Have You Checked the Canary in Your Coalmine?

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I read the legendary story about rock band, Van Halen, stipulating in his contract that he must have a bowl of M & M’s backstage before every concert and that all of the brown colored candies need to be removed.  I didn’t believe that an entertainer could be so demanding and capricious.  However, I did my research on Snopes.com (https://www.snopes.com/fact-check/brown-out/) and found that the story was, indeed, credible and accurate. 

The legendary “no brown M&Ms” contract clause was indeed real, but the purported motivation for it was not. The M&Ms provision was included in Van Halen’s contracts not as an act of caprice, but because it served a practical purpose: to provide an easy way to determine whether the technical specifications of the contract had been thoroughly read (and followed). As Van Halen lead singer, David Lee Roth, explained, Van Halen was the first band to take huge productions into tertiary, third-level markets. His show consisted of nine eighteen-wheeler trucks, full of gear, compared to the standard rock concert, which simply required three trucks. With so much equipment and so many local stagehands to help build the sets, there were often many technical errors.

The contract rider read like a version of the Chinese Yellow Pages because there was so much equipment, and so many technicalities required for proper functioning. So just as a little test, to ensure compliance with the technical aspect of the contract, it would say article number 126, “There will be no brown M&M’s in the backstage area, upon pain of forfeiture of the show, with full compensation.”

So, when he would walk backstage, if he saw a brown M&M in that bowl, he knew there would likely be a lack of adherence to the more important details of the contact.  He said that a brown M and M almost guaranteed that there was going to be an error of omission about the erection of the expensive sets that could result in damage to the equipment or injury to personnel. If the local team of assistants and the promoter didn’t pay attention to the little details, the bigger and more important requirements could also be overlooked. The M&M was his canary in the coalmine.

So what is your canary in your coalmine?  What clue do you have that things aren’t going to be right when it comes to caring for your patients?  In my practice, it is the restroom.  If I walk into the restroom at any time of day and if I see towels or tissue paper on the floor, the wastebasket overflowing, and no sterile containers for the patients to give a urine specimen, then I know that the other details might not be in place or the staff is not completely engaged and ready to see patients. 

Examples may include confirming that the proper chart is pulled for each patient with the appropriate chart on the door or the proper EMR encounter on the computer at the time the patient is placed into the exam room.  Another important detail is that all of the laboratory, pathology and x-ray reports in the chart prior to the patient being placed in the exam room.  And finally, have someone check that each exam room is fully stocked with the necessary supplies, prescription pads, and educational material to give to patients for the most common conditions.  These are critical details that have to be implemented to be fully ready to care for patients, just like the proper specifications necessary to erect a rock concert set. 

So what might be the canaries to monitor in your practice:            

  • Are staff members chewing gum?
  • Is the uniform neat and clean?
  • Are the staff members wearing their nametags?
  • Are the computers turned on prior to placing patients in the exam rooms?
  • Is the practice’s telephones turned over to the answering service each evening?
  • Does every piece of paper or educational material have the practice name, address, and contact information on every page of the handout?
  • Are the restrooms checked multiple times of day for ample tissue and toilet paper?
  • Has the coffee been brewed for the doctor?  (This is bordering on Van Halin’s M&M request!)

Bottom Line:  Just like the blood pressure, pulse and respirations are the indicators of the overall health of your patient, so are the small details that indicate your staff’s preparation for your patients.  So listen to your canaries.  If they “tweet” (this is not meant as a political message!), then you can be sure you are ready and prepared.

*Dr. Neil Baum is a Professor of Clinical Professor of Urology at Tulane Medical School.   

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Dr. Neil Baum

3525 Prytania

New Orleans, LA


504 891-8454 (o)

504 891-8505 (f)

Key Words: Patient-doctor relationship, patient satisfaction, staff motivation, patient expectations, outstanding service.Abstract: A medical practice is based on attention to the little details because they do make a big difference.  It is not easy to stay focused on the little details and the staff has to be reminded of exceeding patients’ expectations regarding the care they receive in our offices.   This article will provide suggestions for making certain that every patient has a positive experience with the practice by focusing on the smallest details. 

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