Are There Any Pebbles in Your Shoe?

I really am not trying to poke fun at the writer here. I promise. I just have trouble not laughing at this article by the AMA:

Leaders at Wisconsin’s Marshfield Clinic Health System have undertaken an effort to find what they call “pebble in the shoe” problems afflicting their physicians and other health professionals. Once a year, they invite doctors and others to roundtable events where they share what they’re frustrated by. The pebble in the shoe problems are ones that could be solved within three weeks—a mere moment in time in the health care world.

One notable example: a physician complained that the toilet was broken and had not been repaired for nearly a month. It meant he had to walk to a distant bathroom and made it harder for the practice to stay on schedule.

“The chief administrative officer of the facility was right there and it became very evident that nobody knew about it,” said Narayana S. Murali, MD, a nephrologist and executive director at Marshfield. “They got that fixed.”

You see how awesome that chief administrative officer is? He got the toilet fixed!! This was the ONE NOTABLE EXAMPLE!! I almost snorted coffee out of my nose reading this. The AMA is trying to position themselves as “burnout busters”, even though they agreed to EVERYTHING that has caused burnout. Then they use this “pebble in the shoe” concept as one way progress is being made.

This particular story gets funnier:

Issues submitted at the roundtables are categorized into three areas:

  • Red—Cannot be accomplished.
  • Green—The work can be completed easily.
  • Yellow—Work will take about six to nine months.

“We had a facilitator who broke the physicians into different groups to have the conversation internally so that they could come up with the key areas where they saw gaps,” said Dr. Murali, a member of the AMA Integrated Physician Practice Section Governing Council. “We took that material back to our clinic board and addressed some of those elements and created a sequence in terms of what we need to address at the board level.”

About 1,200 line-item issues were brought to the attention of leadership through roundtable events across the health system. To date, about 30% that were deemed “pebbles” were resolved. The others were tied to processes across the system.

I just love this. I love the big words like roundtable, facilitator, sequence, etc. I love they have color coding to give these pebbles “grades”. I can just envision the big cards that the administrators of the clinic board holds up like a judge for figure skating.

Let’s look at the details. There were 1200 line item issues! That is a ton of problems going on. Anyone want to address that? Nope. And only 30% resolved? That means 840 items couldn’t be fixed!!! Hold on, there’s more:

When at the Marshfield site in Eau Claire, Wisconsin, leadership learned the lights where the surgeons park were not working. This issue was taken care of “almost immediately” because it affected the surgeons’ ability to get to the parking lot, Dr. Murali said.

Another pebble popped up at a new facility in Eau Claire. A physician noted the surgical operating room lacked a place to hang coats or put on aprons, while another said the TV remotes were missing.

Lights? Coat hangers? How about they pay for one maintenance man?

Another physician suggested fixing the electronic health record, but that can’t be fixed overnight.

Yeah, the ONE THING PROVEN to cause physical burnout, that being the EHR, is ignored. “Yeah, sorry, we can’t fix that.”

I have to stay this is the most PERFECT example of administrators running the bureaucracy of healthcare. When a doctor owns the office, as in DPC, she gets the toilet fixed or fixes it herself.

This, more than any other example I have ever read, shows how poorly things are done in big systems:

  • They only do this ONCE A YEAR!! Good luck if your shitter is broke a week after the meeting.
  • 70% of issues are tabled. Are they ever seen again?
  • They are trying to brag about something that makes them look like idiots. Seriously this is the AMA and the medical system putting this out to the world for a pat on the back. Can they be more clueless?
  • I wonder what would happen if they would add up the cost of the facilitator and the meetings and lost time with patients in order for doctors to meet and compare that to the cost of the things actually fixed? I bet it would be hundreds of thousands of dollars paid to fix three thousand dollars in problems. Sounds like the government.

Lastly, what do you think was on the list of 840 items not fixed. My guess is that doctors want:

  • Stop the stupid clicks for metrics
  • Stop replacing us with non-doctors
  • More time with patients
  • Less administrators
  • This stupid “pebble in the shoe” program to stop

And by the way, Narayana S. Murali, MD, a nephrologist and executive director at Marshfield, is also a member of the AMA Integrated Physician Practice Section Governing Council. This concept is his crown jewel to show doctors how burnout is easily fixed. Well done, Dr. Murali. Well done, AMA.


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Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  6 comments for “Are There Any Pebbles in Your Shoe?

  1. Kurt
    April 24, 2019 at 3:53 pm

    Don’t forget the AAFP agreed to all the same C$ap that the AMA agreed to.

  2. RSW
    April 22, 2019 at 9:01 am

    Fix your toilet and rediscover your joy in practice!

    I’m sure Dr. Sinsky, AMA VP for Physician Satisfaction, considers this the triumphant result of all her work.

  3. Pat
    April 20, 2019 at 3:15 pm

    If walking to a bathroom farther away will throw a physician off schedule, then proximity to plumbing ain’t the problem.

    I doubt Dr. Murali can even grasp why the majority of us would quit and do happier work if we could.

  4. PW
    April 20, 2019 at 9:14 am

    I don’t think doctors have pebbles in their shoes. More like boulders smashed their feet.

    • Sir Lance-a-lot
      April 20, 2019 at 10:50 am

      I’ve ‘ad a bee in me bonnet for some time now…

      • PW
        April 20, 2019 at 2:28 pm

        I’ve a hornet’s nest in me bonnet.

Comments are closed.