NEJM Catalyst Thought Leaders describe people, organizations, and practices in health care delivery that make them want to imitate, adapt, and make their care better. See all stories here.
There’s a saying from Confucius that, if three people are in the street in front of you, two could be your teachers. In other words, you have something to learn from almost anyone, if you are open to it.
Another way of articulating this ancient Chinese wisdom that could help accelerate improvement in the value of health care is this: Almost everyone is doing something that should make you jealous. The goal should be to find it, imitate it, adapt it, and make your care better — so that you can make someone else jealous, too.
In that spirit, let me describe something that has bothered me since I first learned about it a decade ago: Mayo Clinic physicians have a social norm of answering their beepers immediately. They don’t finish driving to their destinations; they pull over to the side of the road. They don’t finish an email or a conversation; they pick up their phones, punch in their page number, and are connected directly to the person who paged them.
The people who paged them are holding their phones to their heads, because they know the pagee is going to answer right away. And, within seconds, the two are talking about what to do with their patients.
I learned about this while sharing a taxi ride with Catherine Roberts, MD, a radiologist and clinical informaticist at Mayo’s site in Phoenix, Arizona. It is the one and only conversation we have ever had. She was behind me in a long line waiting for taxis on a rainy day, and we were going to the same place. I offered to share my cab, and I have been stewing about what she told me ever since.
She said her colleagues in radiology don’t like to recommend additional tests at the end of their radiology reports. They don’t want to box other clinicians into having to do tests that might be unnecessary. Instead, they just page them, talk about the patient, and decide what to do. “It makes the radiologists happier,” she told me. “Instead of being someone in a dark room processing images, we feel like we’re members of the team taking care of patients.”
I told her that I was jealous, but in actuality I found it hard to believe. And when I finally visited Mayo Clinic’s original site in Rochester, Minnesota, a few years later, this was one of the first things I asked about — several times, actually. It was true, I learned.
“How do you get people to do it?” I asked. “What happens if you don’t answer your page right away?”
I swear to you that the first three people all paused, and then answered with the exact same phrase. “You won’t do well here,” they said.
It was a little scary. I imagined being put outside in the cold in the Minnesota winter, and dying within minutes.
I asked an old friend who had trained with me in Boston before moving to Mayo. “There’s no explicit penalty for not answering your page,” he said. “But the last thing you want is for people to say ‘He’s the kind of guy who doesn’t answer his page.’”
But another cardiologist told me, “The earth will open up and swallow you” if you didn’t answer your page right away.
I have been muttering about the Mayo social norm of answering pages right away for years now, and physicians elsewhere always bring up circumstances in which something might be more important. “What if you are in the middle of doing a procedure?” they say. Or, “What if you are in the middle of talking to a patient?” You won’t be surprised to learn that the Mayo folks have figured out ways to deal with these contingencies. Someone answers for them during a procedure. They apologize to the patient, but say they need to talk to a colleague.
What do they do when they get paged by two different colleagues at the same time? That certainly happens, and I don’t know how every Mayo physician handles it. But I do know that we have a tendency in health care to get paralyzed by exceptions, and this social norm seems likely to improve care much more often than worsen it.
Social norms matter, and this one makes me jealous.
Who or what in health care makes you jealous? Comment below!
This blog post originally appeared in NEJM Catalyst on May 17, 2017.