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Indication of fundamental problems where you work


Patient feedback surveys are fashionable. Every healthcare organisation feels the need to do them; hardly anyone does anything in response to the feedback unless it comes with the threat of a formal complaint. Yet we spend countless hours designing and administering the surveys so that someone can tick a box to say the job was done as per their Key Performance Indicators (KPI). I have to agree with others who have said similar things.

People who use the health service range from those who work in the service to those who have never been ill before. They may speak perfect English or require a translator. They may have a PhD or never have been to school. They may have come to collect a prescription or require cardiac surgery. They are about as different a group as it is possible to be.

If you really want to know what your patients /clients/ customers think of the service they received. Do one of the following:

  1. Ask the front line staff, not those who might be criticised if the feedback is bad, but the staff that sees that person before and after they have been served. I’ve mentioned them before.
  2. Sit in the waiting room and listen to those waiting talking among themselves.

But before you find out what the people you serve think, consider what they need and how you might respond if that need is not met. Do you have the wherewithal to fix what is most problematic where you work?  Where are the bottlenecks? What is in short supply? What leads to unhappy customers? Do you really want to know or by asking what you already know are you simply adding insult to injury? Why not ask instead how the customer would change the experience? Are you then willing to admit to the shortages in what is available? Are you willing to tell them that one of your staff is not coping with his /her job and letting the side down? Are you willing to say that your organisation is not willing to invest in order to change the experience for that customer? Before you commit to finding out what the patient thinks ask yourself:

  1. What do I already know that isn’t working?
  2. Why haven’t we done something about it yet?

If you want to know what your patients think and anything they say suggests a serious deficit, of which you as a senior stakeholder in that organisation were unaware, then you should be alert to the fact that you have not been keeping your eye on the ball.

Picture by Montecruz foto

An object lesson in caring for people facing difficult decisions


It was always going to be hard. The property market is super heated. Houses are selling at record prices, sometimes several hundred thousand dollars above the reserve. Coming from overseas and with no experience of auctions, our friends struggled to make any head way purchasing a home. They attended several auctions and soon realised that the first to blink leaves empty handed. Alpha males turn up determined to be the one holding the keys at the end of the day, emboldened by low interest rates.

They urgently needed support from a buyers agent. In the week before the auction the team took them step wise through the process urging them to focus on their choices and then sleep on any decision. They had one member of the team as their designated point of reference. The team included excellent communicators. Listening, reflecting and clarifying before summarising what they thought was being said. The inspections of the property were detailed and accompanied by photographs of every fault no matter how trivial. Comparisons with similar properties and their sale price were presented.

Our friends were urged to focus on the decision to buy and not to become distracted by technical aspects that required professional skills nor speculating on who might be competing for the property. They felt secure that the team would advise them if they were about to offer more than the market might be prepared to bid on auction day. At the same time they were given no guarantees and there was always an element of risk. A pre-auction bid was delivered within 24hours of the auction accompanied by a cheque as a full deposit on the property. The strategy was successful. The team sent them a huge bouquet of flowers and hand written card featuring a picture of their new home. Subsequently a series of messages on what the team had learned about the possible competition they might have faced at auction.

How often in healthcare do people face difficult choices- defined as choices that may result in unfortunate consequences? Elsewhere in the world a member of our family had a very different experience awaiting a hip replacement constantly worrying about issues over which he has no control such as appointments that he is powerless to organise. Rarely if ever feeling that he can focus on the decision to have the operation more than the technical aspects of how and why a hospital schedules surgery. During an illness doctors can do for patients all that a buyers’ agent might do for their clients. Perhaps that should be a quality indicator for those in healthcare where life and limb are at stake not ownership of bricks and mortar.

Picture by Picture by Neil Moralee

Work with employers to improve health


Annual profits confirm whether the staff of a company performed well. Profit margins, and the rate of innovation, closely reflect the health of the people who deliver that success. Employers are, and perhaps always have been, a key partner in the drive to improve the health of the nation. What has become a greater imperative to forge a partnership is the threat to profit margins from the looming spectre of chronic illness in epidemic proportions. Work is a vitally important aspect in most of our lives:

The average working American spends the majority of his or her waking hours on the job. Some of us live and breathe our work. Others of us work to pay our mortgages. Either way, the workplace has become an important source of social capital for millions of Americans – a center of meaning, membership, and mutual support. More than ever, we find our close friends and life partners on the job, we serve our communities through work-organized programs, and we use the office as a forum for democratic deliberation with people different from ourselves. Countless studies show that a workplace with strong social capital enhances workers’ lives and improves the employer’s bottom line.The workplace and social capital.

Similarly in Australia people spend most of their waking time at work. On average 34 hours a week . Sixteen percent of us work more than 50 hours per week. In contrast we spend 6-9 hours  per week doing house work and 6 hours and twenty seven minutes per day asleep. The impact of the working environment on health ranges from physical to psychological and can be both harmful and beneficial. Employers in most developed countries are therefore legally obliged to provide:

  • safe premises
  • safe machinery and materials
  • safe systems of work
  • information, instruction, training and supervision
  • a suitable working environment and facilities.

However there is much more that can be done to optimise the health of employees. The economic argument for this is clear and closely related to the rising incidence of chronic and complex illness among the working population. In 2002 approximately 59 per cent of global death was attributable to chronic, non-communicable diseases and the toll is projected to increase to 66 per cent by 2030.  The other outcomes that should worry employers is the prospect of premature retirement from the workforce.

It was found that individuals who had retired early due to other reasons were significantly less likely to be in income poverty than those retired due to ill health (OR 0.43 95% CI 0.33 to 0.51), and there was no significant difference in the likelihood of being in income poverty between these individuals and those unemployed. Being in the same family as someone who is retired due to illness also significantly increases an individual’s chance of being in income poverty. Schofield et al

A report by the Australian Institute of Health and Welfare in 2009 outlined the consequences of chronic illness and early retirement on the entire Australian economy. It concludes that:

  • People with chronic disease had, on average, 0.48 days off work in the previous fortnight due to their own illness, compared with 0.25 days for those without chronic disease.
  • The annual loss in workforce participation from chronic disease in Australia was around 537,000 person-years of participation in full-time employment, and approximately 47,000 person years of part-time employment.
  • For people participating full-time in the labour force, there was a loss of approximately 367,000 person-years associated with chronic disease, approximately 57,000 person-years in absenteeism associated with chronic disease and 113,000 person-years were lost due to death from chronic disease.
  •  Estimates of loss do not take into account lower performance while at work. Similarly, the effect of loss from participation in the unpaid labour force (carers, parents and volunteers) has not been accounted for. The estimates, therefore, underestimate the loss in workforce participation associated with chronic disease.

Therefore employers who wish to retain an effective workforce, and by corollary their profitability, need to invest in the well being of their workers. This responsibility extends beyond ensuring the physical safety of their workforce. A workforce that is under threat from an ageing population and an alarming incidence of retirement through ill health. If employees spend most of their waking hours at work then the following might concern the employer (click the links for the literature):

I believe health innovators who address these issues in their dealings with industry will discover an open door with massive potential for mutual benefit.

Picture by Vase Petrovski

The bean counters of BoGIn

5085594028_fc5d378a40_zThe bean counters at BoGIn (Bank of Good Intentions) noticed that some people came to the bank to get mortgage advice and others for personal loans. In fact there was a lot of money to be made by persuading people to borrow money. So they decided to make some reforms. A memo was circulated informing staff that customers will only be able to deposit money in the afternoons- it was to be called the ‘deposition clinic’. Similarly customers would only be able to make withdrawals on Wednesday mornings. Additionally this service would be manned by the most junior clerks who must have all their work checked by the bank manager who would also spend the day at meetings reporting his branch’s performance on key performance indicators.

Customers who withdraw their money are not good for business.

Bank tellers were ordered to ask every customer to fill out a form documenting how much they owe other banks. Customers must always do this before tellers can attend to any other reason the customer came to the bank. Forms must be completed with a black pen and the signatures witnessed by two independent adults. Bank tellers would earn a bonus every time a customer takes out a loan and would accrue points towards promotion if the customer takes out a mortgage at 5% above the cheapest rate on the market.

The bank managers and their staff were shocked. How was this to be achieved? However the bean counters pointed out that the shareholders required the staff to be accountable and there was a need to increase profits by at least 25% this year. A percentage agreed by the committee of bean counters advising the shareholders.

But we are doing so well. The bank makes a hefty profit and our customers are among the most satisfied in any industry. We offer a service. We listen to our customers. We try to help our customers achieve great things that keep our economy afloat.

The bean counters were not impressed and threatened to force managers to be recertified every year or lose their right to bonus payments. Many managers have since found alternative employment. Recently the CEO of BoGIn attended her branch to deposit a cheque. She queued for hours before she was first asked to complete a form documenting her debts and given a brochure on mortgages. Then she was informed she could only make deposits in the afternoon so she had to return the next day. The bean counters have been sacked and were last seen at the department of health next door.

Picture by DaMong Man

What do you want from your doctor?


Finding a good doctor is like finding a good lover: there are lots of anecdotes but no data Richard Smith

Our family has moved to an new city and we are looking for a family doctor. What would you look for if you knew a little about evidence based medicine? Would you want your doctor to have read the latest medical journals and could quote research evidence for every decision they make? New premises? New furniture? Free wifi? Short waiting times? A coffee machine? Text messaging? Internet booking? A PhD?

How do you choose a new dentist? A new hairdresser? Do you just walk in to the nearest premises and hope for the best? Do you ask your neighbours for a recommendation? Do you google the names you see in the phone book? The chances are you spend more time choosing a restaurant then you do choosing your doctor. And yet there is far more at stake other than a good meal or a hair cut.

For us in selecting a doctor nothing matters as much as the doctor’s interest in our family. Our new doctor may not have read this week’s medical journal but he or she will be curious about our family because they will want to understand the context of any symptoms . That isn’t simply limited to our medical history, allergies or genetic predisposition. It also means the fact that we have moved interstate, we have new jobs, renting for the first time in years and experiencing a number of other life events. They will take into account any support we might be receiving from friends or family and our satisfaction or otherwise with our decision to relocate.

If you feel the same way then you might agree that doctors, especially family physicians aka general practitioners, provide a relationship and not just a service. This is what we seek when we consult a doctor:

Their willingness to make eye contact, to listen actively, to pick up verbal and non-verbal cues, to be respectful  and unwavering in the opinion that our perspective on our bodies and its functioning is what matters the most. To our new doctor we will be free to make choices. They will see their role as adviser and advocate rather than enforcer of what’s best for us as determined by somebody else. The best doctors understand that they may not have all the information on which we make decisions but faithfully realise that we also want what they want i.e. what’s in our best interests.

I love this quote from Anatole Broyard:

What do I want in a doctor? I would say that I want one who is a close reader of illness and a good critic of medicine…I see no reason or need for my doctor to love me, nor would I expect him to suffer with me. I wouldn’t demand a lot of my doctor’s time, I just wish he would brood on my situation for perhaps five minutes, that he would give me his whole mind just once, be bonded with me for a brief space, survey my soul as well as my flesh, to get at my illness, for each man is ill in his own way.

We will choose our next doctor based on how we feel not what we think. Is that a good thing? It’s not logical, but it’s the only basis on which humans make the most important decisions in life.

Picture by frances1972

Willingness to pay


Often what we need from health care providers isn’t a specific product or service but to be signposted to the best that’s available even if that isn’t something they are able to provide on the premises.  That was the conclusion to a paper just published in which the researchers asked West Australians whether they would pay to be better advised about their symptoms at a community pharmacy. The majority said they would even though the advise they would receive was to go and see their general practitioner. What’s remarkable about these data is that people are already able to get ‘free’ advice from their local pharmacy. What would make them reach for their wallets is if that advice was delivered systematically, in private and with reference to an evidence based protocol. What’s more the enhanced service included a written referral to a general practitioner, something tangible, something that might be helpful when negotiating an appointment at the clinic.

In the published study people were shown a brief video of what they already experience followed by a video of what a ‘quality enhanced’ service would look like. They were then invited to vote. The results were clear they don’t value what is but they already like what could be. What might drive such innovation is the notion that the public will pay out of pocket for something that is perceived as offering better quality.

Better quality does not mean making a diagnosis if that is not a reasonable expectation. However it is about making the most of what is possible so that the patient’s need is met in this case to have their concerns validated. You don’t need to radically redesign for a  quality service, above all it means making sure you ‘see’ the person who has chosen to seek your help. In what circumstances are you unable to offer what’s ultimately needed but are able to facilitate access to it? For that you will be rewarded, because your customers will want you to thrive. Find that opportunity and either re-engineer or rehearse your response.

Picture by Dwayne Madden

Prepare to avert a drama in a crisis

128886598_e895d6d0a0_zWe were dismayed that there were no seat back screens for our five hour flight back to Perth and there was a feeling of foreboding as we took our allocated seats on what was clearly an aged plane. As we were taxiing onto the runway the pilot made the fateful announcement:

I’m sorry to report that a warning light has flashed in the cockpit and I must return to the terminal for engineers to investigate. We regret the inconvenience caused.

When we pulled back into the gate the pilot turned off the engine and engineers boarded the plane. 45 minutes later the pilot was heard to say:

Ladies and gentlemen I have good news and bad news. The good news is the copilot has just become an uncle (applause rippled through the cabin). The bad news is that we have discovered another fault on this aircraft and we will be off loading you until safety checks are completed.

We gathered our belongings and when the seat belt signs were turned off we filed back back into the terminal. Everyone headed to the desk where the ground staff were busy apparently seeking telephone advice from supervisors. They seemed oblivious to the many anxious faces queuing for information. Ominously the crew wheeled their luggage past and headed off down the corridor. Some of the 400 passengers pushed their way to the front of the queue and demanded information. These eventually passed on the news that the flight was cancelled. Some people walked away muttering that they had given up on the airline and would stay the night. The rest of us waited for a couple of hours returning to the desk every few minutes, still ignored by the staff until eventually one said that frequent flyers would be boarding the later flight to Perth the rest would have to take their chances with other airlines or stay the night. Surely that was always the plan from the moment we were off loaded?

In such a situation the behaviours the airline would wish to see are:

  1. Staff know what to do and are instantly at action stations, reassuring, advising, assisting and redirecting. Effectively minimising the damage to reputation.
  2. Passengers queue in an orderly fashion, remain calm and reassured that the airline has a plan B. Making it less likely to make a drama out of a crisis.

The pilot could not be faulted he knew exactly what to do in the event of a potential emergency. However ground staff struggled to be polite much less organise themselves to inform all the passengers what contingencies were in place when one of their aging fleet of planes was unexpectedly deemed unfit to fly. Consequence- very unhappy customers who will blog about their experience and write complaints.

This happens in medicine all the time. The surgery is cancelled, the medication isn’t in stock, the patient has a cardiac arrest, the transplant organ is rejected, there is a flu epidemic. What makes a difference is anticipating such a crisis. Medicine too often gets this aspect wrong. Surgeons, like pilots, usually do exactly the right thing- abort the procedure, delay the treatment or place the patient in intensive care. However that isn’t the end of story. If we claim, as medicine does that we aim to support the patient through the crisis, disruption, shortage or adverse event then we need to do more than simply hope they don’t turn up at reception to ask the difficult questions. Flights are cancelled on a regular basis as is surgery. This is a set play just as everyone is shown the brace position on boarding the aircraft and as the safety announcement states:

You must know this instantly in the event that there is an emergency

However ’emergency’ isn’t just a threat to life and limb. Emergency is also a situation where there is a substantial and immediate risk to the brand. The staff behaviour did not trigger the desired behaviour from the customers. And as anyone who has done an Advanced Trauma Life Support course knows the noisiest patient isn’t the one whose life is at greatest risk. Find the one who really is going to die without a timely intervention. It seems the airline policy was to attend to those customers who were most vociferous. Many of us deemed it rude to push our way to the front of the queue. But those who had no such compunctions were rewarded with boarding passes to the few flights leaving the city that evening. We can all learn from these experiences. Health innovators have something to offer the airline industry. An industry that remains the leader in safety but not in customer service.

Picture by Alex Avriette

Prepare to say no


For 10 years I have ridden my 50cc scooter on the streets of Perth, Western Australia. I now want to take my scooter to other parts of Australia- but alas the laws in some states won’t allow it. In WA you can ride a scooter on a WA car license, elsewhere, mostly you need to do a motorcycle test.  Nonetheless I decided to speak to the people at the licensing offices. May be someone would find a way around this. Several people in officialdom seemed irritated that I was making life difficult on the 2nd of January with an office packed full of teenagers doing their test. They vaguely looked at their computer and told me to speak to the licensing offices in the other states. I already had. No one had a definitive answer. Eventually I was ushered in to do a theory test- despite the fact that I had a valid license that allows me to ride my scooter in this state. Having passed the test in about 5 minutes I was ushered to counter 18 to speak with Jayne ( not her real name). She said what I was thinking:

This is ridiculous. Did anyone speak to a supervisor?

I didn’t think so. I didn’t want a motorcycle license. I just want to ride my Vespa moped in other places in the country. My existing license needs to indicate the inclusion of the class ‘RN’. A class that is already incorporated in my ‘LR’ designated license. She looked concerned:

If I can sort this out today, I will refund the money you have just paid for that test.

She spoke to her supervisor, I saw it happen. Then she went to the ‘big boss’ in the office next door. Through the glass window I saw her pleading my case. She eventually told me what I had already guessed- I would need to do the test although I was apparently already qualified. The authorities could then indicate that I had formally been tested and could add ‘RN’ to my license. I’m dubious but that’s the best that was on offer.  Throughout her dealings with me Jayne was empathic and supportive.

If you have any problems on the day of your practical test please don’t hesitate to ask for me at this office.

This was an object lesson in how to enforce the rules even when saying no. We decline requests in healthcare often:

Patients often arrived at the office armed with complex and marginal information from the Internet that was inconsistent with standards of care. Sometimes, if the patient’s spouse was enrolled in a separate insurance plan, the patient moved to a second “primary” provider through that plan to obtain the desired referral. Even if I work with a different kind of patient population in my new practice, I would like to know how to handle patients who insist on having unnecessary and expensive diagnostic studies performed or request treatments of dubious benefit. Victoria Maizes

We need Jayne’s skill in handling these situations. In soccer terms this is a set piece play.

Be Prepared: know exactly WHAT your responsibility is;
Be Organized: know exactly WHERE on the pitch you should be;
Be Aware: know exactly WHO is where at all times;
Be Active: know WHEN to move and HOW to get where you need to go — Get to the ball!

Circumstances in which we have to say ‘No’, are easy enough to predict in health care. Not all of them are curved balls. Our team needs to be prepared for a situation when the ball is kicked out of play. Jayne was motivated to give me what I wanted but because she was not able to, my request did not trigger the response I desired. She took longer to deal with my problem than she needed to. She demonstrated that she was indeed not able. I was in the office at least 90 minutes. She asked me to wait while she investigated and dealt with other customers.  She went above and beyond the call of duty. She offered to reimburse me if the rules were wrong. She made eye contact. She smiled. She showed empathy. In the end I will do that test and whatever the outcome I will write to the licensing office in praise of Jayne. Her job is to apply the rules, not write them. She need never see her customers again and can remain yet another faceless person there to enforce the rules even when they are daft.  In health care where continuity of care matters, we cannot simply vanish into the ether like yet another public official. Denying someone something that they feel might help them, or that they are entitled to may have greater consequences than the right to have a toy on the street. On the occasion when the patient is unable to trigger the response they wish from us their relationship with us is strained. We need to be prepared to say no but to retain their trust.

Picture by Carlos Fronseca

Personal choice versus social responsibility- compassion before all.

9363012140_4304b8498b_zAt 52 years of age Suzy knows better. She is unemployed and divorced, again. She takes her antihypertensive only very occasionally. She is obese. Often sleeps rough, drinks far too much especially when flush with social security payments and is frequently at the emergency department with injures following a binge drink or a fight. Her destiny is to become a statistic.

Nothing is more evident in the statistics of public health than the role played by individual health behavior in contributing to accidents, illness and disease. Daniel Callahan

In a now classic series of studies Lester Breslow and his associates revealed that men who successfully adopted seven good personal health habits had lower morbidity and mortality rates than those who followed six; those who followed six of the habits had better health and mortality outcomes than those who followed five; and so forth. Kayman, Bruvold, and Stern demonstrated that individuals who develop their own diet and exercise plans are more successful at achieving and maintaining weight loss that those who play a more passive role. Each year, millions of smokers successfully quit the habit (albeit usually after several attempts), and most who do quit do so on their own.  Individuals have a fundamental right, based on the principle of autonomy, to choose health-related behaviors. Yet, with this right, so it is argued, comes a responsibility to make wise choices. Herein lie the strongest case for innovations targeted at the individual.

It is often supposed that given information people will make the right choices. Suzy knows that when intoxicated she is likely to injure herself, she has been advised that she is at significant risk of cardiovascular disease and is aware that her junk food diet is likely to maintain her BMI at 35. She has had bariatric surgery but she had the surgery reversed. Knowing is not enough. So one point of view says:

Being ill is redefined as being guilty. MH Becker

At the same time epidemiologists such as S. Leonard Syme have pointed out that people at progressively lower socioeconomic status (SES) levels have correspondingly less opportunity to control the circumstances and events that affect their lives. Conversely, for individuals at higher levels, factors like higher income and greater discretion, latitude, and control over their lives may contribute to a more generalized sense of “control over destiny, ”which, in turn, may translate into enhanced health behaviours and health outcomes. Suzy  could be, and is, stigmatised. Conservative governments have used the rhetoric of personal responsibility for health to justify cutbacks in needed health and social programs. Only this week the Australian Government was urged to consider a proposal in which

about 2.5 million welfare ­recipients on “working-age ­payments”, including disability support pensioners and carers, would be forced into a cashless world where 100 per cent of their payments were income-managed and they were banned from purchasing “prohibited” goods. The Australian.

Meanwhile concerted efforts have been made to support Suzy to lose weight, drink less and take more exercise. Clearly none have succeeded so far. Suzy may turn things around despite previous failures. On the other hand if she is forced to use her social welfare payments for food she may trade food for alcohol, and it’s unlikely to be a fair trade. Suzy’s response to life, may be a factor of the attitudes she comes across on the street. How do you innovate against disdain?

There is no question that her poor choices have landed Suzy in trouble. But no one who takes the time to listen could possibly believe she doesn’t want better. One day we might find the trigger for a radical change. In the meantime what Suzy needs most is someone on her side. She needs continuity of care, someone who understands the complexities of her deeply troubled life, someone who knows the actors and can interpret her cries for help, often couched in somatic terms. As her clinician she deserves my undivided attention anything that comes between us would detract from the chance that she will one day reinvent herself. ‘Suzy’, as described, doesn’t exist- but the elements of her story are true for many who seek help from their general practitioner.

Picture by Kat N.L.M.

How to make data more valuable

The 1st of July 2014 will be forever etched in my memory. On that date I woke up and peered across the bed to the window. Realising by the half light it was just past dawn I wondered why there was another body in the bed. It should have been at the gym. So I turned over and put my arm around her. I registered she was looking straight at me. She then uttered the words no man wants to hear who hasn’t planned for it. ‘Happy anniversary darling’. In the micro seconds it took my male brain to weigh up a response, her female intuition had already worked out my dilemma and laid the charge. ‘You’ve forgotten haven’t you?’  Guilty. I had forgotten. The rest of the day was spent demonstrating that 1. I loved her and 2. regretted forgetting our special (and easily remembered) date. It would have been so much easier to focus on one rather than both. A stitch in time and all that.

Later in the week I received what looked like a court summons with an official looking government stamp on the envelop. The letter inside read:

Dear (first name, last name),

Did you know that around 80 Australians die each week from bowel cancer? ..blah, blah , blah,…inviting people turning 50….blah, blah,.. faecal occult blood test kit with instructions…sent to you in the next few weeks…blah blah. If you are already being treated for bowel cancer contact….during business hours.

Yours sincerely,

Scanned signature

Chief Medical Officer.

Not ‘Happy birthday this is a big one mate!’ Not ‘We want you to stay healthy and happy’. No connection with me. Just a cold request to take a government funded test now that I have reached an age when my bowels are more likely to turn on me. Were they concerned about me or the statistics? This lack of connection may be part of the reason most people fail to participate in what is a life saving program.

Still later in the week my reception staff told me that a patient had left something for me in the staff room. Also being an Indian he anticipated my penchant for curries and had prepared a small feast as a thank you. Instant connection. I felt appreciated. I pulled out my pen and drafted him a note. The government invitation on the other hand, though it may save my life didn’t have the same impact. Sure I’ll take the test but only because I know it’s a good idea.

People who chose to share intimacies with us want to know that we really see them and that they matter. Medical practitioners and general practitioners in particular document all sorts of information about their patients; height, weight, gender, waist circumference, family history, alcohol and tobacco consumption, sexual orientation, menstrual history, temperature, blood pressure, pulse, heart sounds, medications, allergies, etc. How about their date of birth? Anniversaries of births, deaths and marriage? Why don’t we collect and use this information to make a connection? What I would have appreciated from my doctor in April this year was a hand written card that said something like:

Happy Birthday Moyez! Thank you for letting us be part of your life. We wish you health and happiness always. Don’t forget your wedding anniversary 01/07/2014! This year you can help keep yourself in good shape by taking the bowel cancer test, someone will write to you about that soon. To mark the very special occasion of your 50th birthday we have donated $20 to Medecins sans frontieres  Australia ( Please stay in touch and call us if we can do anything to help you stay in good shape this year.

If a practice manager at an average Australian general practice searches their database for every 49 year old who visits the practice, I guess the list would contain a 100 souls at most. A 50th birthday card would cost the practice less than $25 including the donation. The goodwill that would generate would be priceless and make all of our lives better. As experts have noted:

GPs who initiate discussions about screening with underserved population segments in particular (e.g., those aged between 50 and 55, men, and people from a non-English speaking background) are in a unique position to decrease inequity in health outcomes and improve morbidity and mortality from bowel cancer. Carlene Wilson