What doctors can learn from working at Starbucks

What doctors can learn from working at Starbucks

She sat in her crisp, white coat, probably not much older than I am now, leaning back with all of the assurance of someone who recently completed a cardiology fellowship, newly hired by the academic medical center to which I was applying for residency. One of the first of many interviews for me, the conversation was anything but smooth. She clearly wasn’t sold on me. To remain genuine and avoid canned responses, I never bothered to research popular interview questions. Unfortunately, that also explains why I fumbled a little bit when answering “What three people who are not alive would you like to meet?”

I had just about given up on getting a good review from my interviewer, especially considering that she had already met some of my brilliant classmates whose parents worked for the same institution. But she had one more question for me. “So,” she said, twisting her chair to the left with her arms crossed, looking at me a little sideways. “What makes you think you would make a good doctor? What have you done in the past that makes you think you would be a good physician?”

My answer was ready … and not because it was rehearsed. It wasn’t the volunteering in nursing homes and Habitat for Humanity. It wasn’t the good grades. It wasn’t even because I was a caregiver at one point or because I had spent countless hours in labs.

“Waitressing, actually.” I said this without hesitation and with an even tone. “I learned a lot by interacting and talking with customers.” I knew I was taking a chance with this seemingly unsophisticated response, but I didn’t seem to have much to lose at this point.

“You know,” she said, looking surprised, suddenly animated, and mildly… exasperated? She turned to face me square on now. “My best friend keeps telling me the same thing. I don’t get it, but she keeps telling me that it’s true.”

And then the ambience changed.

***

This having been my – paraphrased – experience years ago, I could not ignore a recent article entitled: “Do Starbucks Employees Have More Intelligence than Your Physician?

The short answer is: Yes … and no, of course.

Articles like this paint a sharp caricature of the emotionally “unintelligent” physician. Here, Dr. Peter Ubel points out that Starbucks employees “undergo rigorous training in how to recognize and respond to customer needs,” and he describes the Starbucks solution for dealing with unpleasant interactions, called the “Latte Method” (listening, acknowledging, taking action, thanking, and explaining).  He contrasts this with the physician whose nose is buried in labs, insensitive to the emotional needs of his patient.

Needless to say, a barista’s work and a physician’s work are not quite the same. A negative interaction within a doctor-patient environment is less like one in a food service industry and probably more similar to one experienced, say, by an airline customer service representative and a customer who finds himself unexpectedly stranded after his flight is cancelled, trying to get home in time for his mother’s funeral. (A free coffee rarely solves this sort of problem.) The intensity of emotions tends to be quite high, the variables are many, and there can be a certain level of uncertainty that is uncomfortable for both parties involved. AND, there are multiple other people waiting in line with other high-intensity needs. There are certainly some doctors who seem oblivious to the emotional state of their patients. But there may be other factors, as well. For example, a burned out physician will find it difficult to empathize, and physicians who are essentially running on hamster wheels may feel too pressed for time to address complaints effectively. That being said, I happen to like the “Latte Method” described in the Forbes piece, as it can be applied to various aspects of our personal lives and across different industries.

A lot more work should be done in early medical training to help future doctors acknowledge and effectively deal with the unpleasant interactions between doctor and patient. Out of training now for some years, I was interested to hear about a group called The Balint Group, which focuses on exploring the doctor-patient relationship. Our clinic, The Polyclinic, has a Balint Group, so I decided to join and explore this subject some more. In this group, the meeting begins with one physician presenting a recent difficult or uncomfortable interaction. The rest of the physicians then discuss it by exploring both sides: what it must be like to be the doctor and what it might be like to be the patient in the case. It is very non-judgmental and not meant to be a problem-solving session. While many times there is no one right answer, the mere act of thinking about and discussing this topic can help improve interactions during the regular workday. I would recommend The Balint Group to any physician with an interest in the doctor-patient interaction.

Perhaps Dr. Ubel is onto something when he suggests that Starbucks employees have more emotional intelligence than physicians. Until these goggles that help detect facial cues become available and universally accepted, doctors will have to rely on their own radars, which may be fine-tuned with some more training. While I am not sure I could survive the Starbucks pace at this point, I did sign up some time ago to be a volunteer server for a local culinary and job training and placement program called FareStart. Who knows? I may come back a better doctor for it.

Linda Pourmassina is an internal medicine physician who blogs at Pulsus.

Image credit: Tupungato / Shutterstock.com

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  • http://www.facebook.com/jonathan.marcus.ca Jonathan Marcus

    I am a family physician from Toronto. I would say the biggest barrier for me is feeling like I’m on a hamster wheel. Given the time, I sometimes respond to patient’s emotional needs amazingly, probably better than a Starbucks employee. However I will admit that there have been times (perhaps too many of them) where I have missed the boat in communicating properly to patients. If I had more time, most of these bad interactions I believe, could have been better. It’s not a matter of knowledge. I think I could write a book on how to communicate. Doing it masterfully every time is another thing.

    • buzzkillersmith

      A Canadian! Finally. Do tell, doctor. Please tell us what’s it’s like to practice up there. I’m a family doc from WA state and they’re always looking for docs in BC, although perhaps not in Vancouver or suchlike nice places. Tell us about your experiences.

    • http://www.thehappymd.com/ Dike Drummond MD

      That is the missing piece in all the “doctors should be doing this and doing that ” articles. 1 in 3 doctors are burned out every day. We don’t have the energy or bandwidth in many cases to do anything other than the clinical tasks.

      If you don’t lower the stress and improve the working conditions for doctors and staff … you can’t get changes in performance or patient satisfaction without actually adding to the stress with one more thing we “ought to be doing”.

      In the future, all studies of physician communication and patient satisfaction should be normalized for the stress and burnout levels of the doctors. THEN you would see the real reason we are often communication challenged. Not that we don’t smile and say hello like they do at Starbucks or Cheesecake factory or Wyndam hotels for golly sake,

      Dike
      Dike Drummond MD
      http://www.thehappymd.com

      • mike

        I am interested in hearing specifics about what must be done, in your opinion, to reduce physician stress and improve working conditions. What type of organization describes where you practice?

        I interact with many physicians involved with population management in organizations run by physicians. Maybe you are in the wrong organization without full engagement and input as to how things work and should be improved for benefit of patients and clinical personnel.

        • http://www.thehappymd.com/ Dike Drummond MD

          Hey Mike … 20 years of research shows that 1 in 3 doctors are burned out on any given office day. A survey done this year showed a rate of 87%. Another survey showed 60% of doctors would retire if they could. Online physician sites like Sermo.com are filled with fed up doctors and posts here on KevinMD.com are consistently lamenting the state of healthcare stresses in the front lines.

          If you have an example of a healthcare organization that claims to have “Full Engagement” of the providers … please let me know who that is … so that I can study them in detail as an example for all to emulate. The people you want to be talking to are the front line doctors in those organizations and ask them what their experience is of working in the system.

          I have over 100 ways to improve the stress and working conditions of providers in healthcare – about half of them are ones the organization can take responsibility for.

          If you would like to learn more, please use the contact form at my website.

          Dike
          Dike Drummond MD
          http://www.thehappymd.com

  • ButDoctorIHatePink

    People in the service industry do tend to have a talent, learned or not, for dealing with people and their moods, A more apt example would be a school secretary, because you don’t see angrier people than when they think their child has been wronged. A sponge left in a bowel is nothing compared to perfect little Megan being told she has to change her inappropriate shirt. However, learning to listen with empathy and at least try to imagine what it is like on the other end of the exam table is a worthy goal and can make one a better doctor. Those who only see their side, in any situation, never fare as well.

    • http://www.compdentalhealth.com/ Joseph Tagliarini

      I think you make a great point. Sometimes you have to put yourself in the shoes of your patient so you can empathize with what they might be feeling. They don’t have the training or expertise that you do and often turn to Dr. Google for help first, which usually only makes them more nervous and apprehensive and frustrated.

  • azmd

    Actually, I avoid Starbucks like the plague, mostly because of the supercilious attitudes of the majority of the barristas I have interacted with. Also, a little bit because I don’t like their coffee, but I digress…
    Getting back to the barristas, most of them seem rehearsed and quite non-genuine in their interactions with their customers. If this is truly what my patients want from me, I need to find another line of work.

    • http://onhealthtech.blogspot.com Margalit Gur-Arie

      I am a Starbucks addict, and I also travel quite a bit, so I can say with some anecdotal authority that all that friendliness stuff is fake, and it feels fake if you experience it often enough as I do, and there comes a point when it actually starts to get on your nerves. I don’t think physicians should engage in perfume-spraying or coffee-serving customer service tactics.
      That said, the Starbucks closest to my house, where I go most often is different, because over the years I came to know the folks that work there and they know me. We chat about their life and family and they feed my dog whipped cream. In medicine that’s called continuity of care, or longitudinal relationship with a patient. That’s what we need instead of corporate standard issue of faux politeness….

    • Homeless

      I feel the same way about doctors. I avoid them like the plague. The care they provide is substandard….but I digress.
      Most of the doctors seem non genuine in their care, recommending treatments to line their pockets.

    • Epador

      This article is a great idea if you work at an overpriced concierge practice franchise. I have had my own private solo practice for 15 years in a highly competitive environment, served military medicine and now FQHC’s. I am bored by folks complaining about being burned out. If you don’t like your job then try something else. If you aren’t astute enough to have good people people skills, then become a pathologist or a surgeon. (Ducking quickly as that WAS a joke).

      The culture of medical practice is the most safe AND the most fun when it is a congenial team endeavor. If where you work isn’t then either get off your duff and advocate for change, or find a job where they can satisfy the team approach. Whining like a six year old that it is everyone else’s fault you hate your job and are burned out really doesn’t cut it for me. Anyone smart enough to make it through medical training should also be responsible enough to control their own fate, much less offer excellent care to those that seek it from them.

      • azmd

        I am not sure why exactly this remark is in reply to my post, but on the off chance it was not misdirected, I am going to clarify that physician burnout is not actually a problem for me personally, as I am very fortunate to have a good job in the public sector where I am given ample time to meet my patients’ needs and am part of a congenial team working together to treat our patients.

        I am, however, aware that good jobs like mine are in short supply and that many doctors are struggling with seriously adverse working conditions which do not seem likely to improve any time soon unless we all get organized and do a better job of advocating for our profession.

        Advising individual doctors who are unhappy to “get off your duff and advocate for change,” is really not realistic advice for the vast majority of physicians employed by non-physician led healthcare systems as they will for the most part just end up being labeled “disruptive.” Telling people to get a better job in a market where the good jobs are increasingly rare is likewise unhelpful. We all need to work together to effect change, not take pot shots at those members of our profession who are struggling.

        • Epador

          Well, then we’re just supposed to support the deadly status quo?

          I totally agree with your distaste for Starbucks. I equally have distaste for branded medical franchises. There ARE lots of good jobs out there, but there are also lots more bad ones.

          It is quite possible to advocate positively without disrupting your employer or your workplace.

          I tend to use parenting skills honed on four kids when getting administrators to eat their broccoli.

  • Lbc

    Well, I am both a physician AND a former Starbucks barista. One can be successful in both jobs by focusing on polite efficiency and enjoying the chance to do something with your hands. For what it is worth, my advice to all parents (and my plan for my own daughter) is to encourage your kids to work a real “job” in the service industry. They teach you to be on time, to follow instructions, and to value your education as that $8/hour paycheck doesn’t go very far. I credit a lot of my success to lessons learned in that and other menial/service jobs!

    • http://www.thehappymd.com/ Dike Drummond MD

      With one in three doctors burned out on any given office day and compassion fatigue as one of the first symptoms – no wonder docs don’t give the same customer service the baristas at Starbucks do. There is no comparison between the role, stress levels and importance of a barista and a physician.

      if you want better customer service, you must focus on lowering the stress levels and improving the working conditions for the doctors and staff. Then they will be more open to communication skills training and the like. If you just pile this as one more thing they “should” be doing. You are tossing them under the bus.

      Dike
      Dike Drummond MD
      http://www.thehappymd.com

      • Epador

        Dike, sounds like you voted for Mr. Obama twice.

    • azmd

      This is actually great parenting advice, and has been wildly successful for our 20 year old son, who has a great work ethic and great work habits, courtesy of several years of working at a minimum wage job at a local movie theater. We think the lessons he has learned will translate well into most professions he might pursue.

      We are, however, encouraging him not to pursue a career in medicine, although he would like to. The working conditions for most doctors these days are adverse enough, that we suspect his everyday stress levels would be too high to be able to consistently and successfully incorporate what he has learned at the movie theater job into a future career in medicine.

    • Even Steven

      Amen, a REAL answer.

  • http://www.facebook.com/profile.php?id=614010948 Earl Smith

    Great article. I am fellowship-trained and boarded in Palliative Medicine, and I am still learning from my social worker and other co-workers how to talk to people. My favourite job in my life was when I worked at IGA. Now I find that common courtesy works, but active listening works more. Let someone tell you their point of view (“I don’t like green Jello, I want orange, they keep giving me green”) and even if it’s beyond your power to correct, repeat it back, paraphrasing, to indicate you are listening. (“Yeah, the kitchen only ever serves green Jello.”). Boom, your patient is heard, he knows you can see his worldview, and he trusts you more.

  • Barbara Bohan

    Cute article! I have been to a professional who in tight time constraints was able to still make me feel valued as a human being. As I know people who are over weight and very sensitive about this subject, it surprises me how doctors “beat a dead horse” telling people they need to eat right and diet. I know someone who said she visited a doctor for the first time and that the doctor lectured for a half hour on that very subject. Why I didn’t have to get an MD to observe if a person could stand to lose some weight for better health and I bet the person knew it when they left home, but I tend to use the edit button and not state the obvious. What is worse is when a person receives a serious prognosis in a very detached manner. I do have compassion for doctors who have to give a lot of bad news. If they had to feel the pain and suffering for everyone that would be unbearable. And yet, they could try not to be cold. Well, the dentist said how great my teeth were when I went a few years ago. Great interpersonal dynamics there lol!

  • http://www.thehappymd.com/ Dike Drummond MD

    Poppycock …

    There is very little comparison between a Starbucks employee and a physician. Except if you descend to the level of “customer experience”. Even if you do that … the differences are so glaring it boggles the mind to see article after article comparing the practice of medicine to Starbucks or the Cheesecake factory for heaven’s sake. A quick reminder …

    - People don’t go to Starbucks when they are sick, hurting and scared.

    - No decision at Starbucks has a shred of relevance to the person’s larger life.

    - 1 in 3 Starbucks employees are not burned out on the average office day.

    - People at Starbucks don’t have an insurance company telling them they can’t have the pumpkin spice latte because that particular flavor is not covered … then the barista has to call up the insurance company and fight for those three pumps of pumpkin spice for 30 minutes while the rest of the line waits.

    Do I really have to go on here. The relevance of a starbucks employee to the average physician seeing patients is incredibly superficial and these articles are pure fluff – popular light reading of little practical use.

    I can learn a couple of things from a barista – mostly around trying to be nice.

    The healthcare industry could learn a whole lot more about creating physician and staff satisfaction and lowering the workplaces stresses for the folks in the front lines of medicine … if they would stop writing and reading articles like this.

    You cannot have patient satisfaction without physician satisfaction and remember one in three is burned out today in the office. This is where to focus. How can your organization better support the health and wellness – not just the efficiency – of the doctors and staff in your system … today .. right now … what are you doing about that?

    People at Starbucks are happy. You go there for happy things. People in healthcare are stressed and burned out and you go there because you are some combination of scared, sick, hurting. If I smiled and gave you a tasty, overpriced coffee drink and moved on to the next suffering patient – well that is not what you expect from your doctor now is it.

    Dike
    Dike Drummond MD

    http://www.thehappymd.com

    • http://www.facebook.com/lucas.mattiello.1 Lucas Mattiello

      Great points Dike. What would you say are the 3 biggest stressors facing Physicians?

      • http://www.thehappymd.com/ Dike Drummond MD

        Hey Lucas … top three is a tough one. Being a doctor is like battling through your day and ending up bleeding from a thousand paper cuts, just hoping there is some of you left when you walk in the door at home.

        Some of the biggest practice stressors I see in my clients are

        - the overwhelm of the sheer volume of tasks and patients
        - all the non clinical bullpucky involved in patient care and reimbursement – coding, making your production numbers, multiple insurance plans each with a different matrix of covered services and drugs, office politics, keeping up with changes in care and CME
        - the demon that is EMR and the way it slows the doctor down and gets between them and their patients

        BTW, no one at Starbucks has to deal with ANY of this. They don’t even grind the coffee and pull the espresso shot any more – they are not even baristas … they push a button and smile. No comparison at all in their job and being a physician.

        Why do you ask Lucas?

        Dike
        Dike Drummond MD
        http://www.thehappymd.com

        • Even Steven

          AHAHHAHAHA
          Political/sales posts are too funny/

          all the non clinical bullpucky involved in patient care and reimbursement – coding, making your production numbers, multiple insurance plans each with a different matrix of covered services and drugs, office politics, keeping up with changes in care and CME
          - the demon that is EMR and the way it slows the doctor down and gets between them and their patients

          I call BS. NEVER seen an MD worry about ANY of those…Hope you get LOTS OF MONIES from the suckers.

          phony.

  • DCBO

    I get tired of hearing doctors complaining about how over worked and burned out they are. I’ve worked in healthcare for 30 years and have watched it transform during those years from a very manual, error prone system to one that allows physians to see the same number of patients and decreased errors. The bigger problem is that new physicians want 9:00 to 5:00 jobs that pay $350,000.00 or more per year, where their predecessors worked 70 plus hour work weeks and made less. As far as having to obtain approval from insurance companies, that is part of what I do. I can tell you this has been going on for the past 20 years, while the procedures requiring authorizations has increased, the processes for obtaining the auths has become automated making the process less time consuming.
    With regard to the article, while expecting a physician to behave as a barista, in fact I think most pattients would find it a little unnerving, patients do want a doctor who listens to them. Some of the best doctors I know were able to diagnosis patient simply by listening to them and then examining them accordingly.

  • HotDawgs

    I am not a physician, nor have I worked at a Starbucks. I have owned a gourmet coffee house, and did hear the comments about Starbucks from folks like AZMD. I have visited physicians, as we all have, and have found some extremely good, and some extremely . . . well, not as concerned about patient care. Booking patients every 15 minutes, when there is no way to ‘listen’ to a patients concern is impossible. Treating them for a specific problem in that time-frame is also impossible. So while I’ve been waiting, sometimes up to two hours, the next patients are also waiting. My time is just as valuable to me as the physician who expects patients to wait on them. I won’t do that anymore.
    If there is stress for physicians, it could be from over-booking, thus losing
    touch with the details of the office, perhaps not catching something the
    patient might have been saying. It has happened to me. Not only have I owned a coffee house, I was also a bartender in my early life, and I always appreciate what service people have to go through. And of those who have written here that it might be well to learn from them, they are right. I have been in Human Resources and Recruiting for many years now,
    and I have to read body language, watch how people react to questions, and actually make ‘next steps’ in process. With doctors, I’ve been astounded; the stories I could tell . . . Suffice it to say that there are doctors on both sides – those who would ‘build their business’ with other physicians, and bill the insurance companies – sometimes with incorrect codes. (Yes, there are those who do that!) And then there are those physicians to whom I say ‘Thank you!’ for being the kind, caring, knowledgeable, and assessable doctor, who has made a difference in the lives of so many. Yes, there are changes in processes, insurance, codes, but the rest of us have to keep up with constant changes to requirement changes . . . and we work long hours as well. My life can be extremely stressful with all the reporting and tracking, too! For me. . . I simply care about my candidates, and do whatever I can to ‘make a difference’ in their lives, because they are more than a number. Every person I interview won’t get the job, but I want them to feel good about the experience of working with me, and perhaps in the future there will be another opportunity. Physicians can make you want to come back to see them – or drive them away with what some perceive as ineptness. Just pause long enough, and listen to their problem, so they know you care. We know you do, or you would not have gotten into part of the medical profession – it takes special people to do what you do.

  • Even Steven

    As an Allied Health Technologist… Bedside Manner is what impresses most Physicians I have worked with. The simple ability to be extremely comfortable around people, and do your job, while continuing to talk casually. I have met MANY old MD’s that have yet to master this.