Take this from the wisdom’s true fount
Or you’ll never know the amount
Of things saved or spent
Or where the time went
Unless you keep true account.
The day started with dropping my car at the garage. When my gas mileage plummeted I checked my tires and found a slow leak in the right front, which I couldn’t have done without a pressure gauge. As I walked away from the service station in the clear sunshine and bitter cold, I reflected on the damage done by estimation in the absence of accounting.
A vague answer to a specific question means either “I don’t know,” or “I don’t want to tell you.” Navajo has a specific word, hola, which means exactly that. In English, we just prevaricate.
When I ask patients, “How much does your smoking cost?” frequently the answer comes back, “I know.” But when I press, I find out that they haven’t done the arithmetic.
With alcohol, my query starts “When was your last drink?” and goes on to “How many did you have at that time? Is that typical for you? When was the last time you had more than five in a night?” The vaguer the answer, the more I worry that the person really doesn’t know and doesn’t want to know. I never ask “How much do you drink?” because the only accurate answers come from people who don’t have a problem.
The same thing happens with eating. The greater the overweight, the less well the person knows when they’re hungry or keeps track of how much they eat.
When I worked in private practice, I did a lousy job of keeping count of my hours. When, in Barrow, I filled out a time sheet to the tune of 63 hours in a week with a lot of leisure, I realized I hadn’t been working 56 hours a week but usually 80. I hadn’t counted the calls at home, the time spent in medical records, the after work documentation, or the time spent doing Continuing Medical Education (CME). Nor had I amortized the hours spent on weekend call over the course of the month.
Though most docs receive good pay for their services, we perform many professional duties for no reimbursement. A fifteen minute patient visit generates five minutes of dictation; one visit in two results in lab work for review; one visit in six demands a call to another doctor. Time spent reviewing refill requests or lab data generates no income. We don’t get paid for phone calls to worried patients.
The corporate parent of Care Initiatives Hospice asked me to start filling in a time sheet. Why should it matter, I asked, if I’m paid straight salary?
I started keeping track of my hours. I was surprised at how fast twelve phone calls, five minutes each, add up to another hour.
Estimation never compares to keeping count. If we don’t have a gauge, we won’t know about our leaks.