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

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