More patients are being referred to as consumers, and some don’t agree with the connotation.
“That puts a bigger emphasis on how much profit the patient can make a company, which can lead to less-than-optimal decisions on behalf of the patient later on,” says diabetes blogger Manny Hernandez.
However, patients are now encouraged to advocate on their own behalf, and entities like high deductible health plans and health savings accounts make it a requirement to shop around and compare prices.
Fellow diabetes blogger Amy Tenderich writes that being a consumer implies being a customer, as in, “the customer is always right.” But how realistic is that?
When a patient presents to the emergency room with crushing chest pain and is diagnosed with a heart attack, are they really able to shop around for the lowest price or request angioplasty versus bypass surgery?
After being evaluated for back pain, should patients who request an MRI automatically receive one? Or when in chronic discomfort, should they receive narcotics on demand?
The answer to all those questions is no. Patients can never “always be right,” and for that matter, neither can doctors. Ideally, medical decisions should be made with patients informed each step of the way, with guidance by a medical professional.
Hopefully, the resulting shared decision would then be agreeable to both sides.
Related posts:
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- Patients as customers
- Patient satisfaction vs pain relief
- Kidney stones treated in the emergency department
- Should some doctors be restricted from prescribing narcotic pain medications?
- How pain is treated around the world
- Pain management and contradictory articles
{ 14 comments }
A lot of clinical decision making is based on cost-efficacy in today’s medicine. Although patient autonomy should be at the core of western medicine, our clinical decisions are heavily influenced by cost-considerations. Having said that, I don’t see why a patient who has been informed of potential harms and benefits as well as the (low) diagnostic yield of a relatively harmless test should be turned down if s/he is willing to pay for it.
As someone who used to work in customer service, the issue isn’t that the patient is always, but that the patient always thinks they’re right. It’s still up to the provider to decide whether or not to administer any service, which gives doctors some leeway in refusing things that aren’t going to help the patient.
Consumerism is killing primary care just as much as government intervention. It is promoted by the insurance industry which benefits from pitting patients against their doctors. The doctors, and not the insurance companies, are therefore perceived as the problem.
One of my biggest pet peeves in private practice is when patients with sniffles complain that the wait is too long (usually 20-30 minutes). They don’t care that there was a walk in laceration, or someone with chest pain in the other room. They don’t care that my staff spent 20 minutes on hold to verify their insurance coverage. They don’t care that they were 5-10 minutes late for the appointment to begin with(along with many other patiets).
All they care about is their service. And, dammit, it’s never good enough. If they don’t like the service at McDonald’s, they will simply go next door to Burger King.
Well, I say, let them go.
The doctor-patient relationship is complicated, much moreso than a customer going to a restaurant. It requires give and take. Yes, I may be running late, but you know what? You may be calling me after hours for something that easily could have waited for the morning. Why do patients call so much after hours for trivial matters? Answer: they feel entitled as “consumers” of healthcare, even though after hours calls do not involve any monetary transaction.
Come on people. We are your doctors, not your waiters.
A family practitioner
There's a panoply if words associated with this. I use the panoply on purpose because individual's and services can hide behind words (as we all do) using them as a defence.
'Patients' will also tend to be viewed as 'customers' when the systems used to collect their 'satisfaction ratings' of the 'patient experience' are adapted from existing CRM applications.
There's a dated concept in nursing (and medicine?) 'patiency' when does it begin, when does it end…
If the public is engaged then (idealistically) they can 'shop around' before they reach mobile paramedics -> A&E.
Then the public has acted politically and socially prior to their need to engage in the actual care processes themselves.
Thanks for this prompt – I'll frame a blog post around it.
Here's a post on the 'public' and the sanctity of records…
http://hodges-model.blogspot.com/2009/02/confidential-letter-to-self-and-you-and.html
(Confidential) Letter to self – and you, and you, and you… ?
http://snipurl.com/beqf7 [hodges-model_blogspot_com]
Best,
Peter Jones
Hodges' model:
http://www.p-jones.demon.co.uk/
one of the few nice things about the primary care shortage is you don’t have to worry if some patients decide they want to go elsewhere.
Do what you think is medically appropriate. If the patients don’t like it, they can try to find another doctor, (or go to a “pseudo-doc” in-the-box place.) Plenty of others waiting to be seen that can fill out the schedule.
Siiigh. Medicine is not a service industry! Service industries exist to give people what they want. Medicine exists to give people what they need. Very different. If only more patients would realize that …
“One of my biggest pet peeves in private practice is when patients with sniffles complain that the wait is too long (usually 20-30 minutes).”
I bring a good book or play games on my PDA and enjoy a little down time from my busy schedule.
“All they care about is their service. And, dammit, it’s never good enough.”
We patients are treated as consumers and you wonder why we act like consumers? I wish I had a warm caring relationship with my doctor-but what I get is customer service-”do you want fries with that?”
As I become a health care consumer instead of a patient, my trust for the medical profession is about the same as a car salesman.
I think patients are customers – but they aren’t always right. If you were an automobile mechanic, would you always consider the customer to be correct? No. You would want to make them happy, overall and within reason. There are plenty of customers who are too demanding, who think they know what you should do, or who ask for too much, and you learn to set limits (as any service industry must).
It is the insurance industry (including Medicaid and Medicare) that interposes itself between the customer/patient and the physician – this adds to the complication of the interaction and results in worsened customer service.
“The customer is always right” was said as a joke. It is black irony. It was a shopowner’s conundrum: if you wanted return business, you had to keep your buyers happy or they would go somewhere else. Of course the customer wasn’t always right, but you still had to make them think that they were. As an axiom, it was meant to be funny.
Love the comment about how all nasty patients b*tch about having to wait a few minutes. As all generalizations, it’s crap.
I try to schedule appts for the early morning and usually arrive at least ten minutes before the scheduled time. More often than not, I’m called back right away. The doctor gets a jump on his day and I don’t have to wait. Works for both of us.
Longest wait I ever faced was 90 minutes past the scheduled time. This was a post-op appt with a specialist and yes, I was angry. After that wait, he spent less than two minutes with me. As I left, the front desk apologized and commented that the surgeon was running behind because he’d brought his young daughter to work with him that day. Seems he’d just gotten back from a ski vacation and his wife had decided to spend a few more days on the mountain without the kid. IMHO, not a good reason to inconvenience your patients to such a degree. People were standing in the hall because they’d run out of room in the waiting room.
Most human interactions follow the same basic rule: you get what you give. Before you lambast your patients, who are paying you for your time (not vice-versa), think about how you treat them. Maybe they aren’t the problem.
If the customer is always right, who runs the asylum?
Neither. Take Type 2 diabetes for instances. On one hand, you’ve got doctors advocating that weight loss can reduce the risk for Type 2 diabetes. On the other hand, you’ve got Type 2 diabetics who learned from other diabetics that by skipping insulin dosages, they can lose weight faster.
Who’s right in this case? Neither.
Patient or Customer? Neither.
Patient describes a business relationship too: I am only a patient when someone is getting paid. And the word patient carries baggage that comes from its meaning in regard to acute medicine; this acute baggage is inappropriate when referring to someone dealing with a chronic condition.
We can do better than modeling ourselves after the players in a business transaction or the passive language of acute medicine. Living with a chronic disease takes far more effort than establishing a handful of business arrangements or just being informed of what the doctor thinks is best. We should look to the business language of partnership or affiliation rather than the language of the business transaction.
I’ve come to the conclusion that achieving efficient practice operations comes by having a customer (not patient) service centered approach to the medical practice. I say customer and not patient because the word patient implies cared-for from a clinical perspective and a customer implies someone that we care, provide and accommodate for their needs.
Of course doctors are not going to give in to everything a patient wants because they have a “customer” centered approach to their practice. But I think we can improve how health care is delivered if we take a customer service approach; especially in a private practice setting.
If a patient/customer dread coming to your office because the staff is not courteous, has to wait hours (without being informed as to why the long wait), or your office is too strict with policies, charges for every little thing if patients don’t comply with “practice” rules, then I think taking a customer service approach is a good thing.
And remember, happy patients not only strengthen the relationship between the patients and practice, it also helps improve on other things; like collecting patient balances, reducing bad word-of-mouth and potentially, malpractice claims.
I believe that taking a “customer” approach not only will it help us achieve efficient practice operations, but more important, provide patients with a remarkable experience when they visit your office.
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