a 4.1 against the group average of 4.3. But hey! Once you get them into the room, you’re a 4.2 against the group’s 3.9!

So what are you going to do with that information? Quicken your visits by 0.2 in hopes of shortening the wait by 0.4? And does a delta of 0.2 mean anything, anyway?

The problems associated with surveying are legion. Just ask someone doing meaningful research – that is, something other than devising the 1,232nd question to detect the closet alcoholics in your practice. If you’re relying on a survey, your research is crap. That’s why I always file them in the wastebasket.

If you’ve read this blog more than once, you sense that I’m impatient. I don’t like wasting time. If it’s not actionable intelligence, bother somebody else.

But I know I’m in the minority. If I were still in academic family medicine, it would be an infinitesimally small minority. The world is full of talkers. Cogitation and blophilating* pass for action. But they are not action. They are vapor, like carbon monoxide.

If you are a young family physician, and you like to spend time with your family while earning a good living, you’ve got to develop strategies to avoid the time wasters in your professional life. President Obama can’t do it for you. The AAFP can’t do it for you.

On rare occasions I read something heartening in my local paper. The city council voted to spend $20,000 for a study of bike trails. They were “incentivized” by the Feds, who would toss in another $80,000. That’s the way the Feds add value.

Our elderly mayor, a man of distinguished character and long experience, is fighting pneumonia. He rose from his hospital bed long enough to veto the expenditure, noting that the city planning staff is quite capable of performing that function in the normal course of their duties. In fact, the staffer who designed a wonderful plan of bike trails for our town – which is being implemented, one year at a time – is one of my patients.

The mayor knows that a whole industry has grown up to “facilitate” planning, strategizing, surveying, resolution-writing, brainstorming, consulting, goal-setting, and focus-grouping. If you don’t read Dilbert, do**: that’s where you go to get your head straight after you’ve run into one of these gurus. They want your $100 grand, in time or money.

Just say no. You must develop a bias for action, and a nose for BS. To help get you started, browse at despair.com. I put their posters on the ceiling, for patients suffering indignities in the prone position.

* neologism: "the love of being a blowhard"

** Six hours after I wrote this (no kidding) the Sunday paper arrived on my driveway. The Pointy-Haired Boss tells Dilbert to collect useless information that will be out of date before it is compiled. Dilbert: "The best way to compile inaccurate information that no one wants is to make it up." Pointy-Haired Boss (to Catbert, evil head of HR): "I hope no one ever comes here to learn our best practices."

Posted at 11:03AM Jul 17, 2009 by Doug Iliff  |  Comments[1]