Recently, I watched a disturbing video of a fellow physician being dragged out of an airplane. I find it hard to understand how these events unfolded despite Dr. Dao being a customer who chose to fly United, paid hundreds of dollars for his ticket and legally boarded his flight. Whether blame belongs with United or the Chicago Department of Aviation, this was an unsettling occurrence. Yet somehow — I wasn’t surprised. For the past few years, I have had moments where I have been less than enamored by the aviation industry. It’s not that I’m an unreasonable traveler. I understand that safety issues, equipment failures and weather can impact whether or not I will have a successful travel day. However, I’ve had enough distasteful run-ins, delayed flights, lost items and heard enough horror stories to keep me wary.
Dr. Dao’s story got me thinking about the states of customer service in the airline industry versus the health care industry. As a health care provider, it seems like we are being held to a much higher standard of customer satisfaction than other industries. The slightest drop in patient satisfaction has quite real and serious consequences. While the health care industry as a whole is becoming increasingly more obsessive about the satisfaction of its customers, it feels as though some airlines have moved farther and farther away from this concept.
When you think about it, health care is a necessity for society — as an example, ERs must be readily available for the public, and they must function regardless of a patient’s ability to pay. On the other hand, an airline company is a purely a business service. Its paying customers solely support an airline’s; thus customer service should be it’s number one priority.
The health care industry has progressively become more concerned about patient satisfaction over the past 30 years. Not that I disagree with the general concept — as a physician, I actually do believe that our patients should be happy with their care. Taking care of the consumer’s needs by providing respectful, professional and quality service are the pillars of customer service and apply as well to treating patients. A patient comes to me during a vulnerable time in their life, and for a service they cannot provide for themselves. As the person leading their care, it is my duty to be empathetic, compassionate, educate them and put them at ease about their care.
In the 1980s, hospital systems and clinics began to realize that patients could take themselves (and their money) elsewhere if they weren’t happy with their care. They realized that patients were paying for a service provided by their doctors, nurses and staff. With this realization, patient/customer satisfaction became a legitimate concern, and in 1984 the Press Ganey patient satisfaction scoring system became a phenomenon. A large percentage of clinics and hospital systems within the United States offered their patients surveys made by Press Ganey to allow them to grade and review various aspects of their health care experience. This gave some power back to the patients, and I do believe the initial concept of patient satisfaction had genuinely good intentions. However, what started off as a way to reward quality care and identify areas needing improvement soon turned into a runaway train.
These scores are tied to reimbursement, salaries, departmental funding and job security. In some cases, patient satisfaction is a significant source of unhappiness for health care providers because it can interfere with a physician’s oath to “do no harm.” In fear of receiving poor patient satisfaction scores, some providers feel fear in saying “NO” to patient requests for tests or medication, even when we know they are unnecessary or even dangerous. We now realize the impact of our inability to say “NO” has had some contribution today to our increased health care costs, the opiate crisis, over radiation of patients and antibiotic resistant infections.
So where the health care industry has had an excessive, and at times almost dysfunctional, emphasis on patient satisfaction — it seems some members of the airline industry have not been compelled by these same desires for customer service. Widespread frustration and concerns by the public are not the motivators it should be for improvement. Of course, there are some airline companies that do try to excel in customer service. Simply, it seems they have grasped the concept of treating their passengers with respect and the fact that these passengers are paying for the service provided by their company. Over the years I have found these airlines to be the minority, not the majority. Simple issues such as seating families together, avoiding overbooking or respectful communication are not the priority they once were. Where is the attention to detail that should come with customer service? We are at the mercy of the airlines to get to our vacations, our loved ones and our business trips, so we suffer through it. We complain to deaf ears, quickly forget how we were disrespected and pay our hundreds of dollars to fly again in the future.
So how has it come to be that a health care provider is being held to a higher standard of customer satisfaction than a member of the airline industry? At the very least they should be equal. A person being treated for the common cold is entitled to prompt and timely care, just as they are entitled to their seat after paying a private company to fly. Why is it that I am held to the normal standards of respect and decency that should be expected from any human interaction when I speak with my patients — but Dr. Dao was not offered that respect when he boarded that plane? How have we gotten to a place where the health care industry cares too much, and at times to their detriment, while the airline industry doesn’t care enough?
“Dr. M.S.” is a physician who can be reached on Twitter @meshmedblog.
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