Tag Archives: no app for that

Staff needs should drive improvements


I sometimes go to the bank on a Saturday. It’s the only day when I can afford to take the time to pack a picnic and wait in the long queue with everyone else who can’t make it there during the week. This week I sold some unwanted furniture and decided I didn’t want to leave the money in cash. So I made my way to the shopping centre and then to the back of the queue and waited with parents who were trying, feebly I thought, to keep their bored kids taking all the leaflets out of their holders. The attraction I’m sure wasn’t the apparently lowest ever interest rates.

Then, and I could have sworn she simply apparated Harry Potter style, a teller sidled up and asked what business I had at the bank. I explained my need to deposit money so she led me quietly outside to the ATM. As if talking to someone very old and deaf she explained that I did not need to queue to deposit money. It can all be done via an ATM. She talked me through the process, waited till I collected my receipt and then smiling kindly waived me off to my next destination. This got me wondering how many patients feel the same way about taking the time to visit a clinic. Waiting in line even when their need is not urgent and when it may be possible for them to get what they need without the inconvenience of attending in person.

The secret to dealing with the problem is to reframe it as staff’s problem. I hope the bank teller is rewarded for assisting me, for taking the time to make some Saturday excursions to the bank unnecessary, perhaps even getting a high-five from her manager. She certainly needs to make a habit of what she just did. I bet even bank tellers prefer to have their exploits celebrated by bloggers than deal with grumpy people who have waited an hour on a hot Saturday morning.

The issue of improving customer service can be reframed as something to be tackled in response to staff needs. Only then will it be a sufficient priority for front line staff to act in response to a trigger- such as ‘there are now more than five people queuing at the counter’. It’s time for someone to see if we can send some people on their way sooner rather than later.

That was quite different from my experience with Rain man’s favorite airline. My flight to Sydney was diverted to Melbourne three months ago. The ground staff gave me a note to send to their customer service people to refund me for the flight to Sydney early the next morning. Three months later and despite following instructions the money wasn’t credited to my account. Eventually I found the number for customer service and after waiting what seemed a very long time spoke to a human being. She assured me I was given the wrong information.

You must claim the money from your insurer.

Nope. No can do. Your staff told me to send you the invoice and I will call you every hour until you credit my account. What your staff are telling your customers in these circumstances is not my issue.

That’s all it took. I got the money refunded before the second call. No good will generated despite, eventually, doing the right thing. It was much easier to hide behind the anonymity at a call centre. Little motivation, despite the ability, so not triggered to act to when the customer calls. How often does this happen in medicine? How often are front line staff put in the position of fending off demands from the customers even when the customer is acting in accordance with information received? This does untold damage to the brand. Our time is at least as important as those who provide services. We scarcely put up with shoddy service in other aspects of life. Why should medicine be a special case?

Picture by A. Currell

The power of the pregnant pause

313238312_3c0b16565f_zJohn made an appointment recently. Never seen him before. He shook my hand enthusiastically as he strode into the room. A forced smile. Lots of eye contact. A need to look brave. I remember noticing his hand was a bit wet and his deodorant was working hard. He had flu like symptoms, runny nose, dry cough, sore throat. He had taken a few days off and needed a certificate for this employer. That didn’t explain his anxiety.  He seemed to have come to the right conclusion about his symptoms. I examined his throat, listened to his chest, took his temperature and agreed it was probably ‘a virus’ and that he should be fit for work before the end of the week. Then he hesitated. A pregnant pause. Seemed a bit unsure and blurted out those immortal words

There is just one other thing.

I was expecting it. I’ve seen this before. Adult males who exhibit signs of anxiety in a seemingly ‘routine’ consultation. If I’d looked closely I’d have noticed the dilated pupils and slightly rapid pulse. Sometimes ‘John’ comes with a request for a ‘full body check up’. Nonchalantly declaring that he’s getting older. Occasionally he brings his wife or partner, or perhaps they bring him. But when he comes alone the potential agenda is quite short- an embarrassing problem- impotence or sexual indiscretion and a need to be screened for ‘those other infections’, prostatism or something like what brought John in.

I have a very itchy sore bottom.

A life long problem it seems. Been using creams for years. Not helping. Bleeding a bit too. He knew what was coming. Hence the anxiety. The erythema and excoriations around his perineum verified the history. He left with a prescription for a steroid cream and a request to make a review appointment. It wasn’t as difficult as he had imagined. I clearly had heard all this before and he was pleased to be congratulated for being brave enough to ‘do the right thing’. The smile was now genuine. The prescription tucked away into his top pocket. It doesn’t take a lot to work out that there is more to the patient’s need for medical attention then meets the eye. The ‘Flu thing’ is what he tells people why he needs to see a doctor. In reality it’s a lot more serious- not the eczema that remains undiagnosed but the fear that the ‘itch’ is never going to go away and can’t be brought up in polite conversation despite ruining his life. It’s worth offering every man the pregnant pause. They might spit it out, if you’ve done your job right till that point.

Traditional masculine traits intersect with other physiological, sociological and cultural aspects of men’s lives when deciding to seek help. Andrology Australia

Often the patient wears the hidden agenda on their sleeve. No data or app necessary, just be interested enough to notice.

Picture by Drew Leavy

The importance of touch in the medical consultation. There is no app for that

When people are scared or in trouble what they want most is to be touched. Information alone is never enough to satisfy the deepest human needs that bubble up when our bodies appear to malfunction. This was recognised generations ago and the role of doctor was socially ordained. Doctors are licensed to examine the body intimately. Any doctor who abuses this trust is severely punished. The examination provides the healer with the information required to make a diagnosis, but more importantly it comforts the sufferer through human contact.

When I was a ‘wet behind the ears’ GP trainee, my clinical mentor offered me two pieces of advice in relation to the medical consultation. He told me to always stand up to greet the patient as they walk into the room and to look for an opportunity to lay hands on the patient, even if only to take their pulse.

Innovators may be tempted to think that everything that takes place in the consultation can be distilled down to the exchange of information and advice. However the consultation is designed to promote healing by allowing people to express concern and empathy through verbal and nonverbal behaviour. The former requires excellent communication skills, the latter is conducted as a series of rituals: ‘inspection, palpation, percussion and auscultation‘. And even as the body is examined the patient needs to feel that the examiner is concerned and respectful. If this is done well, healing can begin, sometimes against the odds.

This has important implications for innovation in health care. It’s not possible to interrupt or diminish the direct association between the doctor and the patient with gadgets or gizmos. If we do we may lose more than we gain.