2 Great Customer Service Experiences in One Day?

If you've read some of my previous blogs, you know I'm someone who appreciates customer service a LOT.  Today, I had two marvelous experiences.  The first was at Whistle Workwear in Shoreline.  Chris and I have been talking about getting overalls for a while since we want to be as cool as Ralph and Greg(s) so we went out in search for some today.  I have also been looking for work boots for a number of years as well as a new buckle belt so I can wear my CP belt buckle without needing to tape down the lengthening tail of my old belt.  Well, lo and behold, this store had all three things!  Something I've had trouble with all my life is finding a store that sells clothes that have a larger vertical dimension but a regular horizontal dimension.  Also, I haven't been in a shoe store in 5+ years since most of them don't carry larger than a 13 and I wear a 16 shoe (15 boot).  The employee at this store today was very helpful in getting a boot that fit me well and spent at least half an hour customizing the insole setup so that I was as comfortable as possible.  In the end, I walked out with a pair of overalls, a pair of work boots, and a quality leather belt.  She even threw in a free pair of socks and was far more than friendly and courteous the whole time. 

The second experience, immediately following, was at Famous Dave's BBQ in Everett.  I hadn't been there before, but had heard of their excellent food in the past so we made the journey up I-5.  Their wait staff attended to all the small details that, individually, aren't all that significant, but when added together, make a superb experience.  They open the door for you, seat you promptly and make sure you understand the menu (in a non-robotic manner), and most importantly, make sure your drink is full.  I was just setting down my coke after taking the last sip and the waiter was standing there with a full one.  The manager even came by to make sure we were enjoying our food, which was amazing.  It's a little pricey and far north, but the combination of great food and fabulous service make it well worth-while.

It's getting more rare that you see such great customer service, but these two establishments are still going strong.  Whenever I need barbeque or work wear, these two places will top my list.  After all that, I stopped by my parents' house to do some laundry and it just happened to be filet mignon night!  It didn't take much convincing to get me to stay for dinner and we enjoyed a meal of a quality that I never buy and cook for myself (both for lack of a steady income and a barbeque.)  Tomorrow I guess I will need to start studying, as I've put it off for long enough during this unexpected ten-day vacation.  Since the stuff we missed on the snow days will be on Friday's exam, I better take a first look at the stuff we've covered so far this quarter... 

Flowery Language

When people talk, listen to the words they choose.  People are judged on the way they speak every day.  Whether or not they say "like" a lot, if they use proper grammar, and the "caliber" of words they choose are all things that form ideas about their intelligence in other people's minds.  Something I have noticed a lot, especially in school, is the use of lots of fancy words when simpler words will suffice.  Sometimes people try to use words of which they don't know the meaning, but I'm not talking about them.  I'm talking about the people that try to make themselves seem smarter or superior by using as many twenty-dollar words as they can. 

When I'm sitting in school, I don't get to hear patient cases, I get to hear patient-care case vignettes.  We no longer go to work, we go to our "work sites" which will become our "practice sites" after we graduate.  People don't talk about things they've seen at work, they talk about experiences they have encountered in their practice.  We no longer have externships, we have "introductory and advanced pharmacy practice experiences."  As pharmacists, one of our jobs is to encourage patients to be "concordant" with their therapy.  Who even knows what that means? It's the new term for "adherence" which was coined when "compliance" was deemed not to be politically correct.  When we write "patient care notes" we have to say things like "her past medical history is significant for hypertension" not that she has high blood pressure.  They mean the same thing and one is much simpler and easier to understand.  One professor actually said, instead of "you should ask a nurse," that we should "utilize our multidisciplinary friends."  Now that's going a little too far. 

I had to stay after class once because I was "using my positive influence over the class to squash people's self-efficacy."  I had no idea what she meant by that, but didn't take the time to ask what her fancy (and I think some made-up) terms actually meant.  I think the problem she had was that I said differentiating between concordance, adherence, and compliance was stupid.  My other point during that day's discussion was that people don't care if you refer to them as "customers" or "patients" when they come into a drug store (sorry… a pharmacy practice site).  It confuses some people, because they think of themselves as "patients" when they're in the hospital, and even if we are providing healthcare, they are also paying for a product and service from a business, so they are customers.  When we call doctors about things, we refer to the people as "patients."  It all depends on context and who you're talking to, but in a lot of cases, it just doesn't matter.

Now I understand the need, in medicine especially, to speak and write in such a way that your intent is clear and the points you make are specific, but when you add all that flowery language, it just makes for more to sort through and takes extra time.  Shouldn't we be using as few words as possible to fully get a point across since we're so busy as healthcare workers?

My main point is that when you speak, choose the correct words ("because these words have meaning") but don't go over the top trying to impress people with extravagant language that is time-consuming and over-the-top-unnecessary for the situation.  

Tried and true methods are best left alone

There is this new method of learning that I have been dragged through a couple times in the last few years.  I'm not sure if it's a widespread trend or just someone's "brilliant" idea at this school, but I don't like it one bit.  It's called "Team-Based Learning," abbreviated TBL.  The concept is that the students learn the material on their own and in teams, then it is reviewed as a class.  It is an ineffective teaching method (if you can call it teaching) for two big reasons: it puts the traditional lecture---learn/discuss---exam method in a really odd order and it wastes a lot of time, both before and during class.

This is how the process goes:

1. There is a pre-class multiple-choice quiz (online) over the subject for the following day's class.  The student works on his own, using whatever resources he wants (not having had any instruction on that topic yet).  This is called a "readiness assessment test (RAT)."

2. There is another quiz at the beginning of class (the same questions and answers) but this time it is taken as a group.  So there is a lot of time given for groups to argue between their answers, still not having had any instruction on the topic.  All the discussion stems from whichever resources each student found and the impressions they have based on their very limited experience.

3. The class discusses each of the questions and the answers their group chose.  This is the first time in the whole process that the instructor may insert her own experience and make sense of all the resources that provide conflicting information or guidelines for treatment.

So, in effect, most of the process is a struggle for each student to find information on his own, and that information is usually limited to the specific circumstances surrounding each question, not how to treat the disease state in general.  I understand that students learn better when they can come up with some of the knowledge on their own, but providing absolutely no basic knowledge or information in advance of two quizzes is not the right way to make that process happen.  Answering the quiz questions usually comes down to trying to justify little pieces of each option that are not ideal and arguing between two answers that are probably both semi-correct.  I don't know about the "ideal modern student," but I learn best in the traditional manner: give some preparation work before class (reading, etc.), lecture on the material (supplementing the text with personal knowledge or experience), allow time to study the material on one's own, then give an exam.  It's frustrating to take a quiz and have to come up with all of the answers from scratch rather than drawing from a professional's knowledge (since that knowledge was never provided in the first place).

Secondly, it's a huge waste of time.  If we had at least a basic background of the topic beforehand, quiz time could be spent looking up exceptions or juggling two good options, rather than that in addition to learning all the general knowledge of the disease state.  Then, in class, more time is wasted when the groups are given time to discuss.  Many times, the whole group agrees, and when they don't it is on something that only clinical experience could decide (something which the professor has not commented on yet).  So inevitably, there is a 10-30 minute period when your group is done with the quiz that you do absolutely nothing.  All this does is take away from the time at the end when the instructor may or may not add to the discussion with the experiences he's had, which is the only thing worth the huge amount of tuition that goes towards these classes.

The class I'm taking now uses parts of this method, so at least it's not as bad as last year's class that used every bit of it, including scratch-ticket-like answer sheets (another great use of tuition…).  But I still feel like the teaching process is turned backward and a lot of my time is being wasted.

So that was the second half of my day…  The first half of my day was about the same level of frustrating and waste of time, learning things I'll never use as a pharmacist.  But that's a different blog for a different day.  Off to camp for a long weekend and work party tomorrow!

Computers in class?

Brace yourself for another old-man-esque rant about technology…

If you sit down in the middle of a pharmacy lecture and tune out the professor (something I may occasionally be guilty of) you hear one sound: the incessant pitter-patter of keyboards.  Now I understand the appeal of using a computer to take notes, but I think sometimes, it's a little unnecessary and can sometimes be detrimental, both to yourself and those around you.

There are a lot of arguments for bringing a computer to class.  I do agree with some of them, but I think that the reasons not to bring it outweigh the positives.  The biggest argument you'll probably hear is that it's easier to take notes on a computer.  Ok, for some that may be true.  However, I think that pen(cil) and paper offers much more.  Learning to take notes in a shorthand form is important so that you can write more quickly and not miss as much of the lecture.  Part of that shorthand is using symbols (arrows, abbrevs that require non-letter/number characters, etc.) and making those symbols, drawing arrows to different parts of the notes, and making quick diagrams takes much longer on a computer.  Some people say they can type faster than they can write, which I believe, but for a lot of the people who use their computers in class, that isn't true.  The slowdown of typing and trying to make crude diagrams on the pdf of the notes causes them to lose time.  They miss points made and have to either ask their neighbor or interrupt class to ask the professor to repeat himself.

Another advantage of pen/paper notes is that when you go to study, you have the wonderful opportunity to copy those notes, organize them, and make them legible.  Seeing (and especially writing) something more frequently means that you learn it better.  If you want computerized notes, just add it into the pdf at home when you are reviewing the lecture.

You may disagree with the points I've made so far.  Fine.  Everyone learns differently and has different talents with typing, writing, and drawing.  But the aforementioned reasons are not the only reasons that computers don't usually belong in the classroom.  Computers are a distraction both for the user and those around him.  Computers open you up to any resource you could dream of, which could enhance your learning (if you need to, just look it up after class, I say…), but they also open you up to distractions like shopping, facebook, chat, email, and lots of other things that you don't need to be doing during class.  If you are just going to come to class day after day and not pay attention because the internet is so enticing, why even come to lecture?  I know how hard it is to resist temptation.  I'm often guilty of checking my phone during a dull point in class, but what bothers me are the people I sit behind who, without fail, are doing five or six things during every single class.  It's not uncommon for someone to have open facebook, google chat, their email, the Coach shopping site, many other random things, and somewhere in the background, their notes.   Not only are you distracting yourself, you're distracting the people around you who can't help but see your shopping or chat windows flashing different colors as you talk to classmates.  I will say, though, that there are a rare few who I have sat behind and do nothing but pay attention and take notes.  I commend them on their ability to resist the powerful pull of the world wide web.

One other thing… computers are pretty heavy.  Even with lighter computers, once you factor in the protective case and power adapter, that adds up to much more than a small stack of looseleaf paper and a pencil or two.  You're not doing your back any favors by lugging that thing around every day.

I may be old-fashioned with my learning styles (see my post on why powerpoint is an asinine alternative to overhead projectors), but I do think that more often than not, computers are used for non-academic purposes when they are being used during class.  There are definitely times when computers can be of great benefit during a class, but most of the time, they're unnecessary.  I don't really care all that much when so many people have their computers; when an interesting person is lecturing, it's not hard to focus solely on him or her and take my notes on my sheet of paper.  The people distracted by their computers are the ones who have the potential to lose out on a good lecture or miss good points made that weren't in the furnished notes.

Just be patient...

The impatience of some people amazes me. So many times, someone's desire to get somewhere or make something happen a few seconds quicker clouds their common courtesy.

A pretty common example of this, one that I encounter almost daily at school, is when a class runs a couple minutes late and the next class floods in before the class before them even begins to leave. All I can think of is that they must just be excessively eager to learn. Today, our once-weekly class ran a little (4 minutes) past the scheduled ending time. The professor for the following class came in and shouted "are you almost done?" in a pretty impatient tone. We had literally just finished wrapping up and many people were packing their bags. Our teacher said "yes, we are done now" to which Mr. Crabby-pants replied "good, because there's a seminar in here in TWO minutes." Apparently he missed the day in professor school when you learn that when the minute hand is on the five, there are not 2, but 5 minutes until half-past the hour. Then, as soon as we stood up, the seminar attendees rushed in like the flood gates had been opened. I stood at the door watching every person come in while 10-15 of them squeezed past me trying to get in. I wanted to see how many people would go by before someone realized that letting us out first would make it easier for them to enter and find seats. But that moment didn't come, so I ended up just pushing my way through.

Some people just need to chill out a little and realize that maybe getting somewhere fifteen seconds later or waiting briefly before doing something is worth sacrificing in exchange for showing a little consideration for someone else.  I won't even get into impatience on the road, as that is a whole other topic altogether, but in most aspects of life, people would be a lot happier and tolerant of each other if they just slow down and show a little courtesy to one another.

The Cost of Healthcare

Today was the first day of class.  The only class I had was one I thought might be boring, but it turned out to be pretty interesting and I think I will get a lot out of it.  It's about healthcare, our current and future system, other systems in the world, economics, and related topics.  The instructor made the assumption that we've all had at least a basic economics course (which I haven't), so hopefully that won't hinder me.  I guess if I don't understand something, I'll have to find a friend who knows something about Econ.  I think I have one of those…

An interesting point was brought up in class today that related to an experience I had recently at work.  We discussed the relationship between the patient, the provider, and the payer in our current healthcare system.  The patient doesn't pay nor choose services; the provider doesn't pay nor use services; the payer doesn't choose nor use services.  The analogy was made to buying a cup of coffee.  If you had "insurance" that would cover a cup of coffee, you'd probably be more likely to buy more often and more extravagant (expensive) drinks, especially if the copayment was similar or the same for differently-priced options.  After all, you're not the one paying for it…  I think this is one problem that contributes to our high cost of healthcare.  When people aren't asked to pay for things more than a minimal copayment, they're way more likely to choose more expensive treatments that may only work slightly better or sometimes not at all. 

One man that is a regular customer was picking up his wife's prescription for a drug that had been recently switched from a shorter acting form (taken twice daily) to a long-acting form (taken once daily).  His copayment was the same for the two products, but he noticed on his receipt where it lists the "usual and customary" amount, which relates to the cost of the drug to his insurance company, the long-acting drug was considerably more expensive (somewhere around 10-fold).  Even though his cost would be the same, he asked us to switch back to the short-acting form.  Having taken both in the past, his wife didn't notice any difference therapeutically and he said he'd rather not get something that is going to cost his insurance company ten times as much if it only means having to take it twice a day. 

That was a shocking interaction, as that line of thinking is so rare.  Most people don't care what their drugs cost to their insurance company, as long as their copay doesn't increase.  Maybe if more people thought like this particular man, insurance premiums and healthcare costs wouldn't be as astronomical as they are.  It's amazing how many complaints we got with DSHS started charging a $1.10 copay for drugs that were previously free to patients (drugs which may cost hundreds of dollars) or how much people complain about a ten dollar increase in copay when the drug they switched to costs way more than the alternative.  An example is minocycline (used commonly for acne in teenagers) vs. its extended-release form, Solodyn.  From what I've heard (I haven't read studies), there isn't much of a difference in efficacy.  The big difference is that you don't have to take Solodyn as often.  But get ready for this… the average wholesale price for Solodyn is more than $28/pill where we get generic minocycline for less than $0.20/pill.  And patients complain when their copay is $10 more for a month's supply of Solodyn.  So what if it doesn't work quite as well.  Is that $25+ difference in the price of each pill really worth the convenience of less-frequent dosing?

Another example is when doctors start patients on a nasal steroid for allergies.  Two common choices are Nasonex (not generic with a ~$105 wholesale price) and Flonase (generic wholesale price ~$20).  Nasonex might work a little better for some people, and many doctors will try to start people on that, but why not start on Flonase and see if that works well enough for that patient.  If the insurance company actually does pay for it (many don't), it costs much less for all parties involved to try the cheaper one first, and it will likely work just fine for most people.

When you think more broadly, past the amount you're paying and more about the true costs of things and who is actually paying for it, you begin to realize why our healthcare costs so much.  It also makes you lean more towards the insurance companies in some situations when they say they're not going to pay for some incredibly expensive treatment that isn't much better than the standard.  Sure, if people want to pay the difference to get the state-of-the-art treatment, that's fine, but they shouldn't expect their insurance (especially government-subsidized or -sponsored plans) to do so.

Without economics in my background and not having much in-depth knowledge about the healthcare system, I think this class will bring up a lot more topics that will help me relate to, work in, and understand the healthcare system as well as the current healthcare reform.  I hardly get involved when politics come up, but this is one topic that I actually do care about as it relates to my future career and the well-being of myself, friends, and family.