Tuesday, September 4, 2012

* Dartmouth's DIC Mindset: The Bubble Sheet Mentality at DHMC's Data-Industrial-Complex Headqaurters

On Fri, Aug 31, 2012 at 5:04 PM, Paul Keane

   Dr. James N. Weinstein, MD
   CEO and President
   Dartmouth Hitchcock Medical Center

Dear Dr. Weinstein,

Thanks for your cordial reply. The professionals at DHMC saved my life, so I am a bit touchy about making sure they have enough breathing room to do their job. 

In the drive for efficiency and its measurement, we may suck the oxygen out of the examination room.

Recall the  Chinese farmer who was so anxious to see his rice plants grow that he pulled them up every day to measure their roots.

Best wishes,


Paul D. Keane
   M.A., M.Div., M.Ed.
   Independent Candidate for the Vermont House

On Fri, Aug 31, 2012 at 2:50 PM, Jim Weinstein, CEO and President wrote:
Good Afternoon Mr. Keane,

I wanted to reply to your thoughtful email to thank you for expressing your gratitude to your care providers and for your overall satisfaction of care for twenty plus years at Dartmouth Hitchcock!  I have been at D-H for 16 years and I believe it to be an outstanding academic medical center and I am proud to work with such skilled and professional colleagues.

I also sincerely appreciate your comments and criticism about the questionnaire.  As leader of D-H, one of my main goals is to improve the quality of care we provide. We rely on feedback from our patients to improve our care and processes.  I want to apologize for any  inconvenience and negative perception this has produced.

Thanks again for taking the time to communicate.


Dr. James N. Weinstein
CEO and President

A Culture of Caring

From: Paul Keane
Sent: Friday, August 31, 2012 9:25 AM

Subject: "Your Request for Feedback"

Dr. James N. Weinstein, MD,
President and CEO
Dartmouth Hitchcock Medical Center
Lebanon, NH


Dr. Edward Catherwood, MD
Dr. Beach Conger, MD
Dr. John Seigne, MD
Dr. Vernon Pais, MD
Dr. M. Shane Chapman, MD

Dear Dr. Weinstein,

As I do not operate behind people’s backs, I am sending courtesy copies here to the fine physicians at DHMC who have kept me alive and percolating for the last four years, subsequent to the removal of half a kidney for cancer.

Yesterday I received a survey from Dartmouth Hitchcock Medical Center, or its software surrogate, asking me to comment on my recent experience with an MD whose name was typed into an empty space on the mass-produced bubble sheet I was expected to fill-in.

Simultaneously, I  received yesterday a candidate survey from an association of labor unions called “Working Vermont,” since I am an Independent candidate for the Vermont legislature, a survey seeking to know my opinions about labor matters.

I am sorry to disappoint you and the labor unions, but on principle, I do not surrender my thinking capacity to the words and choices of others.

Surveys and bubble sheets demean human dignity and I will not participate in their use.

 As a recently retired Vermont public school teacher, I was always ashamed during my twenty-five years of teaching, every time I was required by the “higher-ups” to participate in administering such bubble sheet exercises to children. I believe they actively harm children’s self esteem and self image, just as I believe such bubble sheet evaluations harm doctors’ self esteem and self image and the very status of the medical profession itself.

Need I say that doctors are professionals, not products?

Their science approaches an art, it is not a service to be advertised. (“89% of all DHMC physicians meet their patients on time and treat them within a 20 minute period”)

It is disgraceful to diminish their dignity and their image to the general public by asking that public to tangle itself up in the flypaper of trivialities and inconsequentialities which I found enumerated in your software company’s “survey”.

Particularly galling was this question: “How well were you kept informed regarding any wait you experienced? : Poor/Fair/Good/Very Good/ Excellent/ Don’t know.” [“Good?”  I was informed “good” ?!  Come now, really. UGH],

Not only are the choices imbecilic and ungrammatical, but the process of a bubble-sheet-survey diminishes the very profession of medicine and the institution of  Dartmouth Hitchcock Medical Center itself, (which purports to have authored or approved the survey) by luring unsuspecting patients into the false belief that they should be evaluating their physician.

Despite having spent 17 years in college and acquiring four degrees, I am in no position to evaluate a physician on anything at all (except his or her  hair style), especially whether he/she is on time, or whether he/she had the staff  inform me “good” about the exact nature of  and reasons for my wait.

I was born in 1944 and I was raised to believe that it was natural, expected, and  even LAUDABLE, for the doctor to be late for his/her appointments, because he/she was giving another patient the care the patient needed.

I consider it a mark of my doctor’s competence if he is late. 

He is CARING for another patient, in exactly the same way I want him to CARE for ME, with whatever amount of time it may take-------- not a twenty-minute medical encounter, recorded on a bubble sheet and evaluated by a mindless computer, aggregated by an administrator and advertised to the public.

My doctor is caring for his patients with his mind and his heart, not with a twenty-minute medical tidbit.

That’s what I want and what I expect. (Be as late as you want, good doctor.)

I suppose you feel  I do not understand your imperatives as the chief executive officer of a vast Ivy League Hospital, even though I was born in one (Yale/New Haven Hospital, then called Grace/New Haven) and participated in a project with them in 1982-4 while a student at Yale Divinity School, a project on AIDS which wound up on “60 Minutes.”  http://aidsatyale.blogspot.com/

I suppose that some remote accrediting or government or private funding source is badgering  you to survey your patients, record their “feedback,”  analyze that feedback and demonstrate that you have used that analysis to improve your “outputs,” and meet expected “benchmarks,”-------that is if you want to gain accreditation or government funds.

And of course all this procedure must be accomplished through digital programs, feeding the insatiable Data-Industrial-Complex , which grows more grotesquely obese every year. (One wonders if it will suffer a debilitating cerebral accident soon.)

Well, I do understand.----- I  understand all too well.

You, and the rest of  the “21st century” professions, are trapped in the exponential expansion of Data which society almost worships in a mindless idolatry.


I don’t want to leave you on a sour note. 

So let me say that as a twenty-plus year patient at DHMC (formerly Mary Hitchcock) I am totally satisfied with your service. 

Indeed two of your brilliant physicians saved my life four years ago and did so with great sensitivity to my needs.  Every physician I have had the good fortune to encounter at DHMC in these two decades has treated me with respect and dignity.

They have cared for me with both mind and heart.  (I am beginning to wonder how they managed it, when they are caught up in the mind-numbing hospital administrivia I found in my mailbox today.)

I would be happy to write a personal recommendation for any or all of them should they so desire, in English sentences, with a signature. 

But I will not bubble-wrap them in the suffocating data your office desires.

Let the doctors alone. Let them practice medicine. “Do no harm [ to them ! ]”

I do not regret at all refusing to add more bureaucratic flypaper to their lives by declining to engage this survey .

It would demean them and dehumanize me.

Yours sincerely,

Paul D. Keane
M.A., M.Div., M.Ed.
Independent Candidate for the Vermont House

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