For months I have been bothered each time I hear the radio ad for Angie's List, an online review mechanism for all sorts of local "service providers." I have struggled to understand what it is that perturbs me about being grouped together with technicians of this sort when I consider what I do as an adolescent doctor something very different and more complicated to judge than the results of a repair to a leaky roof or faucet.
Well today, I got some experience to help me sort it out. For a few days my bathroom hot water faucet has simply not let any water out. All the other faucets work fine so I figured it had to be some odd sort of blockage...maybe the kind they could have used in the pipes of the oil rig in the Gulf coast. Anyway, I couldn't see where the problem might be so I called my local plumber. Within minutes of looking he found a kink in a metal tube high up under the faucet. What happened next?
He told me to take down the name of the manufacturer and go on line, order the part and call him back once I had it. Sure I would order the wrong thing and making a quick calculation as to what my own time is worth compared to a plumber, I told him I really couldn't do that, that I considered it his job. "That's sort of like a doctor telling you to go order your heart valve and then they can schedule surgery." He just looked at me, relented and then told me he would take care of it, probably making his own calculation about how much he could charge for this.
But he went on to explain that he doesn't normally do parts any more. Since the advent and rise of the "big box stores" plumbers no longer are the experts on this or make any money when they deal in anything but repairs.
OK, so that's where we had a meeting of the minds. He's got Home Depot and other megastores; I've got Aetna and other insurance companies. We are both diminished in our ability to do the right thing and the whole thing with respect to our customers and patients. Nevertheless, I remain hopeful that with the wink of an eye and a please and a thank you and maybe an extra charge here or there, we can preserve the dignity of our mutual professions. Maybe Angie is on to something afterall.