I’ve been digging into the Pew Research Center’s report on “The Shared Search for Health Information on the Internet”, which was released last month. While it offers a wealth of information, I was particularly interested in the assertion that the Internet and its various applications acts a supplement to health information and can speed information exchange. While this isn’t a particularly startling fact, it includes an important word that should reassure healthcare providers who express concern that the Internet will supplant a healthcare professional’s advice.

The key word is “supplement.” According to the report, “American adults still continue to turn to traditional sources of health information, even as many of them deepen their engagement with the online world.” The report finds that 86% of all adults ask a health professional, such as a doctor, for information or assistance in dealing with health or medical issues.

That fact was highlighted here at Talstone when a woman posted an interesting comment to one of our previous blog posts – D.J.’s 10 questions with Dr. Kevin Pho. Apparently seeing the validity of an “M.D.” on the blog, she provided us with a full description of a recent lab result and asked our opinion. Actually, she asked Dr. Pho’s opinion. While we are always happy to a get a blog comment, D.J. had to inform her that we are a healthcare marketing firm and she needed to contact a healthcare provider.

That one example lends credibility to the survey result that 66% of Internet users have looked for specific information about a disease or medical problem, followed by 55% who have looked for information about a certain medical treatment or procedure.

Social media, social networking, mobile and wireless opportunities – they all provide a rich platform to supplement, inform, influence, and effect healthcare change for the better. But none of them negate the need for healthcare information that is valuable, pertinent, accessible, and meaningful. Content still reigns and the expertise of a provider is highly valued. The Pew study shows us that while it is vital to know how a person looks for information, it’s crucial to understand what they are looking for. Filling that need should prove an opportunity to providers everywhere.

GiggleMed.com material comes mostly from a two doctors who choose to use pseudonyms and one graphic artist. Their aim is bring positive aspects of humor to an increasingly stressed healthcare workforce – a sort of morale healthcare reform initiative.

DJ: How would you describe your audience?

GiggleMed: Most are in healthcare, and nearly all have Glasgow Coma Scores greater than 10.

The audience is made up of nurses, physicians, techs, pharmacists, medics, social workers, therapists – basically everyone in healthcare – and we’re all pretty stressed. We are being hit from a whole host of angles and most of them are outside of our direct control.

You know, it’s stressful enough when you’re responsible for someone else’s life, someone else’s wellbeing. Now add time constraints, being inundated with forms, hyper-analysis of our documentation, the threat of litigation, administrative bean-counter metrics, hard economic times, etc. Oh, and we also have to know our profession – the medicine, the procedures, the processes, the protocols. Across the board we are spending more time with paper and computers than we are with people. And that wears on us. It wears us down. Mostly because it is not why most of us are here. We’re here to help people.

Now add to this environment the fact that healthcare is highly specialized. And like other professions (law, architecture, engineering, sales, internet marketing, drug cartels, prostitution, etc.), it has its own language. We don’t call it “itching,” we call it “pruritis.” Whenever a group has their own language, there can be a unique humor that surrounds that language.

So to finally answer your question, the GiggleMed audience includes anyone within the Global Healthcare-Industrial Complex who feels stressed, or just wants to smile, or both.

DJ: Where did the idea for GiggleMed come from?

GiggleMed: It all started when that bed pan fell on my head…

Actually, the idea for Chart Farts® came first. While preparing for an ultra-stressful, in-your-face, grill you kind of presentation, I came across a medical malapropism or charting blooper. Another resident wrote in the patient’s chart “non-verbal, non-communicative, and offers no complaints.” Of course, I thought that wording was hilarious. I pointed it out to a few nurses and another resident, but then I moved on, preparing for the stress of my presentation.

Well, I’m not sure what came over me, but I added it to the end of my slide presentation. I added it at the very, very end… after a blank slide, just in case I wimped out and decided not to use it. Picture this… there I was… a nervous medical resident, about to give my first presentation at a critical care morning report conference. All of my peers were there – interns, residents, and medical students – scary in its own right. But also, the Chief of Medicine, the residency Program Director, the Director of the CCU, the Chief of Pulmonary Medicine, and several other supervising medical physicians were there. You can imagine that it would take some cajones to actually go through with showing that slide.

Well, I gave my presentation. I waded through some rolling of the eyes. I fielded some tough questions that interrupted my presentation and, overall, I was handling myself pretty well. So as I fearfully approached the end of my talk, the part where residents get ripped new orifices, I decided, “I’m gonna get ripped if I don’t show the slide, so who cares if I get ripped apart showing it.” (No resident feels good while another resident is being completely humiliated, so I could at least lessen the blow for the onlookers with a little humor.)

So I showed it and I put it up there right before the questions would begin. And guess what? Not one question. Not one new orifice. Instead, a bunch of deep belly laughs. So I tried it with the next presentation a few weeks later and got the same thing. No questions, tons of compliments, and lots of smiles.

I was onto something and I actively looked for these things. I called that first slide “Medical Terminology 101.” Soon people all over the hospital were sending me these bloopers. I was amazed at the number of these things. I posted them on a Web site that I made for the department. At that time I continued to call it “Medical Terminology 101.” It was a big hit.

One night, right after passing 150 malapropisms on the list, it came to me – “chart farts.” I jumped out of bed at 2:47 a.m., and I mean jumped, and I bolted to my computer and registered ChartFarts.com. ChartFarts.com skyrocketed to the point where there are thousands of original medical malapropisms. I officially trademarked the phrase Chart Farts®, because the word “malapropism” doesn’t imply humor. In fact, I thought, “chart farts” should completely replace the term “malapropism.” No other phrase really captures the way these things interrupt and punctuate the reading of a professional document.

Well, when I decided to start making related products – medical humor-related shirts, mugs, books, stickers, etc. – I realized that “farts” is no name for a site that caters to health professionals, at least not the mature ones. So I came up with a list of about 40 possible names and emerged with GiggleMed. GiggleMed.com, LLC was formed in 2006.

DJ: On your Web site you tell the story of offending a representative of The Joint Commission with a T-shirt you were wearing. Have you had problems with anyone else?

GiggleMed: So far, no one else…

Now, I must say that one Joint Commissioner does not necessarily represent the feelings of everyone at the Joint Commission. Besides, the shirt only said, “Joint Commission Came & All I Got Was This Lousy T-Shirt.” If you’re offended by that, you should probably be scheduled for sphincter manometry and be given a prescription for Chill Pills BID.

Aside from that one Commissioner, no one else has been offended or upset enough to complain. I think we have a pretty good rule to curb the middle school instincts in our humor. Basically, anything more crude or offensive than “fart” is first passed through the “Wife test.” If our wives (also physicians, but with higher standards) get upset, we don’t post it. And if either of us ends up sleeping on the couch because of it, we remove it from our “idea folder.”

There has been a very rare naysayer or non-believer in the originality of the Chart Farts. In general, they don’t realize how ubiquitous these things are. One person accused me of regurgitating old malapropisms from other sources, but the fact is some of these things repeat. The more common repeats are “chicken pops,” “grand mama seizures,” “Eurosepsis,” “very close veins,” and “fireballs in the uterus.” These are common enough that I’ll probably hear or see at least two of these in the next week.

DJ: It has been said that laughter is the best medicine. Do you think that healthcare is afraid of humor?

GiggleMed: Afraid of humor? No. Afraid of lawsuits? Yes.

Just like there used to be good humors and bad humors, now there is appropriate humor and inappropriate humor. Everything has its place and its time. And everything has its function, too. It’s not enough to say that it should not be harmful. Actually, it should also be beneficial when it occurs in the workplace, especially a workplace where there are people who do not feel well or may have received some bad news.

Inappropriate humor should be feared. There are certain humor red flags that should be avoided in healthcare, for sure. Jokes and mockery that are directed at an individual is one such example. Others include humor that is perceived to be politically charged, sexist, racist, or culturally insensitive. Not only could it be offensive, but it could become a problem for the one using the “humor” and the institution that employs that person. There could be professional and legal implications. And it doesn’t matter what you think of it; what matters is how it is perceived.

Now, that being said, every group begins to develop a culture if they are exposed to each other over time. In the management and administrative world, a lot is made of culture, and we wholeheartedly agree. If you’ve worked in a high-stress, look-over-your-shoulder, or backstabbing atmosphere, you know the downside to a negative culture.

Instead of just trying to avoid a negative culture, you can actually create a positive culture at your workplace. Some of it is top-down, like encouraging feedback and constructive criticism, or rewards and acknowledgement for good contributions, etc. Some of it can be top-down or vice versa, and one component is using humor appropriately.

We use humor in our workplace in a very directed way to drive a positive culture. The patient satisfaction and staff satisfaction rates are through the roof at our workplace. And people come right out and describe it as “both professional and fun,” even patients. When is the last time you heard a patient describe their experience in a hospital as “fun”? Let me re-phrase that – when is the last time you heard a patient with a negative urine tox screen describe their hospital experience as “fun”?

DJ: Your Chart Farts are quite funny and beg the question, what were these
physicians thinking?

GiggleMed: Need… sleep… Must finish… dictation…

Actually, Chart Farts are not limited to doctors. Doctors, nurses, transcriptionists, and patients are by far the largest contributors. There are a few other groups that sporadically contribute – such as respiratory therapists, medical secretaries, techs, and EMTs. There are even some from news media.

Chart Farts have several contributing factors that bear mentioning. Accents, poor penmanship, lack of knowledge, lack of experience, interruptions, and being too busy or spread too thin are the biggies. An example might be when a doctor with a thick accent is dictating and a transcriptionist that is unfamiliar with the procedure or diagnosis is transcribing what was said. The doctor says, “patent foramen ovale,” and it is transcribed as “a plate, a frame, and a valley.”

Sometimes it is lack of knowledge or experience when a new nurse or intern has to document something they are unfamiliar with. Their supervisor says, go get a Foley catheter and they document that a “Folate catheter” was inserted.

Interruptions are huge, actually. Questions, pagers, phones, machine alarms, etc. You’re cruising along in one train of thought and up walks another healthcare worker to ask you a question. You answer the question, but try to get back to what you’re doing, and BAM! You write something related to the conversation you just had.

There are times, even, when a transcriptionist’s macros cause the problem. “Dr. Rao” becomes “Dr. Right Anterior Oblique.”

My favorites come from the triage person in the ER writing down the patient’s own words. Either one of them could screw it up – put them together and it’s exponential.

DJ: Do people ever accuse you of trivializing healthcare?

GiggleMed: So far, not that we’re aware of. If someone does, we’ll probably just trivialize their accusation.

DJ: Do you think using humor (such as in your post about the C.diff sticker),
can change people’s behavior?

GiggleMed: Absolutely. With Chart Farts, I get people coming up to me regularly saying, “Whoa! I almost put a chart fart down today,” or “Those things are hilarious, ever since you’ve been sending them through e-mail I’ve noticed 3 or 4 times a day where I almost write one. It’s amazing.”

One physician I know tells all of the new interns on orientation, “Write this down. This is important. Your single-most important goal on this rotation … Are you writing this down? Your single-most important goal is to avoid saying or writing anything so stupid that I will submit it to ChartFarts.com.” Of course, he chuckles and it’s a joke, but he agrees that there is value in exposure to malapropisms. They’re embarrassing if you write one, but it’s a good embarrassing, unlike the orifice-ripping I alluded to in Question #1.

Now in the example you’re talking about, with the C. diff sticker, I wrote a post on the GiggleMed.com blog after my friend and colleague (the other GiggleMed doc) took a picture of someone’s morning coffee on an isolation cart. I thought, we tell people day in and day out about food and drinks at the nurse’s station and there are Joint Commission recommendations and regulations regarding it, there are hospital policies, there’s even disciplinary action but, frankly, these things are not working.

Instead, what if we put a GiggleMed sticker on there saying, “What’s a Little C. Diff Shared Among Friends?” with a small, somewhat serious warning under it? What if we put one of those on that drink? I bet you’d see more of a change than you do with all of that other stuff. Plus, no one will attribute the reprimand to their supervisor being a jerk or the policy being stupid. Your drink on the isolation cart is the problem, not your supervisor, not the Joint Commission, and not the policy. But let’s say it in a good, funny way.

DJ: Do you believe more healthcare professionals should follow your lead and
interject humor when helping patients?

GiggleMed: Like I mentioned before, there is a time, a place, and a purpose for humor. Not everyone is skilled at recognizing those times, places, or purposes. And not everyone is skilled at delivery, either.

Should everyone do it? Probably not.

But if there are healthcare professionals out there that have a good sense of appropriateness for humor, then yes, they should. Doing so could make an uncomfortable patient a little more comfortable. It could take a scared family member and let them know that everything is going to be all right. It could make a stressed out nurse smile, or a busy secretary laugh, etc. It can make this complex healthcare web a little more bearable for everyone.

DJ: What do you hope to accomplish through GiggleMed?

GiggleMed: World domination, of course, but we’d both settle for early retirement.

Our goals are several. Our tagline or slogan says, medicine is fun again. Healthcare used to be an admirable profession. It used to be enjoyable and immensely rewarding. It used to be that having a patient say, “You know what? You saved my life,” or “If it weren’t for you, I don’t know if I could’ve made it through that,” or a family member says, “Even though we lost Mom, I think she couldn’t have had a better nurse or better care than the care you gave her.” It used to be that these things were our fuel.

Now, though, we are looking at Patient Satisfaction survey numbers and where our institution ranks nationally. Where’s the humanity in that? It’s a stat, a marketing ploy. The question becomes, “How can we get a 10 out of 10 in this metric?” instead of “How can we make this the best experience possible for Mrs. Jones?”

Well, we want to restore that. It’s not all about humor. Humor is one component of our humanity. We want to make medicine fun again so that the right people are entering these honored professions, so that the ones we have don’t burn out, and so that we can make the healthcare experience better for everyone. If we make medicine fun again for the broad spectrum of healthcare workers out there, a cultural transformation will occur in healthcare that must not be neglected with all of these plans for healthcare reform.

DJ: What does the future hold for Dun Tzu and GiggleMed?

GiggleMed: Well, as you know, we use pseudonyms, and “Dun Tzu” is one of them. Dun Tzu is our subliminal attempt at discouraging malpractice lawsuits (Don’t Sue). In addition to Dun Tzu, we also have “Tony Below-Knee” which is a puppet with a South Philly Rocky type voice. His name comes from a Chart Fart where someone wrote, “Baloney amputation” (below-knee amputation). Also, it helps that the South Philly voice is really the only one I have any talent for.

Be on the lookout for several new forms of media for our humor -iPhone apps, musical parody, videos, video games, and more books. We do offer themed Chart Farts in fortune cookies for large gatherings, but we haven’t really started advertising that yet.

We are also exploring the behavior issues we discussed in Question #7 with plans for supplementing healthcare educational materials with humor. And there’s possibly a contest coming up. More on that later.

Bonus Question:

DJ: If you could change one thing about healthcare what would you change?

GiggleMed: Here’s ONE thing… One list of things I would (or would not) change about healthcare:

1. Get the word “healthcare” recognized by spell checkers throughout the world.

2. Eliminate the middleman – that’s you, Insurance Boy.

3. Launch a return to eponyms. They just sound cool, plus, they make me look smart.

4. Make all physicians and nurses who order or administer a medication or procedure first try it – in a hospital gown.

5. Disassemble all hospitals’ Forms Committees.

6. Hire ugly drug reps.

7. Eliminate “just wanna let you know” from nursing vocabulary.

8. Mandate penmanship classes for all physicians.

9. Institute a smoking ban for all respiratory therapists.

10. Form a large oversight committee that could randomly show up and inspect the Joint Commission offices, protocols, and processes. And maybe another task force to provide oversight for that committee.

11. Put public service ads about prostate health on all public urinals.

12. Formally institute a Code Brown Rapid Response team for the comfort of our patients, their guests, and anyone else within nose-shot of the nurse’s station.

13. Start a nursing reality show about what exactly happens when nurses are “on break.”

14. Replace patient call bells with Twitter accounts.

15. Change the name of Go-Lytely to Go-Profusely.

DJ: I would like to offer a special thanks to GiggleMed for taking the time to answer our 10 questions. It has been an absolute pleasure getting to know Dun Tzu. I’m sure our readers will agree that healthcare can be fun again. If you would like to learn more about GiggleMed you may visit their sites which include:

http://GiggleMed.com (blog/home)
http://twitter.com/GiggleMed (Follow GiggleMed on Twitter)
http://ChartFarts.com (medical malapropisms)
http://JCAHOfun.com (Joint Commission humor)
http://cafepress.com/gigglemed (funny medical humor gift store)

If you or someone you know would like to be interviewed for The Pulses’ “10 Questions With…” please e-mail dj@talstone.com with a brief explanation as to why you or someone else should be interviewed along with contact information. You can also follow DJ at http://twitter.com/TalstoneDJ. Until next time – keep your pulse strong.

A while back I missed the first step of our stairs at work and gravity took over. I landed about eight steps down. I didn’t think anything was broken, but on the way home my whole body, particularly my thumb, which I had managed to twist under me when I landed, began to ache. By the time I pulled into my driveway it was swollen, immovable, and the pain was excruciating.

The rest of the evening was spent in the ER. X-rays revealed the thumb wasn’t broken, but the doctor thought I had torn a tendon and would need surgery. He referred me to a “hand doc,” whom I saw the next day. Fortunately, the surgery was never needed. I healed just fine. I saw the doctor for a follow-up visit and went on my way.

Here’s the thing – a full FIVE months later that doctor’s practice sent me an e-mail asking me to fill out a patient satisfaction survey. By then, I couldn’t remember his name let alone the number of particulars the survey wanted me to recall. I had had a positive experience, but they waited so long to ask me about it I could offer them no real information.  I never took the survey.

Timeliness is of the utmost important in gaining feedback. When was the best time to ask me about my experience? How about right after the experience? The next month I received a holiday greetings e-card from. After that, I heard no more. I’m still puzzled about their strategy.

We hear a lot in marketing strategy about messaging, tactics, and tools. But we also can’t forget the importance of timeliness in cultivating relationships with an audience. The iron cools very quickly; we need to strike while it’s still hot.

Recently, my father had shoulder surgery to clean out some adhesions and repair a tear in his rotator cuff. The surgery went smoothly, and as we left the hospital with a phalanx of the sling, pain pump, cold therapy igloo with hoses, and a prescription for some pain meds, the nurse told us, “Doctor Riley will call you tonight to see how you’re doing.”

“Really?” Mom asked.
“Yes, he calls all his patients after surgery,” the nurse replied.

I was impressed but skeptical. After all, doctors are busy people. As the afternoon wore on, issues began popping up. The nurse gave us different directions than the physical therapist. The pharmacist gave different directions about the pain meds than the doctor. We were anxious about Dad’s shoulder exercises because everyone impressed upon us the need to do them religiously three times a day so his shoulder wouldn’t freeze up. But the nurse told us to keep the cold therapy on at all times, which made the exercises difficult. Confusion and worry reigned.

Then, just a little after 7 p.m., Dr. Riley called. He patiently listened to all of our questions, answered them to our satisfaction, and then said with a chuckle, “Now, I’d like to speak to the patient.” Dad’s face lit up as we handed him the phone.

Three days later we took Dad in to Dr. Riley’s practice to have the pain pump removed. While we were in the waiting room the doctor quietly walked in with a carton full of Starbucks drinks. We watched as he delivered one to each of his front office staff, and then asked us to come on back. Dad’s shoulder was healing nicely, and we were sent home with a good report.

It doesn’t take much to win a loyalty in a patient. In this case, a simple phone call from the doctor made a huge difference to my parents. And a gesture of kindness to his staff reinforced their opinion that this was someone who cared.

They still tell their friends about the phone call, and here I am blogging about it. Little things mean a lot.

This week our 10 Questions With… series interviews healthcare attorney Amy Fehn. Amy has been counseling healthcare providers and other covered entities on the HIPAA Privacy and Security Regulations since their inception. Prior to graduating from law school, Ms. Fehn was a Registered Nurse at Summa Health System in Akron, Ohio, and later worked as a clinical systems analyst for the hospital’s clinical information system.

Ms. Fehn has authored and co-authored numerous articles on healthcare issues and has spoken on HIPAA to various local and national organizations. She is the co-author of workbooks on HIPAA Privacy for the Michigan Osteopathic Association (MOA), the Federated Ambulatory Surgery Association (FASA) and United Communications Group and is the co-author of a workbook on HIPAA Security, published by United Communications Group. She was also a member of the State Bar of Michigan’s HIPAA Task Force.

DJ: Why are so many healthcare organizations fearful of HIPAA?

Amy: I think they are afraid, and rightfully so, of complaints to the Office of Civil Rights and also negative public perception if patients perceive that they are violating HIPAA, even if they technically aren’t. The problem with HIPAA is that many areas aren’t black and white but instead allow some discretion or judgment calls on behalf of healthcare organizations. Organizations don’t want to take chances by authorizing too many people to make judgment calls, so they implement policies and procedures that might be stricter than they would technically need to be.

DJ: Many healthcare professionals feel that HIPAA blocks effective communication and education. Is that a fair assessment?

Amy: HIPAA should never block communication that is related to patient care, because any uses or disclosures for “treatment” can be made without an authorization or any “permission” on the part of the patient. It also shouldn’t be a barrier to most education because training programs are considered “healthcare operations,” for which uses and disclosures of protected health information can also be made without patient authorization.

DJ: Do you think there is enough emphasis placed on educating healthcare professionals and consumers on HIPAA?

Amy: I think that larger entities definitely get the fact that they need to educate employees and have processes set up to handle it. I usually find that smaller entities do a good job with initial training but aren’t as likely to have processes set up for training updates and reminders.

DJ: Henry Ford Hospital recently used Twitter to “tweet” a surgery as it occurred. Many people thought that such communication was a HIPAA violation. Did a violation actually occur?

Amy: I don’t know that I have all of the facts; but, to my knowledge, they did not post any identifiable information about the patient. If information is adequately de-identified then it is no longer considered “protected health information” and is no longer subject to HIPAA protection. I recently wrote a post on my blog about the identifiers that need to be removed for information to be considered “de-identified.” They also stated that the patient consented to have the surgery posted on Twitter, so they may have had a HIPAA authorization signed as well.

DJ: Can a healthcare organization or professional effectively use social networking tools, such as Twitter, without fear of violating HIPAA?

Amy: There are ways to use Twitter that would not violate HIPAA, as long as the healthcare organization is not posting protected health information about patients. If the patients choose to post their own health information or identify themselves as a patient, that is their prerogative. My only concern would be to make sure that patients understand that it is a public forum and to not in any way solicit or encourage the posting of personal health information in a public forum, unless the patient signed a valid HIPAA authorization specifically for that purpose.

DJ: Regarding HIPAA, what should a healthcare organization be aware of when marketing themselves?

Amy: Again, they can’t do anything that would include the disclosure of protected health information (otherwise known as individually identifiable health information) unless they have an authorization signed by the patient for that specific purpose. Healthcare organizations are also limited on the types of mailings or e-mail campaigns they can send to lists they derived from their patient admissions. For example, a healthcare organization would be able to send a notice about other services offered by their organization, but they couldn’t use their list to market another entity’s products (although there are exceptions for certain care management communications tailored toward a specific patient).

DJ: You wrote a great blog post titled “Analysis of Changes to HIPAA in Stimulus Bill.” What do you see is the most significant change to HIPAA that the stimulus bill makes?

Amy: I think that the biggest change is that healthcare organizations can expect greater enforcement because the new revisions empower state attorney generals to bring lawsuits for HIPAA breaches. Also, the new law states that future regulations will allow patients to share in a portion of penalties which will incentivize patients to voice complaints.

DJ: If a patient signs a HIPAA authorization form and decides to share their personal health information, is the healthcare provider still at risk?

Amy: The patient can share their own information even without signing an authorization form. It’s their information and if they want to post a copy of their information on the internet, that is up to them. As far as authorizations, once the information has been released pursuant to an authorization, it is no longer protected by HIPAA and there should be a line on every HIPAA authorization that reminds patients of that fact. So, for example, if I authorize a hospital to disclose my information to a disability insurance company and the disability insurance company wrongfully discloses it to someone else, it would not be a HIPAA violation on the part of the hospital so long as the hospital had a valid HIPAA authorization.

DJ: Has HIPAA gotten away from its original intent or has the lack of understanding caused it to become something larger than life?

Amy: It definitely depends on who you talk to, although nobody seems to be happy with HIPAA. Most providers see it as adding administrative burdens that don’t really change the protections they were already providing for patient information (health care providers already had a duty of confidentiality before HIPAA was enacted). Privacy advocates are critical of the law because they don’t think that it goes far enough and they also don’t think that it is properly enforced.

DJ: What impact does the recent CVS Pharmacy settlement with HIPAA have on healthcare as a whole?

Amy: I think it raises awareness and sets an example. It should cause all covered entities to take a good look at their disposal policies, especially with regard to items that can’t go through a paper shredder, such as empty pill vials or empty IV bags with patient names on them.

Bonus Question:
DJ: If you could change one thing about healthcare what would it be?

Amy: If I could change anything, it would definitely be access to quality healthcare for everyone.

I’d like to say thank you to Amy for taking the time to answer 10 questions with me. It was a pleasure interviewing her. If you would like to expand the discussion about HIPAA with Amy she can be contacted through her website at www.healthlawoffices.com. You can follow her blog as well as her postings on Twitter.

If you or someone you know would like to be interviewed for 10 Questions With…please drop me a line at dj@talstone.com. Thanks for reading.

I recently had a retired business executive give me a bit of sage advice. He told me not to waste my time on the one-thirders. The one-who? The one-thirders. He told me that in business there will always be one-third of the people who like what you do, one-third will dislike what you do, and one-third who couldn’t care less. The successful leader will find which group is most important.

In marketing one of the hardest groups to help develop strategies for is a committee. I don’t care what aspect of the planning process you’re in; when a committee is involved the smallest molehill quickly becomes a rather large mountain. Don’t believe me? At a creative directors conference I attended recently one creative director said that their firm would add an additional $10,000 for every person who is in the decision making process because design by committee is so difficult. But why does this happen? In part, it’s because of the one-thirders and if you’re not careful you’ll go insane trying to please them all. Who are these one-thirders?

The 1/3 Who Will Like What You Do

The one-thirders who like what you do will be the easiest to lead. They listen to the plan and any advice that’s given. They’re willing to ask questions from the position of learning. More often they are the early adopters of your plan and will eagerly offer thought and suggestions to enhance the project or team. These one-thirders have usually found a connection with you in some form or fashion and, as a result, establish a good working relationship with you. You need them to be champions for you but not yes men blindly following your lead.

The 1/3 Who Won’t Like What You Do

The one-thirders who don’t like you or your work are incredulous at best. Often you won’t ever find out what the source of their problem with you really is. It may be as legitimate as their experience leads them to believe you’re strategy is flawed or as asinine as jealousy. Don’t expect them to easily go along with you. In fact, you might find them to be a thorn in your side when it comes to feedback – either you’ll get more than you asked for (and mostly negative) or you won’t get any regardless of how hard you try. They’ll ask questions in hopes of tripping you up and making you appear to others as the negative image they have in their minds. You’ll have to spend more time and effort getting this group of one-thirders to actually adopt the plan and even your leadership – but you are just as likely to never get them to agree to follow your lead.

The 1/3 Who Doesn’t Care What You Do

The last group is a bit perplexing. With the previous two groups of one-thirders you knew where they stood. You knew their likes and dislikes and you could develop your strategy accordingly. With the group that doesn’t care you have a complacent group that is rather ambiguous. Former NBA coach, Pat Riley, once said, “When a great team loses through complacency, it will constantly search for new and more intricate explanations to explain away defeat.”

In many ways it may be more challenging to lead and work with a group that doesn’t care what you do than those who dislike what you’re doing. The reason being that any effort you are likely to get out of a complacent team player is likely to show in the final product. They don’t care what you do one way or the other and that lack of passion or purpose to their portion of the work will be affected. You’ll have to spend more time motivating and instilling the importance of the plan or project for them to be worthwhile.

All strategies and projects will have one-thirders in attendance. Some will follow you, some may vilify you, and still others won’t give a flip what you do. The key is in knowing who is in each group. Your approach with each of the one-thirder groups will vary. For one you’ll charge forward with great ease. For another you’ll be the villain and under constant attack. For yet another you will have to serve as a motivational speaker, cheerleader, and shoehorn. The question is which group will you listen and belong to?

The fact that you’re reading this blog means you already belong to the online world. Of course you’ve got a Facebook profile, LinkedIn account, and Twitter followers. You probably have a blog as well. The fact that you have a Web site is a given. Our world fast-paced, and it’s easy to cocoon yourself into thinking everyone connects the same way you do.

Yet while the online world grows, there is still a population out there who isn’t part of it and, frankly, never will be. This was made clear to me last week when I spent an exhausting day taking my 84-year old grandmother to the hospital for a transesophageal echocardiogram. After the procedure, the physician handed her a DVD, told it to take it to her cardiologist, and reminded her to tell him to make sure he turned off his pop-up blocker so he could view it.

“What’s a pop-up blocker?” Grandma nervously asked me later, thinking it had something to do with her meds. Her throat was sore, she was still groggy from the anesthesia, and her wrists were aching from the four attempts “to get a good stick” for her IV. Now she thought there was something else wrong with her.

Point is, don’t make any assumptions about how tech savvy a patient is. It was easy to explain to her the comment had nothing to do with her health, but if I hadn’t been there she would have continued to worry about, wonder if she needed to write it down, and then fret about insurance covering it – all due to a remark that had absolutely nothing to do with her health.

Often, it’s the least “connected” who are the most intimidated about asking their physicians to explain something simply because they don’t want to expose their ignorance. My grandmother will probably never own a computer but, at her age, she will see her physicians constantly. It would help if they understood what she doesn’t.

In the age of consumer-driven healthcare, more Web sites are popping up that encourage patients to review and rate their doctors. These reviews can range from sheer rants to glowing recommendations. At the time of this writing, RateMDs.com, one of the more popular physician rating sites, claimed to have some 186,642 doctors rated among 704,314 posted ratings. The Web site also claims a little over 2,000 ratings were added the previous day. A search on Google using the terms “doctor, review” yielded a whopping 24,400,000 entries.

It’s little wonder why more physicians are looking to squelch the chatter of their patients.  A recent article by Associated Press medical writer Lindsey Tanner, titled “Docs seek gag orders to stop patients’ reviews,” created quite a buzz about the mutual censoring topic. It included a response from the Medical Justice, a membership-based group formed to help physicians avoid frivolous lawsuits and Internet defamation and developer of the agreement used by many physicians to deter patients from reviewing them. The group’s Web site states: “We are not, in principle, against physician ratings. Patients want good information. But, facts matter. Honest – and useful – ratings will require a sophisticated understanding of outcomes research, risk stratification, etc.” The Web site goes on to say, “Our mission is to promote a transformational healthcare system where patients can make informed decisions using the Internet as one means. Patients rely on the Internet information highway for this now – potentially to their detriment.” Here are some things to consider when looking at both sides of the coin:

1. Physicians risk creating unnecessary questions in the minds of their patients.

Often the patient comes in for an exam or procedure with no intention of giving the physician any sort of review, good or bad. They just want their exam or procedure done and go home. However, when asked not to review the care or the physician attending them there is a risk of placing questions into the patient’s mind that was not there. Cognitively, the patient starts rethinking the exam or procedure and calls into question all that occurred – good or bad. In short, as the physician attempts to control the answer to “Will they give me a bad review” they in essence made the patient ask, “Did the doctor do something to me that I need review?”

2. Patients need to own the reviews they make.

Physicians, nurses, and any other healthcare provider can have bad days like anyone else. However, in healthcare, a disruptive behavior by a healthcare professional can result in serious problem for a patient (see our blog post “Doctors Behaving Badly“). When a patient feels threatened or wronged by their caregiver in any way they’re going to talk about it be it online or off. Everyone knows that more people will talk about a negative event that happens to them or that they witness than about a good situation. There is no doubt people intend to provide their impression of the care they receive. However, the patients who write a review anywhere should actually own the review. The healthcare professional should have the opportunity to contact the reviewer and attempt to reconcile the incident. If anything such an opportunity would make for great patient servicing and good will. But when a patient doesn’t make their identity known and provide a way to be contacted then it is cowardice at best.

3. This demonstrates that physicians need a better marketing plan than simply word of mouth.

Medical Justice makes an interesting point about physicians and medical practices when they write on their Web site: “Most medical practices are built through word of mouth. It only takes one negative Internet posting to impact your livelihood.” If this is true, then why aren’t more light bulbs going off in the minds of physicians and practice managers? If word-of-mouth is all you have going for your marketing efforts then you are asking for trouble. Why let someone else do your talking for you when you should be more than capable of utilizing other means of communication to spread the word about what sort of healthcare provider you want to be known as? It makes no sense at all. Marketing built on such an eggshell strategy as word-of-mouth is doomed and should be reevaluated. You don’t need a no-review agreement; you need a marketing firm to build your brand – and like it or not you have a brand. It’s yours and it’s your responsibility to maintain that brand, not your patients’.

There was an interesting article from PR Newswire, dated February 24, 2009, titled “US Physicians Sharply Increase Their Negative Word of Mouth about Pharma, with EU Doctors Also Expressing High Dissatisfaction.” It’s about physicians who have grown disgruntled with pharmaceutical industry and, as a result, started a negative word-of-mouth campaign. It’s unclear if any of the physicians who are attacking Pharma are also making sure that their patients don’t do the same to them, but for the industry as a whole it might be good to practice what they preach to their patients. Perhaps Pharma should just get the doctors to sign an agreement not to say anything bad about them.

As absurd a question as this may seem, you have to wonder if most people, including physicians, know the answer. Dr. Alicia Conill, a clinical associate professor at the University of Pennsylvania School of Medicine, recently wrote and read an essay for NPR’s This I Believe series that confirms the need for physicians and caregivers to take the advice of philosopher Epictetus and listen twice as much as they speak. She speaks of a study that noted that on average a physician would interrupt a patient talking within 18 seconds. Click here listen to Dr. Conill tell her story.

Now, more than any time in history, we have the ability to communicate faster, more frequently, and with a much larger audience. Our communications can race around the virtual autobahn called the Information Super Highway with no speed limits. With the technology we have at our disposal, it is easy to understand why our attention spans are shorter and our minds race at light speed. Still, when a patient is in their physician’s office it’s usually for a reason that they would like to talk about. It is at those points of contact that the microwave life of a physician collides with the crock-pot concerns of the patient and the trouble begins. Just as Dr. Conill learned through her experience, better care comes to the patient if the physician will stop and carefully listen to the story of the patient rather than their own. That’s why we were given two ears and only one mouth.