A quick look back at the blog

I’ve been blogging occasionally over the last few years, and there is no denying that this is a (very) niche blog mostly focusing on the interaction between healthcare, technology, machine learning and process analytics as they relate to operations.

Despite that I’m delighted that the blog had the sum total of 7384 views (!) from 4782 unique visitors (!!) suggesting that the average visitor reads 1.54 posts (!!!).

Realizing that some of the folks who land here do so by accident or are bots, that suggests to me that the average # of reads by real people who land here is much higher, which is gratifying.

Most traffic, of course, comes from the USA. A big hi to the one person who read me from Tanzania.


The most popular posts on the blog are the following:

  1. What big data visualization analytics can learn from Radiology
  2. What medicine can learn from Wall Street, Part 1 (& related posts)
  3. Mentoring, Compassion, Curing and Healing
  4. The danger of choosing the wrong metric
  5. Why does everything work in vitro but not in vivo?
  6. Black Swans, Antifragility, Six Sigma & healthcare operations.

MIT webinar on systems thinking for patient wait times

This should be interesting tomorrow….


This is just a quick post, but these guys are obviously coming up with similar thoughts to the ones I am having.  I am curious to know if they are merely following a six-sigma “low hanging fruit” approach or have started iterative refinement of processes with #timestamped data, possibly with workflow modification (and adaptation!!!) as well.  It is hard to come across competitive data on what people are doing out there – some aren’t eager to disclose competitive information, vs. not really understanding what is being asked (more likely).

And ultimately I am curious to see how they are modeling things, if at all.  Is it a Generalized Linear Model, or are they doing something different?

Excited to see what these gents have come up with – bright people – one from MIT, the other from Amazon.

Hat tip to Paul Levy’s Blog and @Docweighsin on twitter for alerting me about this.  Paul Levy is a consistent source of great, high-level thinking on the internet.

Dear Doctor, (letter to a Doctor)

Physician reviewing records

This is a post from a person I interact with on social media. It has been heavily modified to keep anonymity. I have obtained express consent from this person to share their views here.

Dear Dr. — Thanks for seeing my child today & conducting a comprehensive exam. We were pleased with your care & the recommendations received.

However, please work with your staff on:
1 -Don’t tell me ‘1 hour’ if I ask how long the the appointment will last and then expect me to be happy after more than three.   Yes – I do know I will have to wait  – a range would be helpful.
2 – When called to reconfirm by your staff, I asked if they had all of our reports sent 2 months ago which were printed for you (it’s a little complicated).   Don’t have them tell me ‘yes’ when the answer was ‘NO’.   Putting a ‘see me’ post it note on the file from a staff member who is out of the office is not helpful.
3 – You are excellent in what you do.  I’m happy to pay for your knowledge and expertise but not your data entry skills (see above).
4 – When I explain to your staff that my child is uncomfortable going to physician’s offices and I need to prepare him about what to expect, please don’t giggle.  Is this the first time your staff has been asked this question?  I can’t believe that.

Thank you.



-A friend once sent a bill to his doctor for making him wait 3 hours.

-I hear you . Waiting forever is the worst! Some health professionals need to brush up on their interpersonal skills.

-(We) were just talking about the medical practitioners we’ve left over the years…because of their staff!!

-…staff was really frustrating.  …tried to give feedback constructively and professionally but the attitude was unreal.


Can anyone not relate to this?  (Unless you are a practicing physician or administrator and you are so busy you have no time to go to the doctor!)  I view this as a systems failure.  The processes to make sure that this patient had an excellent experience were not there – the Doctor seems to being doing all he can to make the experience great (except for the ubiquitous data-entry EMR curse that patients hate as much as physicians!), but the staff undermines his efforts and this visit goes squarely into the negative category.  Regardless of where you want to place accountability (the staff, the physician, the office manager, the administrator), the root cause of this negative experience could be looked at and improved.

What the patient (patient’s parent/responsible party) wanted in this circumstance was:

  1. Accurate scheduling (responsible booking, integration with MD’s calendar)
  2. Accurate information (saying “you should block off your afternoon, but we will try to get you out in an hour” would go a long way here)
  3. No data entry (hire a scribe or switch your EMR system!)
  4. Transmissible Review of information by a staff member (no “see me” post-its – that’s poor continuity of care)
  5. To be treated with respect and dignity (NO giggling or attitude).

The last item is the most concerning – I know that we are starting to recognize ‘compassion fatigue’ and ‘burnout’ in docs in increasing numbers, and it almost certainly crosses over to support staff.  But this offending staff needs to be trained/educated, or shown the door.  Someone else’s discomfort is never a cause for a healthcare staffer’s entertainment.  Better to create systems and processes that rein in the chaos and allow these staffers to feel less besieged and give a level of care that supports the hard-working doctor’s efforts, not negates them.


First (and Test) Post

Our healthcare system, once the envy of the world, has become unenviable.  Cost is driving healthcare, and sweeping changes are coming.  Here is an exploration of how to escape the trap of merely reacting to these changes, but instead embracing them and in return re-capturing the spirit of the healing professions that made American healthcare the world’s best.

More to come.