Jarrod Shapiro, DPM
Practice Perfect Editor
Assistant Professor,
Dept. of Podiatric Medicine,
Surgery & Biomechanics
College of Podiatric Medicine
Western University of
Health Sciences,
St, Pomona, CA

Shoddy Workmanship

The coincidences are abounding. The overlap between work and home often surprises me. This week I noticed an overlap which is of the "nonpositive" sort. It was a great example of the principle that when the job's not done correctly the first time, the consequences at a later date can become amplified and costly.

First, the home example.

After my wife and I bought our home this past October, and the Southern California summer rolled in (90's to 100 degrees in the Inland area), we noticed an unequal cooling of the rooms in the house. Specifically, my daughter's room gets cold like an icebox (you could hang meat in there!), while on the other side of the hallway, my son's bedroom could be easily converted to a sauna. Likewise, the other bedrooms, including the master, are also warm. Additionally, we've had to run the A/C for extended time periods and at lower temperatures in order to keep the house cool.

Enter the air conditioning consultant. After taking a thorough look through our A/C system, he informed us that when the house was originally built, the subcontractor installed the system incorrectly. In his words, "It looks like they really tried to do a good job, but just didn't know what they were doing." The main problem, he informed us, was two-fold. First, they installed the furnace horizontally, which has placed structural stress on the center portion, thus damaging the furnace. Second, and more significantly, they installed the ducts incorrectly. Without getting into the details, they made incompetent mistakes which have led to the current irregular air distribution and poor system performance. Any guesses what this mistake will cost me? $4000 for the duct replacement and another $4000 or so for the furnace. Yea! Lucky me. I get to lose more money on my house. Who needs $8000? I can't think of anything else I could do with the money.

Tonight's Premier Lecture is
Understanding Pigmented
Lesions of the Skin
Marie Williams, DPM

The poor workmanship from the homebuilder has now resulted in a compounding of the problem, with significant implications later down the line.

Now, for the work example.

In a couple of days, I have a revisional surgical case of a rheumatoid arthritis patient who'd had a bunionectomy several years ago. The procedure didn't relieve the patient's pain, so she went to a second doctor, who did an interpositional arthroplasty with a Swanson implant. Unfortunately for the patient, the implant failed. Again, without getting into the details (and no, I'm not going to show the preoperative images – I'm not here to put another doctor on trial) it was mainly due to poor procedure choice and execution…shoddy workmanship.

Now the patient will experience her third surgery to this joint with a fusion and bone graft, with a much greater risk of complications. A lot of extra cost, discomfort, time, and effort could have been avoided with appropriate initial treatment…just like my air conditioning system.

So, for those of us who hate doing a good job, here are four rules for making absolutely certain to create poor workmanship:

Be incompetent. Don't know what you're doing. Make certain that if you don't have the training, go beyond what you're capable of. This will set the stage for later complications.
Be overconfident. If you don't have the skills, convince yourself that you'll still get the job done, and do it anyway.
Be unprepared. Whatever you do, don't prepare beforehand. Then, when something unexpected happens, you won't be ready and will increase your chances for a poor result.
Never analyze your own work. Keep your head in the sand and never look back at your own work with a critical eye. That way, you'll never improve and will be more likely to make the same mistake again.

Our first reaction is to say, "Of course this shouldn't happen. How obvious." But for those of you with any experience at all, I'll bet you can think of many patients you've treated who were the unfortunate recipients of someone's incompetence, overconfidence, or unpreparedness. Yes, sometimes we don't get the best result, but that's not the same as simple poor workmanship.

Perhaps with a little less hubris, we can expect to see less shoddy workmanship and less revisional work. Or maybe not. As for me, I'm so looking forward to writing that check for a repaired A/C system. Fun!