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Dr. Tomaino's Blog

Intangibles are Immeasurable

April 24th, 2011
On a plane ride home yesterday from a “spring break” vacation with my family, I read, on B7 of the Wall Street Journal, a most interesting article entitled: “In a Data-heavy Society, being defined by the Numbers.”

The gist of the article, as you might expect, was that numbers may be over-rated. How one arrives at a numerical rating, and whether a higher number reflects superlative value is, indeed, worth thinking about.

Whether the issue is your child’s class rank in high school, a college’s ranking as they assess the best school for them, the NCAA rank of your favorite college football or basketball team……….whatever--we are all admittedly preoccupied a bit with “Numbers” as a proxy for what may be better, or the best! Of course, we’ve all been disappointed by underperformance despite an otherwise attractive numerical rating.

Indeed, as a singular metric, numbers may not necessarily differentiate relevant from irrelevant, satisfied from dissatisfied, or excellent from mediocrity. Nevertheless, we all may from time to time be prone to a sort of deferential acknowledgement of a higher number, as if it meant something!
For example, I recently heard a radio advertisement for an Orthopaedic practice that proudly extolled a #1 ranking in NIH funding for Research —as part of a broader solicitation for business—and pondered as to whether that statistic mattered to most potential patients with musculoskeletal pain.

Notwithstanding the impressiveness of the numerical ranking—being awarded NIH dollars is competitive—the true litmus test of relevance to the patient might never be attained simply because of the NIH research ranking alone-- absent successful commercialization of experimental findings along with, not only efficacious outcomes, but also affordability. Ofcourse, marketing gurus probably figured that #1 was impressive enough to tout.

I, on the other hand, would be more impressed by the family physician who never performed research herself, but conscientiously kept abreast of the most current literature, assessing the results of others’ research, and , in an unbiased manner, applying her new knowledge when it served her patient most effectively.

Numbers, themselves are frequently “marketed” in our society, despite the fact that they have no inherent meaning. Numbers and rankings are everywhere—and I’m not just talking about Facebook friends and Twitter followers. We use standardized test scores to evaluate teachers, students, doctors-- and University hospitals take pride in their annual rankings by US News and World Report—as if ranking, alone, is a proxy for customer satisfaction with their offering. To a certain extent, we might all agree that we need to find ways to measure and evaluate people and products in as objective a way as possible—especially in health care.

But isn’t it our “human condition” -- our soul, compassion, conscience and ability to navigate what is not black and white-- which more frequently differentiates our offering? As far as I know, there is no effective way to measure intangibles like a smile, hopefulness, compassion , and kindness.

As the article I mentioned above suggested--numbers make the intangibles tangible. They give the illusion of control. Like one’s preoccupation with horsepower when shopping for a new car, we may be inclined to quantify everything, to ground a decision in fact, instead of asking whether a particular variable matters.

When I started Tomaino Orthopaedic Care nearly 3 years ago I referenced a book by Seth Godin in one of my early blogs entitled “Small is the New Big.” His point was that size (the number) may be a metric which is deceiving—though used all too often by businesses as a basis for marketing a competitive advantage.
What I have found as a Physician is that all those “Numbers” may result in us losing sight of why we are really doing what we’re doing. Again—as part of the same radio message I referred to earlier, a local practice’s advertisement claimed that their practice was 6x the size of any other local practice—40 doctors—after which I thought, “ isn’t a patient’s satisfaction with their visit based, more likely than not, on an interaction with a single physician—as opposed to the shear size and scale of the office?”

If you need a shoulder replacement, a rotator cuff repair, care for your sprained or broken wrist, or a carpal tunnel release, is the size metric—the numerical scale—really relevant? Our reliance on, and overwhelming trust in numbers reflects our discomfort with, and arguably our mistrust of, the immeasurable—intangibles such as experience, accountability, expertise, wisdom, and authenticity.

Interestingly, Seth Godin’s suggestion that “Small is the New Big” suggests, in fact, that it is the immeasurable that may differentiate the offering. The relevant metric, he would argue-- and I have experienced this throughout my career at two University-based practices and now at Tomaino Orthopaedic Care—is neither size nor scale dependent.

Although the intangibles are immeasurable, so too might the numbers be misleading.




Malcolm Gladwell also wrote about this sort of thing in his books, Blink and Outliers. It doesn’t really matter how much we think we know from the numbers aspect…how perfect a choice may be or the potential outcomes, the reality is quite personal and based on those intangibles. I recently purchased a new vehicle. I spent a few weeks searching out what I thought I wanted based on those numbers. When I got to the lot and test drove that ‘one’, I hated it. The salesman took me in the direction he thought I should go based on my numbers; credit score, payment options, even my age. Instead I walked through the lot and picked out something based on how I felt when I looked at. I think he was still shaking his head when I pulled out in that bright yellow monster!
You mentioned the radio ads for the large practices with ’40 doctors’. So true that bigger isn’t always better. We have two of those practices within 20 minutes of us. When my husband broke his shoulder in February there wasn’t an orthopedist in either facility who could handle his repair. The one office we did visit had us wait nearly an hour and a half before getting into the exam room and another twenty minutes to see the doctor. He was already an ‘established’ patient too. We find it a much better use of that time to make the two-hour drive to your office where we can then be seen usually within ten minutes. Another thing those numbers from the ‘big’ practices don’t show is the quality of interaction with the office staff. Tomaino Orthopaedic Care can’t be beat!
I have and will continue to refer people from our area to your office. When ’40 doctors’ and Physician Assistants can’t manage to see a patient within six weeks and a 30 minute office wait something is definitely wrong with those numbers. Given the choice, I’ll take the Outlier.

April 24th, 2011 @ 8:32 pm
maryann mazzaferro

Dr. Tomainos orthopedic care has a unique system that falls into a ranking All its own. After 2 shoulder replacements and quality care that is absolutely the best who needs numerical ranking? I am sure any patient of dr tomaino would agree!!! Combined with compassion care kindness tomaino orthopedic care could far surpass any #one numerical ranking!!!!! I hope there is a stream of responders to ditto this! Who is at the top of the list?? Don't need any magazine report to answer that one! Patient satisfaction right here says it all.

April 25th, 2011 @ 4:07 pm
Jenny Sanderlin

I wonder how promptly one of those BIG practices would respond to someone in pain? I had an elbow replacement done (expertly, of course) by Dr. Matt and have not needed to see him since 2006. I fell yesterday and e-mailed him last night. He replied within 5 minutes and I called today and they are seeing me next week. Mind you, I did not break anything, the arm with the area of the implant simply does not look right.
There is a quantifiable aspect of Tomaino care. #1 in response time to clients. There is no way to rank the rest though, but I would say that he goes above and beyond; gives 110 % What better way to find a physician than by listening to those who have been cared for and followed by him.
{{insert happy smile here.}}

May 20th, 2011 @ 2:07 pm

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