Random Stew It seemed like a good idea at the time.


Be Careful What You Wish For

I recently wrote about the difficulties I had getting an appointment with an ENT to fix a broken nose. I finally was able to see an ENT six days after breaking my nose. He came into the examination room with Michael, a medical student functioning as his assistant.

After a bit of chitchat about how I broke it while training for a black belt test, the doc examines my nose and X-rays (yes, it's broke). He said the nasal bone had a broken piece that was crushed inward and needed to be pushed back up into place. He then asked me if I would like to schedule a surgical procedure to set my nose or if I wanted him to go ahead and try to set it right then.

fistofcashI hate to admit it but, as someone who is self-employed and carries a high-deductible on his health insurance policy, when he said "surgical procedure" I swear I heard the cha-ching of a cash register.

"Doc, if you can set it now, go ahead and do it," I said. "But you hear that 'if' loud and clear, right?"

The doctor assured me that he both heard and understood exactly what I was saying. He then shot some topical anesthetic up my nose and told me he'd be back in about 15 minutes.

Fifteen minutes later, the doctor is back and asks me if I'm ready. Like a fool, I said yes. Michael, the medical student, tells me he has a morbid excitement as he's never seen this procedure performed. In hindsight, I should have handed him my cellphone to video the next couple of minutes; I'm sure it would've gotten a million hits on YouTube.

fingernoseeyeThe doc quickly puts on a glove, squirts a lubricating gel on his finger and rams his finger up my nostril, pushing on the misplaced bone fragment with all his might.

Now I know that I only had a broken nose -- not a major injury. But, trust me, having someone jam their finger up your nose, pressing on a broken bone, is a very intense experience. He literally lifted me out of the chair by my nostril. Still, that didn't work. He quickly reaches over and grabs an instrument that resembles a reinforced, stainless steel coke spoon. He jams that up my nose and starts prying on the bone piece to pop it back into place.

It was toe-curling, testicle-shrinking pain.

As this is happening, I glance at Michael and he's actually cringing!

At the very peak of the pain -- as I'm about to attack the doctor to make him stop -- the misplaced bone pops back into place. Instant relief. In fact, I felt high from the sudden relief and the huge amount of adrenaline that I'm sure was pumping in my system.

The doc then packs some gauze and antibiotic ointment in my nostril. While the doc applies a hard shield over my nose, Michael starts gushing about how he couldn't believe what he had just witnessed and he'll be telling stories about me forever. I'm so glad I could impress him.

The doc gives me a prescription for a few Tylox and some Percocet. As I checkout of the doctor's office, I joke with Michael and the office staff. In my 'sudden pain relief' state, I didn't notice that I did not receive any care or follow-up instructions. I go get the prescriptions filled and am actually feeling pretty good about now, even posting my picture via mobile upload to Facebook.

painThat night, however, the pain begins again. And worsens. And worsens some more. Tylox is not making a dent in the pain, but it is making me almost comatose. All Wednesday night, Thursday, and Thursday night, the pressure and pain is horrible. Almost to the pain point I felt when the doc was setting my nose. I'm thinking I have a raging infection in my sinuses and call the doctor's office. Unfortunately, I miss their return call but their message says I cannot have an infection due to the antibiotic ointment and to just continue with the painkillers.

On Friday, I call the doctor's office again, looking for an appointment with him. Instead, they say I already have an appointment scheduled for Monday and instead write a prescription for more painkillers but say I must come pick it up. After two nights without sleep and constant use of painkillers, I can barely walk around the house so I must wait until the afternoon when my wife can pick up the prescription. When she goes to the doc's office, the doc's nurse -- his normal assistant who was not there on the day I went -- tells my wife that I should continue with sinus washes. Sinus washes? I was never told anything about that.

So, while my wife was having the prescription filled, I give myself a sinus wash. An hour later, a huge plug of gauze, blood, and slime comes sliding out of my nose (sorry, no pictures). Again, the pain relief was immediate. A couple of hours later, I do another sinus rinse. And again, another plug comes out of my nostril. Now the relief is complete and the pain is gone.

On Monday, I see the doc at my appointment and he commiserates for a moment about my suffering. I told him about the sinus washes and the plugs; he nods and says the plug was probably pressing directly on my nose break. As the gauze absorbed more blood and slime, it grew and pressed all the more on the break. He apologized profusely for the lack of post-procedure instructions.

So now my nose is set and healing. In about 4-6 weeks total, I'll be able to start sparring again. Hopefully, I'll be a little more elusive when my opponent throws a big overhand right over my jab. If not, I know which of the two treatment options I'll choose.

Pain is only valuable once you know that you've learned from it. --Anonymous

And for those of you who say I should choose a more benign pasttime,

Pain is temporary. It may last a minute, or an hour, or a day, or a year, but eventually it will subside and something else will take its place. If I quit, however, it lasts forever. --Lance Armstrong


Of Broken Noses and Health Care Systems

As I wrote a couple of weeks ago, I've been training hard in preparation for a black belt test scheduled for this Saturday. Thursday night, I sparred with several visiting black belts who had graciously agreed to participate in my testing. Unfortunately, one of them caught me with a punch that broke my nose.

"Yet who would have thought the old man to have had so much blood in him?" - William Shakespeare, Macbeth, 5.1

So, Friday morning I call my doctor to see about getting my nose fixed. Unfortunately, my doctor was moving his office to a new location and could not see me. So I ask the receptionist if the doctor can just refer me to an ENT specialist.

"No, the doctor cannot give referrals without seeing the patient first. You'll need to go to Urgent Care."

"Can you make an appointment for me at one of your practice's other locations? With another doctor?"

"No, we've already booked up all the other doctors with referrals today. You'll need to go to Urgent Care."

Instead, I decide to call my insurance company to see if I can just make an appointment directly with a specialist, cutting out the middleman as it were. Yes, it turns out I can "self-refer" to a specialist as long as they are a participating provider.

So, I call the ENT and spend the next 30 minutes arguing discussing whether my insurance will allow self-referrals or not. Finally, they call my insurance company and find that I was indeed correct.

"Our first appointment for a non-referral is December 23.", I'm told.

"That's 11 days from now! I'm self-referring; what do you mean by non-referral?"

"You don't have a referral from your doctor."

"If I had a doctor's referral when could I be seen?"

"In 3-5 days, when your swelling subsides."

Arrrggghhhh... I feel the rabbit hole open up beneath me.

I give in and go to Urgent Care. After only two hours, I'm seen by a doctor. I tell him that all I want is a referral to an ENT. He says he can't give a referral without a diagnosis and he needs X-rays to ensure I have a broken nose. He ignores me as I volunteer to ensure a broken nose by punching myself in the nose.

So, I have X-rays and, yes, my nose is broken into 3 pieces (surprising given that I don't think it's that misshapen). The doctor says he will give me a referral to an ENT. Great, I think, I'm on my way.

The staff member charged with dismissing me tells me that I'll need to take my X-rays to the ENT when I see them. So, I ask if I can just have the X-rays right then to save a trip later.

"No, you must have an appointment with a specialist before we can release your X-rays." he says with a kind of sigh that tells me the he's been down this road before.

"But they're my X-rays! Why can't I have them? And once I have an appointment with an ENT, how are you to know whether I'm telling you the truth anyway?" I argue with him.

"I know. The system is screwed up isn't it? All I can tell you is that you need an appointment first."


I walk out of Urgent Care and call the ENT, hoping to get an appointment and immediately pick up my X-rays. The ENT has not received the referral from Urgent Care. I'm amazed that such things aren't automated, but apparently Urgent Care usually faxes referrals. The appointment manager at the ENT tells me that Urgent Care is usually prompt with referrals and since it's now late Friday afternoon, I should call back Monday morning for an appointment.

Monday morning comes...still no referral from Urgent Care. Monday noon comes...still no referral from Urgent Care. I call them and am told that they're running behind from the weekend and will fax the referral shortly. Monday mid-afternoon comes...still no referral. I call again and ask if I can pick up the referral in person to take the ENT. Of course not.

Tuesday morning comes...still no referral from Urgent Care. Tuesday noon comes...you guessed it, still no referral. Finally, the ENT staff has pity on me, calls Urgent Care, and has the referral faxed immediately. I wish they had done this yesterday.

So now I can make an appointment with an ENT. Unfortunately, the earliest opening they have is at 3:15pm on Wednesday at their office on the other side of town. Oh, and they'll be "working me in" so I may have to wait a while. Want to bet that they look at my nose, confirm that it's broken, and schedule another appointment to fix it?


Customer Service….NOT! Part VIII

And  the saga continues...

Again, I received a phone call from Todd, my local telco field service technician, asking me to check my DSL download speed. Again, it was less than 2 Mbps, far below the promised 6 Mbps download speed -- and far below the current speeds I enjoy with my cable-based broadband connection.

This has been going on for 3 weeks now. And the saddest part is that the technical personnel for the company responsible for delivering the service, can't figure out the problem. I suspect they're trying to diagnose a kludgey system that was crufted together as a stop-gap, "me too", answer to the cable company's broadband service.



Customer Service….NOT! Part VII

I'm still playing games with my telephone company trying to get satisfactory performance from my new DSL Internet connection.

My local telephone company field technician called today and left a message requesting that I check my DSL download speed again, saying that the problem should be fixed now. I did. It isn't.

The saga continues.


Customer Service….NOT! Part VI

So my local telco field technician, Todd, came out to my house this morning. He hooked up his equipment to the box outside my house and reported a good strong signal there. He then came inside the house and and plugged his equipment into the jack I'm using for the DSL modem and reported a good strong signal there also. He said I should be receiving 6Mbps download speed. He then hooked up his laptop to the DSL modem and ran a speedtest; he got about 1.2Mbps. Now, he's feeling really stumped and I'm feeling joyously vindicated.

BTW, the DSL modem does have a built-in, primitive firewall but it was not enabled. Todd was surprised at that and said they should always be enabled as no unprotected PC should be put on the Internet. Again, I am intoxicated with a surge of vindication.

Todd tries another DSL modem with the same results. He says there must be a problem up the line with "the programming" in the switch. He also tells me that I'm the first 6Mbps customer on this switch. He sends the problem back to the guys responsible for the programming and says he will give me a call later when they have resolved the problem. Todd then leaves about 10:45 AM.

About 4:00 PM, I receive a call from Todd. He reports that they have now set up my programming exactly like another customer that is using (and receiving) 6Mbsp download speed. He asks me to try another speed test and call him back. I do so with the same results.

So, here I am exactly 2 weeks into my attempted use of the telco's high-speed DSL service and they still have not delivered their product. In fact, they can't figure out why they can't deliver their product. Even if they find and fix the problem, this fiasco does not bode well for when I experience service problems in the future.

Quality in a product or service is not what the supplier puts in. It is what the customer gets out and is willing to pay for. A product is not quality because it is hard to make and costs a lot of money, as manufacturers typically believe. This is incompetence. Customers pay only for what is of use to them and gives them value. Nothing else constitutes quality. --Peter F. Drucker


Customer Service….NOT! Part V

This post is part of a continuing saga of my travails with the local telco, trying to establish reliable and speedy DSL service. And, yes, I gave up on the counting in French.

Why does bailing wire and duct tape come to mind?My local service technician, Jeff, just reported that he had reprogrammed my DSL modem and asked that I check my connection speed now. I did so and am getting a download speed of 1.8 Mbps, nowhere near the 6Mbps I've been promised. During our conversation, Jeff mentioned that the DSL modem actually has a firewall built into it; something none of the other "technicians" ever mentioned. Even so, he admitted that I would not need to hook up a computer directly to the modem.

After the test, he said he would refer the ticket to a "field service technician" who should pick up the ticket by tomorrow afternoon and begin work on it. Supposedly he will trace the connection from the telco's central office to the connection box on my house. I asked if he would be informing me of what he found. Jeff said probably not, that if the field tech found a problem he would just fix it; and if he didn't find a problem, he would refer the ticket back to Jeff who would then call me again.

Is anyone out there taking bets on the outcome?


Customer Service….NOT! Part Quatre

The way to a customer’s heart and wallet lies in how well we initially serve our customers and recover from poor service. Unknown

As I've blogged before here, here, and here, I've been enjoying wonderful customer service from my local telephone company regarding my slow DSL speeds .......................... (long Borat-esque wait here) ............................................... NOT! In my last post on the subject, the service technician had left a voice mail saying that my download speed should now be 6Mbps. That was Monday, November 5. Of course, the speed was not 6Mbps, it was only about 1Mbps. The technician didn't leave a callback number, nor did I have a trouble ticket number. I sure didn't want to endure the telco's outsourced technical support call center again. So I went online to the telco's site and found a form to Submit a question or trouble ticket. At 9:39AM on Monday, November 5, I submitted a request for them to reopen my trouble ticket and send a service technician to my house to diagnose the problem. The telco's site promises a response within 24 hours. I received a response at 11/08/2007 02:02 PM -- 77 hours later. And what was their belated response?

Response (Avel P.) - 11/08/2007 02:02 PM   
Thank you for using Windstream's Support E-mail System.  We would like to thank you for being an Windstream customer, your service is very valuable to us.  The problem you report is not easy to fix over email.  We suggest you contact our helpdesk at one of the numbers provided and we will be happy to troubleshoot with you.

Windstream strives to provide the highest level of service and answers to every question.  Please contact us at 1-800-990-4449 (dial-up) or 1-888-292-3827 (broadband) if you have any other questions or further assistance.


The pleasures of call centers.

Resignedly, I call the broadband technical assistance number, a.k.a. the outsourcing of Hell. This time I talk to "Jim". Jim begins taking me through the exact same customer management and technical diagnosis scripts that I endured for hours last week. Damn, but these support people are trained to the point of becoming automatons. However, Jim surprisingly readily agrees to reopen my previous trouble ticket, but as he's doing so, we are disconnected. Recall that I was disconnected last week when talking to this same support center -- a support center for a telephone company.


I call back. This time I'm apparently connected to a different call center. "Andrea" answers the phone and she has an American accent. And, in sharp contrast to the over-the-top politeness of the other support personnel, Andrea has a very brusque attitude. She begins to insist that I disable all firewalls and plug my computer directly to the DSL modem. I still can't believe that this is the technical support of an ISP suggesting I plug an unprotected Windows-based PC directly to the Internet. A quick Google search reveals all sorts of articles about the inadvisability of doing just what Andrea is advising me to do. When I refuse to do so and instead ask that she reopen my previous trouble ticket, she flatly states that she cannot help me unless I cooperate with her request. I ask to speak to her supervisor. Andrea says she doesn't have a supervisor (how convenient) but that she'll connect me with a "senior technician".

Now Vestil (sp?) gets on the line. Vestil is very polite but he also insists that I plug a computer directly to the DSL modem. Again, I refuse. Vestil then tries to tell me that he will not be able to help if I don't comply with his request. I tell him I will not be able to continue as a customer with his company if he doesn't comply with my request and send a service technician to my house! I told Vestil that his company is unable to deliver on the level of service they promised and now that I'm informing them of the problem and asking that they fulfill their obligation, I'm essentially being told "tough shit". I also asked him to provide a solid technical reason for why I should risk an unprotected computer on the Internet; of course, he could not provide a reason.

How I'm feeling at this point.After much wrangling, I finally told Vestil to forget it; I wanted to cancel the service and receive a complete refund. Now he starts backpedaling, saying he really wanted to help me, they valued me as a customer, yadda yadda yadda. I told him it was too late that he had just lost my business. Finally, I'm connected to the billing department which, I'm told, will cancel my service and provide me with a refund.

Instead of billing, I'm connected to what I'm calling the "customer retention desperation department". What I feel like now.Joyce comes on the line, and she's good. Joyce is obviously well-trained and skilled in sales. She immediately tries to connect with me by telling me she lives in a nearby city and has visited my area many times. She asks why I wish to cancel my service and listens with an attentive and empathetic ear. And despite my knowledge that this is a technique for me to spend my frustration and make me more manageable, damned if it doesn't work. Yes, Joyce weaves her magic and talks me into giving them another chance.

Even so, Joyce did provide a few concessions. First, my service will be free for two months while I try it out. Second, a technician will be here Tuesday morning (my first available time slot), between 9AM and noon, to fix whatever the problem may be at no charge. Finally, Joyce provides me with her direct telephone number as a point of contact for any problems; I guess my file has been marked as a customer in need of special handling -- at least, I hope so.

So, in spite of myself, I'm giving the telco one last chance. At this point, I have spent 6 hours dealing with this stupid issue. At my billing rate of $150/hour, that equates to $900 or, as my business partner pointed out, 60 months of the $15 savings the telco is supposed to provide me over cable broadband service. And I swear, if they don't fix it this time, I'm submitting a bill for my time. I know they won't pay it, but it's the money of the thing, not the principle.


Customer Service….NOT! Part Trois

The local telco technician called and left voice mail this morning. He said they had fixed my download speed problem and that I now had 6Mbps download speed. So, I checked it about 10 AM. At that time I was enjoying 4.8Mbps download speed via my cable broadband connection. I switched over to my new DSL connection.....and was immediately disappointed. Not only was the connection not 6Mbps, it was actually slower than last week. In fact, it's now only 0.8Mbps - 1.1Mbps. Of course, now I'm stuck with closed trouble ticket and no number to call except for an Indian call center. At my billing rate, the time I have spent on this problem is worth more money than I will save in the next year by switching to DSL. That is, if I decide to finalize the switch to DSL.


Customer Service….NOT! Part Deux

As I wrote the other day, I'm having problems enjoying opportunities with my telephone company, trying to establish a high-speed DSL connection. I just received a call from a local technician who informs me that 6Mbps download speed is not even available in my neighborhood yet! He went on to say it should be available next week sometime. One can only hope.


Customer Service….NOT!

Warning: This is a rant.

If you make customers unhappy in the physical world, they might each tell 6 friends. If you make customers unhappy on the Internet, they can each tell 6,000 friends. JEFF BEZOS

As a self-employed programmer, I work from home a great deal and rely on a solid and fast Internet connection. For years, I've used Time-Warner's RoadRunner service because it seemed to be the best value for speed and reliability. That's not to say I haven't had issues with them over the years. I recently decided to switch my broadband service from RR to DSL. RR costs $45/month and the local telco offered a deal of $29/month for a DSL connection with 6Mbps download speed. My cable connection is normally about 3.5Mbps but degrades severely in the afternoons and evenings when all of the neighborhood kids get out of school and online. DSL does not share bandwidth with the neighborhood, so I figured I would take advantage of a two-fold increase in speed with a savings of $16/month. So, I accept my telco's offer and sign up for DSL. I give them a username and password for my account and am told I will receive a package with my modem and software within the next couple of days. Cool. They call back the next day with apologies and say they have "lost" my information. After having them verify they are indeed from the telco, I again provide them with a username and password. Again, I'm told the modem package is on the way. Today, I received my goodie package. I'm excited to try the new service. The first thing I notice is that the username/password combination is not what I provided and is instead a obviously system-generated username with a password of "changeme". Yes, that is the real password. It's incredible that an ISP would not provide a strong, random password. Oh well. I hook everything up and am immediately online. I quickly change my password to something much more secure. The next thing I do is perform a quick broadband speed test. WTF?!? I only have 1.8 Mbps download speed -- less than 1/3 the promised speed! I unplug my router from the DSL modem and plug it into the cable modem. Hmmmm...the cable connection is running at 3.5Mbps.