Saturday, September 26, 2009

Don't I just LOVE totally screwed-up data. (But check how they dealt with it.)

I often say that I like "Good quality data, well managed." And I talk about the importance of having good reliable processes to ensure reliable data. And I talk about how most industries got this sorted out decades ago.

Well, sometimes things go a little haywire. Here's the email I got last night from Verizon Wireless.

Hm, it seems that when I went to Canada for the Medicine 2.0 conference last week, and adjusted my Blackberry data plan to include Canada, something Did Not Go So Well.

Me being me, I'd done quite a bit of research into my options before the trip. (I have this thing about people knowing what their options are, and being actively engaged to find out.) At the time, the Verizon agent I spoke with said that my data charge would be 0.02 cents per KB. I said "So that means 50k would be one cent, and 1 MB would be 20c." She said "Right."

Well, not so much. Their fraud prevention department called while I was in Canada, because my data bill was going through the roof. "No," they said, "that was 0.02 dollars per KB."

Evidently the original agent didn't know "$0.02 per kb" is point zero two dollars which is two cents. And when I did the math for her, concluding "1MB = 20 cents," she said yes; it was evidently over her head.

So when fraud called I popped my cork. But they said "No problem, we're setting it to the other plan, retroactively." So the bill would be just fine.

Well, apparently everyone got the word except the billing computer, which just sent me a bill for two grand.

When I got the email I called customer service and they hopped right on it. They said it'll take a few days to sort it out but they said the conversations are all recorded in the system and they'll work it out. I asked the agent to send me an email confirming that we'd talked. He said he would. He didn't. I called today and repeated the request. This time she sent one.


What can we learn from this? It's not just that companies make mistakes; there are important differences in what happens when there is a mistake. Although errors occurred in Verizon's work (twice), they had checks and balances and processes for correction:
  1. The fraud department detected abnormal values and jumped into action. In fact they called me while I was in Canada to say that the amount was crazy-looking.
  2. They didn't make me wrong about it. Too often a company will say it's the customer's responsibility. Those companies don't win my loyaty.
  3. The people who called were empowered (authorized) to fix the problem. There was no "there's nothing I can do," no "I'll have to speak to a supervisor."
  4. Our conversations were noted in the system so subsequent workers knew what happened.
  5. They sent me the bill amount by email, so I quickly spotted the problem. (I confess that I don't immediately open every bill that arrives, especially if it's one that rarely changes.)
  6. They had customer service people available 24/7. This enables following up on a problem when my schedule allows it.
This is a great model for healthcare providers who are considering improving their processes for detecting and correcting errors in data.

At the same time, note the steps I took as an empowered / engaged / activated consumer:
  1. I researched my options. We as patients can and should do the same. Don't expect your physicians to think everything out for you; get engaged, be responsible.
  2. When I did spot the problem, I called immediately. The sooner you react, the better.
  3. I didn't blame the person I got on the phone. He had nothing to do with the error. (But I did expect him to fix it.)
  4. I described what happened, and ended with "So: what do we do to get this straightened out?" I find that this question puts the power in their lap, where it belongs, and hints that they look up how to solve it (if they don't know). And, the "we" says I know I might need to do something too.
  5. Followed up. When the email didn't arrive overnight, I called back and firmly said what I want.
The takeaway for empowered patients and people improving healthcare:
  • "Good quality data, well managed" doesn't automatically happen; keep an eye out.
  • It can get screwed up several ways, both human and systemic. That's why we need sanity checks and processes to resolve problems.
  • Learn from other industries. There's no reason on earth why healthcare providers can't use the same processes as Verizon Wireless. (It's not like they'd have to invent them - the processes exist.)
  • Expect competence in your data providers.
  • Be responsible: do your own sanity checks. You may not want to micro-check each detail, but never ever presume that anyone is perfect - especially not in healthcare, where errors are common and systematic sanity checks are too rare.
  • Expect corrections. The healthcare industry is immature in this area: from what I hear, it's common for patients to find that a hospital or physician doesn't want to correct errors in your record. Demand it.


  1. Ouch...this was the kick in the pants I needed. Some things need "fixed" on my medical records a few places. Thank you!

  2. check out the pic in this link :)

  3. I really enjoyed reading this. I think it rings so true in every aspect of life,but especially in health care. My husband was in the military for a bit and I saw a different doctor every time I went. It made me responsible for my own care and knowing what was what with me. All of that being said I do have one small bone to pick.

    As I said before I learned my lessons earlier rather than later but apparently not well enough. When I became pregnant I did research all sorts of things except the one thing I "knew" would never happen to me, a Cesarean. I was a healthy young woman with an uneventful pregnancy. Long story short I ended up with a cesarean. Fast forward 3 years and I as thrown into another fire. I want another baby and want a normal natural birth. I was shocked to learn how hard that would be. I never had heard the term VBAC and thought okay so I want one of those. I went no drugs for over 30 hours of labor with my son so I knew I could do it and my cesarean wasn't the life saving emergency surgery that is always talked about. I was fine, baby was fine, but I trusted my OB knew best and wouldn't do this to me if it wasn't really necessary. I was wrong.

    I now find myself awash in true medical evidence that a VBAC is a good option for me barring some serious medical complication with my pregnancy. I have interviewed 10 Ob's over the last year at the $25 co-pay, only to find out they really don't care about the evidence. The main concern is not getting sued. I have been belittled, lied to and called a mother more concerned about her experience than her child's needs.

    My question to you is, What do you do when all of the evidence on hand proves you do know what is best for you but no doctor will listen? You are being your own advocate, but are then called uncooperative or radical.

    If doctors and hospitals want us as consumer to take a more active role in our care then they need to get out of the way and let us do that. Instead they only want to do that when it is convenient for them, not for "Me" the consumer.

  4. Dear Anon;

    You are learning who the obs' true customers are, and that is the lawyers - with good reason. I do not blame them in the current climate. That said, you could write ACOG (American College of Ob Gyns) and complain. You might check first that their guidelines recommend a trial of VBAC in prior Caesarean patients - they used to, but this is not my specialty.

    nonlocal MD

  5. Dave;

    I hope your experience means that Verizon is improving its customer service, because we have had horrible experiences with same in the past (endless "on hold", promises not kept, lack of continuity between service reps called when a problem is not solved in one call, etc.)

    ps I am reading Christensen as you recommended. Were you going to write about the book?
    (I am saying this w/o reviewing your prior posts, maybe I missed it)

  6. Nonlocal,

    Yes, I'm going to write more about Christensen... now that I've got my own nascent business I'm "free" to do whatever I want, which includes a whole bunch of making contacts and looking for grants and contracts. :-) And I haven't finished the book!

    But I did have lunch with co-author Hwang, and learned about some newer thoughts that aren't in the book. I'm more convinced than ever about the future of healthcare; the walls (or membranes if you will) that have kept things separated are evaporating, and at some point a whole lot of new connections are going to come into existence.

    Via the internet, of course.

    That, aggravated by the increasing number of people who can't get care at all through the US system, will create a whole new ecosystem that's neither supported nor constrained by the dysfunctional aspects of today's system. And as with all disruptions, growth is going to happen so fast that the mastadon won't have time to lift its foot, much less get out of the way.

  7. Pregnant anon 9/30,

    I'm no expert in this area but I think you want to contact Amy Romano, blogger at Science & Sensibility, the Lamaze International blog. She wrote a phenomenal guest post on the e-patients blog this week. It links to her own blog.

    It appears the birthing/maternity movement and the patient empowerment movement (aka "participatory medicine") have discovered each other, thanks to Amy. She pointed out that the e-patient research has focused on disease treatments, when there's a whole lot of healthcare that happens in the non-pathological world of birthing.

  8. Anonymous September 30 @ 11:24 said: “What do you do when all of the evidence on hand proves you do know what is best for you but no doctor will listen? You are being your own advocate, but are then called uncooperative or radical.”

    It’s an upside-down world in obstetrics and maternity care in the U.S. When you present scientific evidence to your doctor and ask that they provide you with care that matches, the odds are good you’ll get a handful of anecdotal B.S. Who’s the uncooperative radical then? It’s not you, that’s for sure.

    VBAC is safe. ICAN ( has pages dedicated to helping find VBAC (read: evidence) friendly providers in your area and tools to help advocate.

    I’m sorry to see that the anonymous doctor (nonlocal mD) above failed Medical Ethics 101. Or I guess technically they passed with flying colors if ethics means “pitying the poor doctors who have no choice.” Sorry, but it is NEVER okay to put women and infants at risk by over-medicating, over-treating, over-testing and over-operating, is it? ACOG recently shared survey results via a press release that more than 63% of its members surveyed admit to making changes to their practices “that ultimately hurt patients” because they are afraid of being sued.

    Knowingly hurting patients to assuage personal fears is unacceptable. Always.

    Anonymous, you are right in thinking that you deserve better than the nonsense to which you’ve been subjected.

  9. Unnecesarean,

    For what it's worth, I've followed "nonlocal"'s anonymous comments on Paul Levy's blog for a couple of years, and I'm pretty sure he's safe in the ethics department - I know what he stands for.

    Having said that, I don't know a single thing first-hand about the obstetrics business in recent decades, so I have position on the facts...

  10. Dave and Unnecesarean;

    Dave, thanks for the support. I am a multiparous "she" with a 10 year infertility history, if that makes a difference. I'm afraid unnecesarean misinterpreted my comment - of course the lawyer should not be the Ob's real customer! But malpractice premiums in the hundreds of thousands per year for obs trying to practice ethically put them in a no-win situation. I was simply trying to make that point, not excuse the ob's.
    As a patient, I have had my share of deflating and even infuriating encounters with physicians, to the point that I am discouraged about my profession. But radical mud-slinging and unrealistic expectations of physicians to be super-human will not make things better, either.

    nonlocal MD


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