Daily Movement

What is “fair evaluation”?

You want to be able to determine without experiencing it yourself (saving time, trouble, cost, pain, suffering, etc.) the qualities of an experience that are important to you.

An experience in the general sense means a service provided by a person, device, institution, etc. Such as health care, insurance, entertainment, dining.

Some aspect of experience is subjective and different individuals will rate differently. Other aspects of experience such as price and time, incident occurence (such as failure) could be thought of as objective, but different individuals will rate differently due to memory recall error, variation of experiences over time with the same service.

Statistical correctness is one aspect of fairness — that ratings are not biased one way or other, or if they are, that bias can be noted so the end-user can evaluate.

Coverage is another aspect — if you are rating x,y,z and leave out a,b,c which are measurably better than x,y,z, you’ve limited information. The decider may be unaware of a,b,c because no information is provided about them. On the other hand, we can argue that if a,b,c are worse than x,y,z, then the decider’s situation is not any worse if no information is provided about a,b,c. I.e. information regarding good experiences is better than information bad experiences.

Perhaps a fair evaluation is one that tells the author’s biases and experiences more verbally in addition to or instead of a number ranking.

Here’s an example of bad experiences (and the requisite comparison of good experience):

My personal experience with Mills-Peninsula medical group has been inconsistent. For some services, I have received “marginally acceptable” treatment — a physical that took heart and blood tests and “come and see me again in N [N > 1] years”.

For other services, I have received questionable treatment. Surgery without a second opinion is always risky, but then again, the risk is due to the variance of doctor competence in diagnosis. A second diagnosis is more like a comparison of (and search for) physician competence rather than a “vote” on the recommended treatment. You could say that some physicians are consistently more competent than others, such that for certain good physicians you don’t need a second opinion. I.e. successfully treated patients are the evidence — if such information could ever be made publically searchable.

My wife’s experience with Mills-Peninsula ER team has been fairly poor the one time she was taken to the ER after passing out after having blood drawn. In Dr. Google’s estimation, she experienced syncope. Now that in itself is no reason to be alarmed about the quality of health care at Mills Peninsula. However, when in the ER (which she was for over 2 hours), no diagnostic tests other than listening to the heart with a stethoscope were performed on her. However, 4 more vials of blood were drawn to complete the blood test panel. The blood was continued to be drawn from her while she was sitting up even though Dr. Google recommends to lie down for blood drawing

Here’s some symptoms and search-engine-driven diagnosis: * Her blood pressure was 90 over 60 and later 107 over 70. The blood pressure was taken from different arms. Dr. Google thinks this is somewhat significant. The ER doctor didn’t ask about such in their observations. * In another reference, Dr. Google states that “Although the yield of electrocardiography is low (5%), the test is risk free and relatively inexpensive. … Electrocardiography is therefore recommended in almost all patients with syncope”. However, no EKG was performed during the 2+ hours in the ER. Such a test takes no more than 10 minutes of pasting on electrodes and letting the computer run. Instead the ER folks persisted in taking the rest of the blood samples. * There is a family history of fainting in her immediate family. Again, no such questions were asked although patients with a suggestive history should get more testing..

You can’t expect ER (triage) doctors to know everything. But you might reasonably ask how sick do you have to be to get attentive treatment by a knowledgable doctor? i.e. the process of treatment by Mills Peninsula is somewhat lacking in depth or conclusion.

Here’s an example of a good experience:

After over one year of wound care after surgical removal of a retrorectal abscess with a wound that still wouldn’t heal and before an upcoming third surgery with no planned presurgical tests or communicated surgical plan, I got a “second opinion” at UCSF where I was scanned with an MRI to determine that a tiny hole in rectum (perhaps newly appeared) was causing the chronic infection preventing the wound from healing. I had originally asked for an MRI two years earlier before the initial surgery, but Mills Peninsula only had CT scan facility. This in itself isn’t a bad mark against mills peninsula, but reluctance to refer to a more capable facility is one bad mark. Dr. Google thinks MRI is slightly better than CT scans.

When I was examined initially at UCSF, the first person I saw wasn’t even a doctor, but a second year medical student. She interviewed me for about 30 minutes to take a complete medical history of the particular condition I was asking treatment for. This goes to show that experience does not necessarily indicate quality, but process is an indication of quality. i.e. inexperienced, but following a good process (of detailed interview) produces a good experience and I think a good result.

You can infer from these comparisons that I prefer UCSF over Mills-Peninusla. I have hope for a good treatment result. I also expect to have my wife see a cardiologist there about her fainting.

My assertion is that poor customer service (bad cash register skills, lack of help on sales floor, arguing with customer during sales process) is better than customer unfriendly service (imposition of lose-lose rules “with a smile”, forcing fliers to throw away their nail clippers rather than mail them back to themselves, cancelling flights that are not full enough to pack the next flight, etc.)

As a concrete example, Border’s Books in Union City (maybe elsewhere too since the workers in the trenches don’t dream up these things unless they are looking at bottom line numbers — typically done by managers) has developed a particularly unfriendly policy of:

• not letting customers browse magazines in the eating area even if they have purchased drinks and food.
• not letting customers sit at certain tables and ‘study’ even if they have purchased drinks and food. The idea of study is inconsistently defined to using a computer. To my confirmation, reading a book is ok. It might even be a book that has some educational use. And the rule isn’t as much enforced as it is bullied into compliance. The hard-skinned can ignore the employee requests and the softer skinned, more sympathetic customers will reluctantly obey.

“So what,” you say. The lack of an empty table discourages newcomers from wanting to buy drinks and sit down, and consequently reduces revenue. But is it better overall to let new customers be visually discouraged from buying food and drink, or to verbally discourage existing customers from ever patronizing the business again. These disgruntled customers then make a point of buying books from barnes and noble (where I haven’t personally experienced any verbal confrontation at any of the many stores I have been to), amazon or a local store, and write scathing commentaries online.

So the net effect before and after Border’s Cafe rules:

before:

1. buy food and drink ( + profit )
2. read and work
3. maybe buy book (+ profit)
4. go to step 1 over period of weeks/months.

After:

1. buy food and drink ( + profit )
2. read and work
3. maybe buy book (+ profit)
4. get offended at verbal confrontation (0 profit short term, but - profit long term )
5. go elsewhere ( - profit)
6. don’t bring friends (- profit)
7. write weblog commentary ( - profit through influence)

The history of Border’s increasing customer offensiveness is roughly as follows:

• 1998 - All is well with Border’s cafe
• 1999 - Barnes and Noble superstore with a cafe opens up 1/4 mile away and draws away a lot of Border’s customers revenue.
• 1999-2000 Tipping is no longer allowed at Border’s Cafe. This one is a surprise, isn’t it?
• 1999-2000 - San Mateo Border’s Cafe starts to verbally discourage use of computers by telling customers to not plug their computers into the wall. Yes, corporate policy thinks an extra 12 cents of electricity is worth verbal confrontation with customers.
• 2002-2003 - Union City Border’s Cafe verbally discourages browsing of unpurchased magazines in the cafe.
• 2003-2004 - Union City Border’s Cafe verbally discourages “studying” at tables

As far as I know, there is no competing bookstore near the Union City Border’s Books. Before 1999, my impression of Barnes and Noble wasn’t so great. I liked Border’s selection better. Barnes and Noble seemed to have too many penguin classics and science fiction and not enough current literature. In 1999, they caught up and I think effectively overtook Border’s in the sense of selection, presence and experience.

As a footnote, cafes all over have had to learn to deal with the worst customer: the student. There are many ways of various effectiveness and palatability:

• limiting table time during busy periods and doing so in a fairly consistent and insistent way
• requiring you to buy some amount of food or drink to remain seated
• explicitly banning studying (a most reprehensible rule as explained above)
• limiting table sizes or number of tables to discourage sitting at tables and rather get food to-go
• making environment unattractive to sit in (think fluorescent lighting and linoleum tile that feels like someones kitchen)
• serving all drinks in to-go cups to encourage you “to go”.