Being Misread; A Lesson in Vigilance

Being Misread: A Lesson in Vigilance
By Clare Crawford-Mason. Special to
The Washington Post,
Tuesday, April 23, 2002; Page HE01


Deming to the Rescue

The next morning I arrived at Sibley at 8 a.m., and as I walked into the waiting room, a well-dressed man with a name tag identifying him as Jerry Price, chief operating officer of the hospital, approached me.

"You're Clare, aren't you?" he said.

"Yes?" I answered dubiously.

"You don't know what I want to talk to you about, do you?" he said.

But without his saying another word, I did know: Deming.

"We have all the videotapes and books you did with him, and we practice his philosophy here at Sibley," Price said. "We have plenty of time to talk. Your surgery is not until 10 a.m."

He led my husband and me to his office and told how inspired he and his staff were by Deming's ideas. He told a delightful story of how Deming had been a patient at Sibley in the early 1990s and had called him into his hospital room and said, "You don't trust your patients, do you?"

Price said he was puzzled.

"Look in the closet," Deming roared. He shouted a lot, particularly at top management.

Price looked in the closet and it was filled with the coat hangers used in expensive hotels, the hangers that have little balls that must be fitted into tiny holes.

"How would you like to be 92 years old and sick and you couldn't even hang up your clothes?" Deming demanded. "Do you think your patients want to steal your coat hangers?"

Price showed us a letter from Deming in which he had sent a $25,000 check and instructions to buy new coat hangers for all the patients' rooms.

Price did so, had a number of them sanded down and got Deming to sign them. Today, the quality awards at Sibley are sturdy wooden hangers with hooks and Deming's signature mounted in a frame.

"We are the hospital for demanding Washington residents who have extremely high expectations. Dr. Deming taught us how to meet those expectations through the quality improvement process," Price said.

Later, I had the D&C. The biopsy done on the cells taken during the procedure showed no atypical cells.

A Lesson Learned?
I asked my gynecologist what the lesson of all this was.

"It is a good example of the importance of managing your own medical care," she said.

This surprised me. I thought she was managing my medical care. But of course, she was right. Doctors can only give you advice. And the advice can be no better than the information upon which it stands. And so it falls to you to monitor the quality of the whole caregiving process, from appointments to diagnosis and procedures to recovery and billing.

To a layperson like me, it's difficult to know where to start, even if a leading thinker on quality management is prompting you from the other world. Some questions I would like to ask Deming are: How many readings by how many pathologists of a single biopsy slide are needed to verify a recommendation? Are two data points a trend? Does a single biopsy equal only one opinion no matter how many people read it? And how many doctors should be consulted and about what?

Good luck finding answers to all that. Questioning the authority, advice and conclusions of doctors and risking their displeasure, all done under the burden of a possibly deadly disease, is easier to talk and write about than to do. It is not the same as arguing with your automobile mechanic, putting off talking with your accountant or lawyer, or challenging an elected official.

Incidentally, my gynecologist had said that if the lab reader of the suspicious cells had not reported them and I had had cancer, my survivors could have sued.

Later, I realized that I had been saved from unnecessary surgery because of my work with Deming. I had been able to see the system – though I could not have described it that way the day before surgery. I had seen the intangible connections among the doctors, lab and slides and multiple possibilities. In contrast, the doctors saw only a series of single events: probability of cancer, possibility of lawsuits, cost of surgery and so on. It seems beyond their power to put together an outpatient health care system of different doctors and labs for each patient.

Being a competent patient in the third millennium is a new and baffling challenge. You have to ask impolitic, and sometimes impolite, questions. You have to monitor your care in the system from beginning to end. You have to prod the various parts to communicate with each other. You have to remain focused on your optimal goal – your health – because not everybody else in the system is certain to be. My good doctors were all competent, professional, caring people who were concerned about my health, but they didn't question the work of others in the system. That, in the end, was the biggest threat to my health.

Meanwhile, I have taken no more estrogen. Even though I am having hot flashes and reading a lot in the middle of the night, I am so relieved to have escaped a hysterectomy that I am not as irritable and impatient as I used to be.

Oddly, my lack of estrogen seems to have affected my husband more. He can't seem to do things as well as he used to. I have to keep reminding him what he is doing wrong and how he could do it better. I sometimes wonder if pointing out the things he has been doing wrong is the best management practice.

Somehow, I don't think that is what Dr. Deming would advise.

Clare Crawford-Mason is a producer and author of videos and books about the life and work of W. Edwards Deming. You can visit her web site at www.managementwisdom.com.

� 2002 The Washington Post Company

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