Archive for the 'surveys' Category

What to post

March 22, 2013

I was writing a post yesterday about what happens when life’s excessive difficulties result in a person’s implosion or explosion instead of a “faith experience.”  I called it “Foxholes,” in reference to the old saw, “There are no atheists in foxholes.”  (I think there are.)  After reading David Brooks’s column about foxes and hedgehogs, I didn’t want to post something called “Foxholes,” even if I had written most of it before I read his column.

So I’m going to add a little here about my adventures Wednesday night with our medical system, which I mentioned in a reply to a comment to Timothy Egan’s column on The Five Guys restaurant and its relationship to health insurance.

I had been taking an antibiotic, and after taking a dose, a short time later I felt awful.  Waves of chest pain, nausea, retching, a red itchy rash on the back of my neck and shoulders, including a couple of hives.  The antibiotic was minocycline.  I think what I had was probably a side effect reaction, not what we call an allergic reaction.

I’ve had allergic reactions to other medications, as well as side effect reactions to both meds and vaccines (or their bases, or both).  I was once told by a Dr. Melchinger, who was an internist in New Haven Willy and I both used, that I apparently have a body that will eventually if not sooner react negatively to medicine, and that I should not take any unless absolutely necessary — to save my window of tolerating them for when it’s especially critical.  So I’m a veteran of medication reactions.

I would have called the pharmacy, but they were closed.  I called the prescribing doctor, tried to page her, didn’t hear back, made some other calls, one of which told me try a local hospital and that they should have a nurses line to advise me.  They didn’t.  I tried the nurses line on my health insurance card.  They told me to go to the ER as I might be having a heart attack.  I didn’t think I was, and I thought an ER visit was “overkill” and a waste of resources (including my time and energy).  I tried paging my doctor again, then eventually I went to bed.

At 6:34 a.m. the next morning my doctor called me in response to the pages.  (The second page had been at about 11 p.m.)  To make a longer story shorter, she told me to come in at 11:30 that same morning, at which time we agreed (for slightly different reasons) that I shouldn’t continue taking the minocycline.  She made a new diagnosis and gave me a topical medication.  When I went to fill it, the pharmacist chatted me up, and when he heard its relationship to the minocycline Rx he had filled for me before, he seemed to recognize the reaction as one associated with minocycline and said immediately that I should avoid the med in the future.  It helped to hear that from him.   (Of course, he and I are old chums after discovering our mutual affinity for the Stop & Shop Friday special on rotisserie chicken.)

I am underwhelmed by a health care system in which even when I have good insurance, I can’t get helpful advice in the situation I was in.

When I told my mother about my adventure the next evening, she said she thought the hospital ER would have gotten excited over the heart attack idea and run lots of tests and even insisted on keeping me overnight.  I hope they could have done a differential diagnosis better than that, but who knows.

I’ve had the opposite experience, though, which was even worse: knowing I was seriously ill and being refused an examination, despite multiple requests.  It turned out to be a post-partum infection and the consequences were terrible, both short term and long term.

So the other night’s adventure was, to be sure, unpleasant, but not horrible.  I write about it mainly to point out that we use the ER in inappropriate ways not just when someone is uninsured — it’s as if it has given us an “out” in all sorts of situations, kind of like that Life cereal commercial in which the older kids have Mikey taste it:  “I know, we’ll just send the person to the ER,” as if there were no downsides to that approach.  And I also wanted to point out that having good insurance may be necessary but insufficient to gain access to appropriate care when necessary.  The system does not work as advertized.  Some of it is less-than-stellar implementation, some of it is structural.  Paging systems break down, 24-hour “urgent care” is not available, a patient’s history does not produce adequate planning for pretty predictable negative outcomes, etc.

Instead of patient satisfaction surveys, the system needs a feedback mechanism to transmit more complex information from people with actual experience of the system.  Actual care providers may have this complex information, too, but I suspect both experts within the private system and policy experts in the public sector don’t.  I sometimes think they want to solve the problems they want to solve, not the real problems that actually exist.

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Social service survey

August 7, 2011

I’m not sure why this is on my mind, but about four or five years ago I found myself taking a phone survey for the folks at Big Brother Big Sister.  It must have been before my son was matched with a Big Brother, because that didn’t last long (instead of taking my son directly to the Aquarium as planned, he took my son back to his apartment and at one point threw him face-down on the bed and twisted his arm behind him, and we all agreed to go our separate ways within days of that), and I do remember my son spent a long time on a waiting list to be matched, so I probably got the survey call during that time.

So, I start answering the questions.  I think the survey was supposed to be about finding out more about their clientele, but at some point I remember saying to the young person on the phone with me who was reading out the questions, “I know you didn’t write these questions yourself, but do you realize that all the questions assume a certain level of dysfunction in the family?  They basically ask whether we are dysfunctional in this way, that way, or the other way.  I’m having a really negative reaction to that.”

The young intern suggested she have her supervisor, whom I think was a professor at a local university who was masterminding the project, call me — she would forward her my reaction.  And the supervisor did call, a few days later.

The supervisor/professor was interested in my reaction, and agreed that the questions did imply what I was inferring.  Then she said apologetically that they were the best set of validated questions she could find in the literature, and that was why she was using them.  I can’t remember whether she decided to rethink her use of them or in some way change the survey — I was too fascinated by the idea that this kind of research involved taking somebody else’s instrument off the shelf and using it.  I had assumed the questions had been tailored to some rudimentary understanding of the Big Brother clientele gleaned from applicants’ materials.

Maybe I’m thinking about this experience after hearing about Mayor Bloomberg’s initiative to help black and Latino youth.  Because I do remember that part of my reaction to that was to express the hope that the initiative would be open to finding out what the needs of the people they are trying to help actually are, in addition to trying to meet their needs as the administration perceives them.  I am concerned that their perception may not be wrong as much as not include the whole story or be in need of some tweaking.

In addition, I think maybe everyone who relies on the results of such studies’ being accurate should have a sense of how they are developed.  I truly don’t understand why someone undertaking a study isn’t obliged to develop their own reliable questionnaire for it.  My experience certainly changed my sense that  researchers were testing a hypothesis with an accurate instrument or, in the alternative, that they were looking into a situation in a more open-ended way without bias.  As it is, I now realize I don’t really understand what it is social science researchers think they are doing and whether their methods really are sufficient to meet these goals, whatever they are.