Ask!
February 16th, 2009 by Geoff 10 Comments
This morning my barista asked me if I enjoyed my cappuccino. I responded in the affirmative, and then I asked him if anyone ever told him that they didn’t like their cappuccino. He said that people rarely say anything unless he specifically asks. He went on to explain that when he asks, people might say, “Well it could have been a little dryer” or something like that. He said he likes to know because he is very willing to make another and to get to know how people like their drink.
I had been thinking about the issue of feedback in relation to the medical field over the weekend, so I said, “It is great that you can get that instant feedback and respond to it. It is not like the medical field where doctors and nurses often do not get follow-up information based on their treatment.”
I know that is quite a jump, but thinking about how people get feedback is core to improving pretty much anything we do as humans. In a field like medicine, it seems like we have created institutions that make it difficult for the people on the ground (doctors and nurses) to get feedback on how their treatment plans are working except in the more critical situations. However, my barista has the ability to get direct feedback, learn my preferences and build an on-going relationship.
Consider the situation where you call your child’s doctor when they are ill. They will give advice based on what you tell them and then hang up. Sometimes the advice works. Other times you end up in the emergency room. And for the most part, your doctor doesn’t hear about the end result. Most importantly, they don’t ask for feedback on their advice. They don’t say, “Drop me an email to let me know how things work out” or “Here is how to call me back directly.” You are free to call into the emergency line and talk to whoever is on duty at the moment, but you are not given a direct way to contact them. If it turns out to be serious and you go to the emergency room, they might get a letter from the physician in the hospital (if you request it to be sent) or they might hear about it months later at your next appointment. If their advice is useful and helps heal you, they will likely never hear about it.
But, why?
We all learn from experience. Experience means that you get feedback on what you do, process it and it has an impact on what you do in the future. Let’s hope that most of the time a doctor’s medical advice is confirmed by the feedback they get, but why should we assume that is always going to be the case? As an advocate for life-long learning, I fear that medical institutions are denying our medical professionals the opportunity for on-going learning and direct feedback.
However, our cafe system is pretty healthy. Even in chains like Starbucks, it is really easy to get to know your barista and for your barista to get to know how you like your coffee. I don’t mean to diminish the value of that experience because I believe that a good barista can probably contribute to your health and keep you out of the medical system, but…
I think the biggest take-away for me is to ask people for feedback. My barista this morning is close to the people he serves. He asks, he learns, and he improves his product.
February 16th, 2009 at 4:48 pm
Interesting idea. I bet you would find some resistance to this among practitioners who might say, “a single case is just that and it would be dangerous to extrapolate that into best practices for treatment.” On the other hand, there would certainly be increased opportunity for learning because of it. Maybe it should be part of the standard operating procedure. It can’t be that hard, after all, I get a follow up from my car dealer every time they change the oil.
Although, there is probably a vast difference in feedback between a healthy person, who just gets sick once, and someone with a chronic illness who seems the doctor more often.
There is an interesting article (about basketball, no less) in this weeks Times Magazine that I think makes a good analogy: http://www.nytimes.com/2009/02/15/magazine/15Battier-t.html?_r=1&ref=magazine Good article regardless of your interest in sports.
Also, if you’re not aware of Quality Improvement, it might be of interest. It’s essentially a continuous improvement feedback cycle using patient data, although it’s far from the direct feedback you are talking about. Unfortunately, user adoption is pretty low compared to typical continuing medical education, at least in our experience of administering online CME. I wonder if the patient couldn’t become a participant in this. Seems like that would be useful, especially when taken in aggregate across thousands of docs. Hmmm….
February 16th, 2009 at 4:54 pm
I think there are two main reasons people don’t ask for feedback, besides not thinking to:
1) it takes time to care
2) it uncovers your weaknesses
Asking for feedback requires an honest desire to get it, and enough confidence to process it appropriately.
Solid.
February 16th, 2009 at 5:10 pm
Most hospitals do care about customer feedback and have systems for patient surveys and stuff, but it is probably mostly anonymous, scores used for quality improvement, etc. You probably couldn’t have instant feedback like int he case of a coffee shop (because your not gonna know right away), but maybe there is a need for specific and targeted feedback on treatments (like, “Did the treatment work as expected?”). I would assume doctors are interested in this info. Patients should be encouraged to give it.
February 16th, 2009 at 5:28 pm
Nice post. In this era of measurement, physicians are now evaluated on six core competencies. At least two of these, communication and professionalism come into play in the sort of exchange you encourage. The nature of the exchange gives some feedback as well as testing, but Alex Hillman is correct, it’s not doctors, it’s the human ego that makes this such a lift.
February 16th, 2009 at 5:38 pm
I agree with Ezra’s characterization of where the resistance to such an idea might lie. Medicine is a science and as such, conclusions should be based on scientific study and the scientific method. Having direct feedback would naturally contaminate the physician’s perspective on treatment from having a basis in science to having a basis in anecdote.
The reason that feedback helps a barista and hurts a physician is that the value of a barista’s product is directly correlated to customer satisfaction. It could be argued that a large component of health is mental, and I do think that mental health professionals should have a feedback mechanism, but a physician’s quality assurance should be based on advances in scientific study and not on a drive to increase the number of “strongly agree”s on a survey. There’s a name for that: faith healer.
February 16th, 2009 at 10:26 pm
I think there is a difference between patient satisfaction with the service/experience and the outcome of their clinical problem given the diagnosis and treatment they receive. I’m sure there is room to improve both, but I think they are separate issues. The former is really something any organization can tackle by being customer and user-focused. The later is much more challenging because of the lack of agreement about quality measures, availability and agreement on medical evidence, patient sickness variability (Ezra mentioned), and systems/interoperable data to actually make it possible.
I think medical professionals need more than individual feedback for their clinical performance. I’m not sure if there is value in that or not. You’d have to ask them. Medicine, though some art, has really move towards science and being evidenced-based through randomized clinical trials, etc. I think more valuable are systems to roll-up performance and outcomes data so they can see their own aggregate results, trends, comparisons to others, etc. There are starting to be systems that do this and provide patient sickness severity-adjusted reporting down to the physician or health-care worker level so they can adjust their behavior for particular disease pathways to improve care.
February 16th, 2009 at 10:53 pm
I agree with the many thoughtful points that have been brought up in the comments. It is true that medicine is a much more complicated than making a good cappuccino.
And I realize that I have oversimplified a lot of what goes on in the medical profession.
However, I still can’t help put think that doctors and nurses learn from cases (or their experience). For instance, today our daughter’s doctor said that she has seen two cases in her career where the child looked well, but did have a serious infection. This doctor is a seasoned professional and her personal experience helped her make a medical decision regarding my daughter.
I am only advocating for more opportunities for this type of knowledge acquisition to be part of the modern medical processes. I bet there are lots of people out there working on this problem, and I know there are lots of great medical professionals that go out of their way to follow up on their patients. I would just like to see more opportunities for this to happen.
It grows out of the concept of a profession. Within a profession, certification is granted by other people in the profession. This is a necessary and important component of preserving and advancing knowledge in disciplines, but it also has the tendency to close down communication channels from those outside the profession.
To be clear, I am not addressing issues of patient satisfaction, I am thinking about ways for a doctor/nurse to easily see the repercussions of their recommendations.
March 2nd, 2009 at 12:31 am
well said, finally a good report on this stuff
September 29th, 2009 at 12:58 am
Hello!
buy cialis , buy viagra , viagra , viagra , viagra ,
May 16th, 2010 at 6:38 am
What a lovely post! I’m so glad you decided to talk about it.