Pilot Blues.

For your information, I wrote this while I was very, very upset in the break room at Gouverneur. My voice is shot, my feet are sore, and my head is drained out.

So I shadowed Dr. Song today and decided it was cool to time her patient's visits. She took an average of 10 minutes/patient, which is pretty speedy. It would have been even faster if she didn't see some of Dr. Passloff's [who wasn't here] patients, who all have extensive rap sheets of ailments and medications. An African-American patient had a total of 9 prescriptions, not including his diabetes stockings. I asked him afterwards how does he manage all of them; he just smiled and chuckled.

Observations:

· The hospital posters are obsolete! One of our questions involved HDL & LDL and which one is the “bad cholesterol.” Only 2 out of the 14 pilot surveys got the question correct, and one of the participants answered the question after he finished seeing his doctor. The funny thing is, enormous posters on diabetes’ triple threat (A1C, BP, LDL), with “LDL = BAD CHOLESTEROL” printed in large-type font, were all over the walls of the department. Priya brought up an interesting point about the positioning of these posters. It almost seemed as if the posters were strategically posted in places where people are least likely to be; one would report for the appointment at the Team booth, then would have to make a full 270° turn to face the wall the posters are on. Also, the lighting is poor and even with the large font; one might have to squint to take a better look at the poster.

Problems encountered while doing pilot:

· Mistaking multiple choice for giveaways. When listing the choices available for high cholesterol’s health effects, the patients answered “yes” for every single choice. It’s apparent that the patients were merely reaffirming each choice that they thought was a correct answer.

· The Likert scale was extremely difficult to explain to participants, especially Spanish-speaking patients. They mostly answered “agree” initially, but changed their answers to “extremely agree” when we asked them to differentiate their degree of certainty. A similar problem occurred with “disagree” answers.

· Some questions sucked.

o Question 2 is poorly structured. We did not include a choice for “I don’t know.” Also, most people know about good and bad cholesterol, but not HDL & LDL. But which one is more significant? The acknowledgement that good & bad types of cholesterol exist or an alphabetical difference?

o For Question 5, which instructs participants to select their sources of information about cholesterol meds, many put down “pamphlets around the 4th floor” as an answer. We should include already available resources in the hospitals (i.e. posters, pamphlets, etc.) as a choice.

· “Is this a survey, or an interrogation?” [aka I got grilled by my preceptor today]

o The clinic is only selectively busy in the afternoon, as doctors see patients at varying rates. We picked a busy cluster to interview some Hispanic patients. Usually, we’d sit next to them while conducting the survey, but seating runs out at times and we are forced to stand over the patient, giving him/her an imposing (and possibly intimidating) impression. We actually got grilled by Dr. Stevens because he caught Priya & I standing over our participant. He pulled a chair from nearby and ordered us to sit. That was, by far, the most embarrassing moment of this week.

o Is kneeling/crouching over an option?

· Our Spanish sucks, enough said. Fortunately, Eddie & Reyna gladly helped us out (especially Reyna, she used her entire 15-minute break to help us translate the questions!). It’s also a problem when we can’t understand a patient’s refusal to participate. But this time, the expression (it wasn’t even a disinterested look, it was more like a scoff) was enough.

· Timing matters.

o One of the patients had to be excused in the middle of the survey to see the doctor. Priya waited for him to come out before resume asking him questions. This may affect the answer to Question 14, which asked when the patient last had his/her cholesterol levels checked. From our experiences, some patients were visiting their physicians to check their blood work results, which automatically places them in the group that had their cholesterol checked recently. There is a big difference between “I never had my cholesterol checked” and “Less than 3 months ago.” This will strip the face validity of the variable if this problem occurs again during the actual data collection; any crosstab using Question 14 as a variable might get screwed up.

o A really good way to solve this problem (which worked wonders with my Chinese-speaking patients, as they are much more talkative when they no longer have to wait in the halls. I’m postulating that having their physicians close by makes them feel safer about what they’re participating in…) is to administer surveys to patients seeing doctors in a specific Team during their intake. While the PCA checked the patient’s vitals, I proceeded to administer the survey in Cantonese, and she cooperated fully. The intake room will also offer some high-quality privacy. This brings us to…

· The resistant Chinese patient. The first question dealing with T/F and other knowledge questions intimidated her. She stated that she knows absolutely nothing about cholesterol, and that she’ll be in “deep trouble” if she gives a wrong answer. Eventually, she completely rejected the survey and withdrew from participation without ever finishing the first page. That was one of the biggest problems encountered for the pilot. Personally, I know that I can’t blame them, because hospitals are scary places, but that totally pinched my nerve. At that moment, I didn’t want to be reminded that I will inevitably come across and take care of patients like her.

I was double-damnnnnned today (in a good way!). When I spoke Spanish while surveying Hispanic patients, I got "damnnnn" by the PCAs & nurses. The same goes to the Chinese PCAs when I spoke Cantonese. I always knew languages were important, but their usefulness didn't hit me hard until today.

After a painful afternoon, we managed to get 14 pilot surveys completed. Yay!