Why should practicing medicine be compared to any other occupation?

A while ago, Atul Gawande, the noted surgeon-author, wrote a long piece in the New Yorker on why health care should look to a restaurant called the Cheesecake Factory for some guidance on how to standardize things.

This was met with some derision by a number of physicians who pointed out, among other things, that the food at the Cheesecake Factory is not great and is loaded with calories. But I guess it’s at least it’s “standardized” mediocre and unhealthy food.

Then a doctor named Peter Ubel wrote in Forbes that doctors should take a cue from Starbucks about how to deal with people. He went so far as to say that baristas have more emotional intelligence than physicians.

He says the Starbucks staff are trained to placate angry customers using the mnemonic “LATTE,” which stands for “Listen to the customer, Acknowledge their complaint, Take action by solving the problem, Thank them, and then Explain why the problem occurred.”

I have never worked at Starbucks, but when I was a surgical chairman, I unknowingly used most of their principles in dealing with patient complaints about my attending and resident staffs. I could add another. I used to ask the dissatisfied patients and families “What can I do to make you happy?”

I was surprised that in many cases, the complainants could not think of a single thing that would make them happy. The question often completely diffused the confrontational nature of the encounter. You might want to try it sometime.

Another way of looking at this issue was suggested by a Twitter colleague, Dr. Edward J. Schloss, who tweeted that we work for the government, and we should be compared to the Bureau of Motor Vehicles or the post office, not Starbucks.

Since doctors are already notorious for making people wait, comparisons to the BMV would seem appropriate. And some docs also take forever to return phone calls, similar to the post office’s habit of delaying the mail.

Surely physicians look better when compared to another government agency, the Internal Revenue Service, especially now that the IRS has been accused of selectively harassing certain political groups and spend lavish amounts of money on conferences.

At least no one has suggested comparing us to pilots lately.

Why should practicing medicine be compared to any other occupation?

Doctors are unique. None of us is perfect, but despite the occasional bad apple, most of us are doing the best we can for our patients under difficult circumstances.

“Skeptical Scalpel” is a surgeon blogs at his self-titled site, Skeptical Scalpel.

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  • ninguem

    Skeptical is right.

    I took Dr. Gawande’s advise, and went to the Cheesecake Factory for my checkup. There was a glass right there, so I gave a urine sample, left it on the table, then asked the manager if I should continue to take my pants off.

    …..i did not have a positive patient experience…….

    Press Ganey will hear of this.

    Maybe Dr. Ubel has a better idea, do you think I should try Starbucks next time?

    • Deceased MD

      Our Dear Dr. Ninguem! practically spilled coffee all over my PC got such a chuckle! Well done. You can now be reassured that your Press Ganey score has increased.

    • medicontheedge

      LOL…. perfect!

  • Deceased MD

    Notice the comparisons Skeptical are always to business corporations. After all businesses are in the know. The next time there is a perforated bowel, send them to the cheesecake factory. Or is it Starbucks?

    But then Cheesecake really needs to adopt Press Ganey.

  • southerndoc1

    “Why should practicing medicine be compared to any other occupation?”
    Because it’s an lazy way for sloppy thinkers to avoid addressing the very real problems facing medicine today.

  • Skeptical Scalpel

    Thanks for the comments. On my own blog, I have pointed out that those who want us to use “Lean” methods to improve medicine should look at Toyota, the pioneers of “Lean” who have recalled about 20 million vehicles in the last 5 or 6 years. That’s some goal for us to aspire to.

  • NewMexicoRam

    If we really wanted to use patient satisfaction as the dominator, we should pass out free samples of oxycodone while our patients check in with the receptionist.

  • Dave

    Actually I think doctors have something very important in common with school teachers: the general public feels qualified to evaluate and criticize teachers and public education just because they once sat in a classroom, and they feel equally qualified to tell doctors how to practice medicine because they’ve had a few physicals themselves.

    • RuralEMdoc

      I have often thought the same thing myself. When you consider the regulations, and the drive for “performance based reimbursement”, much of the policies being implemented in medicine mirror that of education. Speaking generally, most teachers tend to be Democrats, and most Docs tend to be Republican, but we have a lot more in common than we realize

  • Patient Kit

    Call me a New York snob, but standardization is not what I look for in a restaurant. I’d eat in any one of Brooklyn’s many independent individual unstandardized mom & pop Italian restaurants before I’d eat in an Olive Garden. The standardized mediocrity of most chain restaurants is not what good doctors should be striving to emulate.

    • guest

      It’s not what you want as a patient, but it’s what your insurance company and your government want you to have.

      • RuralEMdoc

        I don’t think it is the insurance company so much as the hospital administrators. They look at a place like the Olive Garden and see a chain that gets millions of people in and out the door quickly and efficiently, and think “How can I get my clinics to run like that”

        More patients, more money. They don’t care about the “quality of the food” as long as the quality is sufficient enough that the customers keep coming back.

        15 min visits………12 min visits………How can we get your productivity up?……..They only care about one things, and that is billing Medicare/private insurance for as much as they can reasonably get away with.

        The insurance companies catch on to this so they instill more forms and checklists to ensure that the quality of the care being provided is sufficient to cover the billing of said care………

        The result is obvious. Tons and tons of paperwork for every one of us to fill out. Less time with the patient, and most importantly the patient, I’m sorry “consumer”, gets the short end of the stick

    • Skeptical Scalpel

      Well said. I agree.

    • ninguem

      I know what you mean. Only in New York can you get sushi with a floor show.


      • Patient Kit

        LOL and OMG! Blue Ribbon sushi is expensive. I can’t believe they only comped those customers for half, not the full price of their meals that day. I eat much cheaper sushi and it never “rained” on me, thankfully. Sushi is one of my favorite foods. Thank you for this image. I do believe you can get sushi with floor show in Vegas and Tokyo too. ;-)

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