a stream made the canyon

12/2/07

at the University of Bielefeld, Germany

You know what’s awesome – and infuriating – about people? They’re going to do what they’re going to do. Unless you’ve been beaten down by fifty years of communist or fascist rule and thus have no mind of your own, I’m constantly amazed at how people will make the split-second assessment of “this is frickin’ insane” and decide to flout the rules.

We rent our farm out during the summer, and while 90% of our tenants have been an absolute joy, you have to understand that even the best of them are like water, and tend toward their lowest level. As such, you can’t be surprised when something keeps happening that drives you crazy, because chances are you would be doing it too, if you didn’t own the place.

In upstate NY there’s an old toll house that used to charge passengers to get from New York to Massachusetts. When it was operating in the 19th century, it looked like this:

OldTollGateThen(bl).jpg

Now it is empty, and looks like this:

OldTollGateNow(bl).jpg

Yep, just an abandoned old lady waving her hanky while 18-wheelers plow through at 60 mph. But what’s interesting to me is a country lane just behind it, near the Columbia County recycling center, called “Shun Pike Road”. It’s only recently paved, tiny and twisty, with the forest and Berkshires threatening to swallow it whole. One can only imagine the muddy disaster Shun Pike Road was in 1870. But by god, there were so many people willing to “shun” the “pike” that the road got a name.

By the way, “pike” is short for “turnpike,” which comes from the old word “pike” meaning spear, or pointed wood shaft. To keep horses from going on footpaths, they would set several pikes on a rotating wheel (a much larger version of the turnstile), and it came to mean any road that required a special stopping point. That’s where we also get the phrase “coming down the pike.” But I digress.

Wait, what was I saying? I had a point. Something about abandoning yourself to the organic workflow of the humans around you, rather than fighting it. And how it fits with illegally downloading music.

Oh man, I should start writing these earlier.

0 thoughts on “a stream made the canyon

  1. Amy

    ok – Ian – I do not know exactly where you were going with this, but I think it was eventually leading to downloading music for free. this is also a point you made 11/15/07 when you said people hate paying for music.
    I would take that a little further and say people hate paying for lots of things. I am a physician and I am constantly amazed at the number of people wanting free medical advice and treatment. They also want me to fill out countless number or forms so they can get the money back for that cruise they cancelled because grandma was sick.
    Now before you think I am some rich and fancy doctor, let me tell you I live in a duplex in a modest neighborhood ( the house across the street has been abandonded since at least 1999)
    , I am still paying off my medcial school loans, and I drive a 1995 car (which actually seems pretty new to me as I have never had a car less that 7 years old).
    Anyway, back to my point. I am amazed by the number of people that call in each day and leave this type of message “Please call – feeling nauseated and wants to discuss” or “please call- has some questions about her medicines.” It would be one thing if I got one or two of these calls a day, but I get ~20 – 30 a day. Do the math – at 5 – 10 minutes a call that is a few hours that people want me to spend for free. Actually it costs me as I have to pay someone to take car of my children while I make these calls. I have office hours. Why don’t people just come in?
    Thanks for letting me rant.
    Maybe I should be on an SSRI.
    But seriously, if anyone has an insight as to why they think doctors should provide free medical advice over the phone, be availabe 24/7, and fill out countless numbers of forms for free, PLEASE explain it to me.
    PS- love your blog, Ian!!

    Reply
  2. Sean

    It’s pretty astonishing that a doctor and a lawyer would complain about people requesting help for free. The only difference between you and most people is that when you do get paid, you are well-compensated. Try being in the arts – I can’t tell you the number of people who’ve suggested that I could help them with a voice lesson or teach them how to play guitar or read their script and give them notes.
    I can’t say, “Sure, but can you do it during my office hours?” because I don’t have any. And there’s no way I can say, “Sure, but it’ll be X dollars an hour while I’m doing it…” Your line of work is valued enough that you are paid well for your time when you’re on the clock.
    I’ve called my pediatrician a number of times, simply to say, “Should I bring the kid in?” and the answer has always been “No, he’ll be fine.” And that’s why I feel good about my doctor, why I feel good about paying for the service when it’s required, he’s never bitched about his lot in life.

    Reply
  3. jason savage

    And there’s no way I can say, “Sure, but it’ll be X dollars an hour while I’m doing it…”
    why the hell not? it’s your line of work, and asking to be paid to consult would seem perfectly reasonable.

    Reply
  4. Anne

    Amy: I’m wondering if you work with a staff in your medical practice. It seems to me that a nurse-practitioner or a physician’s assistant could screen many of those calls and give people a helpful answer without involving your time, which is billable at a higher rate than the two professionals’ I just mentioned. Even an experienced R.N. can help with a lot of those calls. The tricky calls can still be forwarded to you. I’m sure what I’m saying is a big “duh,” but it’s amazing what a difference even one non-M.D., post-R.N. professional position can do for a busy medical office.
    And Sean– I’m an editor at a nonprofit so I don’t make big bucks, either. It’s amazing how many friends ask me, on my own time, to edit their resumes (snore), sit with them and go through their dissertations, give feedback on a professional-journal article draft, etc. I’m happy to help, but still… drip, drip, drip goes my precious non-office time.

    Reply
  5. Lorelle

    This has nothing to do with the blog today, but since there always seems to be discussion about how health care sucks in this country….Please go to this website and vote for Cooper Green Hospital (or any of the other hospitals if you happen to be familiar with them). Cooper Green is a hospital in Birmingham that provides medical care to anyone who needs it regardless of whether they can pay. My husband works there and did his training there. Their video is actually hilarious! Siemens is giving away an MRI and they’d love to win. http://www.winanmri.com Thanks.
    Lorelle

    Reply
  6. Ehren

    People pay a giant ton of money on medical care. Counting their insurance premiums, it’s a significant chunk of change. So it’s sort of like buying a computer for a $1000, and then when you can’t figure out how to get it going, you call up Dell or Apple and you think that maybe 10 minutes of customer service should be complementary for the grand you just dropped on their piece of solder and silicone. Especially if the Dell person says, “actually, Mr. or Mrs. Customer, whose business we rely on for our livelihood and who is always right, I can’t talk to you on the phone. Instead, you should pack up your computer, find a sitter for the kids, drive a half hour to Best Buy, wait in line for 20 minutes, and then we’ll have a five minute discussion with you about your problem.”
    No offense, Dr. Amy, but try working retail management for a (small) salary, where you can’t bill your hours and yet must still spend a large part of your day talking to customers on the phone about problems with their purchases. I can’t say that I find your plight particularly distressing.
    This probably sounds waaaaaay meaner than I mean it, but I just think that most people don’t get to bill by the hour for customer service.
    But Ian, I loved that little chunk of etymology!

    Reply
  7. Neva

    Don’t know Amy or Ehren, but have to side with Amy on this one. Comparing what we do to customer service in retail work is not fair. Also, until insurers start paying us an annual salary for being your doctor you don’t have a leg to stand on on that arguement. We don’t get paid unless you come into the office. If we do nothing but phone calls and forms it takes away from the time to spend with patients. You don’t expect free law advice without being billed, right? How about free plumbing advice from your plumber?
    And, Ehren, remember you had a chance to go to medical school too. I went to school for a very long time and worked 80 hour weeks in residency for three years. I think it’s reasonable to be paid for my services.
    And, Amy, I think it’s okay to require an office visit for things and be firm about it..

    Reply
  8. Neva

    Also, to you Sean, what you can say to those people who want you to give them voice lessons etc., is “I’m sorry, I don’t have time for that right now in my schedule but if you’d like to make an appointment here are my rates or refer them to someone who does that for a living.”
    That’s basically what I do. I try to help people if I can as long as it’s quick and not time consuming or risky (a lot of medical counseling should not be done outside of an office!).
    This really gets back to the concepts of Ian’s writer’s strike.
    I hear a lot of people who are pissed that they don’t make doctor’s salaries. Sorry guys. My salary is not that awesome and if you want to so something else with your life, go for it, but I hear a lot of jealousy going here, I think.

    Reply
  9. herman

    Amy, you’re supposed to have a receptionist fielding calls. If you don’t, you’re the one making a mistake, not your patients. Sorry to be blunt.

    Reply
  10. Neva

    Don’t know about Amy’s practice but at most offices the receptionists just take the message and send it back to the medical staff. At our practice we have medical assistants (who have very little nurses training) who can’t give much advice either so most requests for advice end up going to the docs.

    Reply
  11. Amy

    Thank you thank you thank you Neva. Not that I am right – just that my view point has some validity.
    To me there is a difference between good customer service and wanting something for free. A lot of people just want the latter. To think you deserve a free phone consult from your doctor just because you saw him/her in the office is kind of like thinking I should be able to download a few songs (or maybe the entire album) for free just because I saw them in concert this last summer.
    Herman, of course I have people answer the phones. The phones ring off the hook! I do have two people that I pay to take calls. Overhead is expensive. The fist 10,000 I make every month pays for staffing, overhead, malpractice, postage etc.. etc.. . The problem is many people do not want to talk to the nurse – but demand that the doctor call them back as they are too busy to come in. BTW – I am happy to provide good customer service in following up with people. But many times people just want something for free.
    Anne, hiring a true RN or NP is too$$. I try to have the medial assistant answer questions or get the answer from me and call the patient back. I suppose if I wanted to change the format of my office to high volume with people mainly seeing the NP I could – but to me that just does not seem right. I would rather have people see me the doctor rather than have them see the nurse practitioner and be billed the same rate.
    Lastly, Ehern, we all pay a TON for health care, but the majority of that does not go to the doctor. Last I checked healthcare executives were making a huge amount of money. I think it is similar to the heads of entertainment industry. Doctors are not starving, but most of them aren’t really getting rich. Of the 1000 you pay – nothing goes to me until I see you in the office.

    Reply
  12. michelle

    I think this problem is pervasive, regardless of the field in which you work. As a community arts activist and administrator, I actually don’t go out much at night because if I do, it is never a night off. If I dare show my face at any arts-related event, I end up either being accosted by an artist who wants to pitch a program, a school that wants funding, or a donor who needs massaging. It’s part of my job, since I live in a relatively small town, and I actually see it as, well, I get paid to be a community arts activist, so my office hours are spread out throughout all of the hours of the week, both in-office and out. Of course, sometimes this drives me crazy and makes me want to run for the hills, but I don’t see how it could be different. I think it’s important to have really clear boundaries, but I think, in some professions, the bleed of work into personal life is inevitable.
    I wanted a job where I could make a difference, where I could be of service, and I could not be successful if I refused to engage people outside of traditional office hours. Also… I believe in giving back to the world that gives me a job, so there are those that I want to help on my personal time. And considering the amount of hours I work *in the office* each week, I have a hard time believing that anyone out there doesn’t have at least a little time to give back.
    Again, it’s all about boundaries. If doctors have patients who incessantly call, that needs to be managed. If a writer continually asks another writer for feedback without offering anything in return, that needs to be managed. But I would like my doctor to return the 1-2 phone calls I make to her a year in regards to ongoing health issues I may have. And I will continue to look at press releases and grants for friends at other agencies, since that is a terrific use of me, even if I don’t specifically get compensated for that hour of time.

    Reply
  13. Ian

    Ken – oh, there was a group staying there over the summer that was a bit of a nightmare, but we’re trying not to dwell on it.
    By the way, I was a late convert to coffee and espresso as well, and became similarly obsessed. You should see my syrup collection (latest entry – cookie dough flavored – one must use sparingly)

    Reply
  14. Ehren

    I’m guessing everyone has stopped reading this thread, but Amy and Neva, I totally get where you guys are coming from. You invested a big chunk of your time and money in medical school, you’re out on a limb running your own business, and you’re not getting rich right now, even if your patients think you are.
    I guess my point is just the one Michelle made. Most of your patients are just sick people who feel like they pay enough money that someone can spend 10 minutes on the phone with them once or twice a year to answer a question. Being sick is frustrating and sometimes scary, and going into the doctor’s office for a quick 10 minute question will probably take at least an hour out of your day, what with the waiting around and filling out forms. Sometimes you just need a short, quick answer.
    I think it’s not that people want something for nothing, I think it’s more that the quick call seems like no big deal and the most efficient way to deal with something.

    Reply

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