Customer service
There are those who believe that the customer service model of medicine has been the best thing since Penicillin. Applying a market model to health-care has its benefits, and make no mistake about it. In medicine, we do a job, we get paid to do the job, and the happier the customers are, the better.
I like the idea of the free market in medicine. But the ‘customer service’ model hasn’t really been everything it’s cracked up to be. There are a few reasons for this.
First, in my mind, is that medicine is full of situations in which the person providing the service isn’t paid a dime.
This is often necessary. People who are sick and/or dying don’t usually have time to run to the pawn-shop or arrange a second mortgage if they aren’t insured. We understand that, and I’ve never seen a genuinely sick, but indigent, patient turned away at the hospital where I work.
However, does that person really qualify as a ‘customer?’ I don’t think the analolgy holds. The thing is, in that indigent situation, where no money will change hands, care-givers are actually acting from a higher motive. They’re doing what’s right; they know it’s the right thing, and so they give away their time and services, often their goods, to treat the person in need. The natural law, the inherent Law of God tells us what’s right. When we don’t, we know it; and we feel guilty, whether we admit it or not. So, treating the patient well because he or she is a human in need is far better than treating them well because they’re a customer.
On the other hand, medicine, especially emergency care, is full of individuals who know that they don’t have to pay to be seen, and who repeatedly use the services of an emergency department for minor, ridiculous problems, thus taking up time and energy; thus diverting resources and effort away from the most needy. Is that person, who abuses a privilege and the good-faith effort of health-care providers, a customer? Well, if you go to Wal-Mart and don’t pay, nor intend to, they don’t call you a customer. They call you a ride…in a police car.
But there are other reasons the customer service model fails. The use of ‘patient (customer) satisfaction scores,’ it has actually caused physicians to do things that they would otherwise deem inappropriate, in order to maintain high satisfaction scores.
They may give narcotics they wouldn’t have given, in order to avoid criticism (which may lead to reprimand, loss of income or loss of employment). They may admit those they wouldn’t, give work excuses when they shouldn’t, order tests unnecessarily as a matter of policy or simply endure demoralizing abuse from individuals who should have been escorted to the door shortly after entering. Those individuals may be ‘customers’ to the administrators, but in person, face-to-face, they’re enormous pains to the provider. That’s a shame.
Finally, I think that the problem with customer service is semantic and philosophic. How far will you go for a customer? Will you stay late, arrive early, endure abuse, clean vomit, wrestle, argue with criminal family members, call consultants at all hours and be an advocate? Will you do that for the fixed amount of income represented by a customer? And if so, will the amount have to grow progressively higher as the difficulties become greater?
Or will you do it for a patient? I think that most of medicine’s great efforts have been for patients, not customers. The treatment of epidemics; the crusades against polio, malaria or yellow-fever; the danger of battlefield medicine; the kindness of those treating HIV or addiction. These are not things done so much for customers, whose compensation is temporal or non-existent, as for patients, humans, children of God, for which service the compensation is spiritual and eternal.
Mind you, I don’t want to abandon the market. It has its place. It guarantees specialists and medications, facilities and (the hope) of efficiency that entrenched government oversight simply cannot offer.
But I think, also, that we’re more compassionate to ‘patients’ than to customers. And compassion, I believe, is the ultimate key both to competence and hopefully, to compensation for a job done well and with love.
Medicine is a wonderful mess in America because we practice at a confluence of two great ideas: the free market, and the inherent worth of all mankind, derived from the Judeo-Christian ethic. They sometimes are at odds, but on the whole, they have combined to make medicine in America the envy of the world.
I hope we never close either road. Even if we have to remain a little frustrated by customers, patients and the necessary admixture of the two definitions.
Edwin
Well said, this just got forwarded to my med dir.
Those who write narcs or otherwise make bad decisions based on patient satisfaction concerns are unclear on the drivers of patient sat (and probably that is the fault of their management team). The most important variables, by and large, are door-to-doc time, face-time-with-doc, courtesy, and level of understanding of the doctor’s explanation. Pain control is in there, but in most cases it is not the key factor.
If your docs are being graded on patient sat, tell them to get right in the room, smile, make the patient feel cared for, and explain carefully the diagnosis and treatment plan. You can still kick the drug seekers and malingerers out; they are a very small margin on top of the much larger cohort of real patients (and they don’t tend to answer surveys).
The problem is not the concept of “Customer Service,” the problem is the managers who don’t understand it or implement it wrong.
According to Websters Dictionary, a customer is someone paying for a commodity or service. So yes, in this definition, people walking in to the ER for free service cannot be a customer. A patient is defined as a: an individual awaiting or under medical care and treatment b: the recipient of any of various personal services. It is definitely a question of : are those receiving medical care a customer or a patient? Unfortunately because medicine in the United States is so money driven, the concept of patient has been lost. Hospital administration sees patients as customers because the majority will bring in the money which is their focus.
Despite the forces of administration, I think we as providers of medical care need to continue to see anyone who walks in the door as a patient and not a customer. I think this is what God has intended and I think this would help us to put aside our cynicism and be able to treat patients as they should be treated despite their motives.
It is a sad reflection of our society that medical care has become so customer satisfaction driven. But perhaps this is a function of our attitudes as health professionals as well as the general population expecting to receive the top customer service.
Shadowfax hits it directly. “The problem is not the concept of “Customer Service,” the problem is the managers who don’t understand it or implement it wrong.”
All the anecdotes you share are faced by any organization serving the public. Customers abuse the system, customers can’t afford to pay, customers want something for free, customers needs don’t fit into standard office schedules…etc
And what you describe is the same problem many ‘brands’ face: An unclear message, with unclear criteria, that’s communicated randomly, erratically, inconsistently, with an unclear understanding of who is serving whom.
Do you serve the public’s needs (all of them) or the hospital’s shareholders? It’s the same question you hear every day in other businesses. Do we serve our shareholders or our customers? Can we serve all of our customers with the highest degree of service and integrity and still keep our shareholders happy?
I admire anyone and everyone serving in the front lines of health care, especially in an emergency room. At the risk of being obsequious, you do a heroic job in a room full of the highest levels of conflict and stress.
It’s magnified by the lack of clarity of mission and priorities and a confusing definition of who is your customer. That’s management’s fault. That’s the fault of our health care system. Oh, and a lack of resources.
But ultimately, we all serve someone. We keep our jobs, our homes, our incomes, our relationships to the extent we’re clear on who we serve and find the skills to prioritize that job.
I see your frustration arising from the very admirable desire to serve, but placed in a position where you’re constantly thwarted by contradictory messages, conflicting agendas, and no real leadership to back you up…not from a customer service model.
Thank you for what you do. I, at a different time, may have been one of those who needed your dedication but was unable at that moment to pay. I’m fortunate to afford health insurance now.