How customer service breeds bad medicine

“Welcome to our clinic. May we take your order?”

Many patients have Googled, Yahoo’ed or Bing’ed their symptoms way before I even lay eyes on them in an examining room. And they have a schema of what they’ll be getting out of the visit.

If the encounter takes a detour — the diagnosis is not in line with what they believe they have, or they are about to stroke out from unmanaged blood pressure but have come in for a cough medication — there is a high chance that I can look forward to a one-star review. The theory of cognitive dissonance is real.

Now here is the dilemma: Does sending someone to the emergency room for vital signs not compatible with life make one a bad doctor? Or does giving them what they want and ignoring those vital signs do? Good medicine says the latter. Customer service 101 tells us the customer always right.

So, let them eat cake?

As physicians, we often have to make the choice between a one-star review for creating cognitive dissonance in a patient and discovering a lifetime of denial in the form of malignant hypertension and potentially saving a life, or a glowing accolade on Yelp for taking an order and filling it at lightning speed.

Business and medicine have mixed, but the one thing that no one teaches you in medical school is how to sell an unwanted item. The birth of franchised medicine cannot compromise integrity.

In the day and age of instant gratification, physicians are meeting a new challenge of attempting to meet sky-high expectations. Up to 50 percent of all antibiotics prescribed in U.S. acute care hospitals are unnecessary. Selling the idea that you have a simple upper respiratory infection and you will only feel better with time is not very appealing to the lay public. Unfortunately, our immune systems have not yet developed the ability to reset on command.

With the CDC cracking down from one end with antibiotic stewardship programs that provide regular updates on antibiotic prescribing, and patients spewing angst all over review sites we are on a new playing field.

These days practicing good medicine doesn’t always equate with positive feedback since Dr. Search Engine makes patient satisfaction impossible. Everyone’s chief complaint has become a diagnosis. Often, I find myself much of the time during the visit spent justifying why an antibiotic will not help a three-day respiratory virus. Do I violate antibiotic stewardship and cave, or risk the one-star review for the company I am working for? Do I choose between good medicine or customer service?

For the first time in my life, I can empathize with celebrities.

Sabina Rebis is a family medicine physician and can be reached at the Model of Health.

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