Patients vs. customers during COVID

Somewhere in Wuhan, China, a bat was eaten — and the world as we knew it was over. (Note to self: Never have your bat below medium, and avoid bat tartare like the plague.)

Kids stayed home. So did their parents. They started talking to each other, instead of watching their phones while rushing from soccer games to ballet rehearsals via McDonald’s.

Sports got suspended, and millions of rabid sports fans remembered that their home team is right here in their home.

Avid shoppers forgot about the latest fashions to fight over PPE and toilet paper.

Salons closed. Haircuts, manicures, and even lipstick fell out of favor.

Couch potatoes got an irrepressible urge to go out. Stair haters started hiking. People who hate being touched became huggers, and fat dogs got slim by walking their extended family.

On TV, ER and ICU action replaced live sports. Dr. Fauci’s wrinkled face outsold Kim Kardashian’s derrière in everything from men’s socks to prayer candles. ER docs, the Cinderellas of medicine, became hotter than Dr. Pimple Popper, and people stopped asking when they’ll finally specialize because COVID put emergency medicine on the map.

More good news: clean air, empty animal shelters, and not a single school shooting.

The pandemic kidnapped our normal life, reset our priorities, and got us thinking. It also reminded us that medicine is not retail.

For years now, administrators have struggled to mold medicine into a customer-driven business. Patients became customers; doctors became providers.

The art of medicine was out. The patient experience was in.

Paper-pushers whipped health care into Disney’s religion of customer satisfaction, bowing to customers, and managing expectations. Their Holy grail tool? Press Ganey.

For those who don’t know, Press Ganey is a standardized survey rating patients’ hospital experience to correlate it with hospital revenues. It’s widely agreed that by imposing pain as a vital sign, Press Ganey contributed to the opioid epidemic.

Regardless of their subjectivity, low response rate, and lack of relationship with patient safety, PG surveys have become the way to assess medical care. For more on the relationships between PG and quality of care, check out “Death by patient satisfaction.”

To put that into perspective: Say you have a hot date at a nice restaurant. You order a nice wine, a steak with fries, a salad with ranch dressing, and a sundae.

The waiter looks at you and asks:

“How much do you weigh, sir?”

“Two-fifty,” you lie, crossing your fingers under the table.

“How tall are you?”

“Six-feet-three,” you say, though you know damn well you’re only five-eight.

The waiter tightens his mouth disapprovingly and says.

“I’m sorry, sir. That’s not good for you. You can have one glass of dry wine, and a skinless chicken breast with steamed kale. Green salad with balsamic vinegar, no oil, and a sugar-free baked apple. That’s all I can do for you. You need to lose a lot of weight.”

He turns to your hot date, who’s watching with her jaw on her knees, and adds: “As for you, madam, you can have fries with your chicken, but I recommend using a mask and ditching this smoker. He’s a heart attack waiting to happen.”

How would you rate your experience?

Press Ganey measures the pleasurable experience of being in the hospital. But suddenly, thanks to COVID, staying alive became more important than being comfortable and more relevant than waiting times, Percocet, and turkey sandwiches.

Patients are still upset and for good reasons. They want tests telling them if they’ll live or die, and they can’t have them. If they do, the results take days. They want to feel safe. They don’t want people coughing on them or touching them, not even medical providers unless they’re wearing PPE, and they’ve been tested.

The regulars, the “pain in the elbow for six years,” and the “I couldn’t keep anything down since January,” and the “I need a note for work for last week,” are gone. They don’t think they’re sick enough to risk their lives with the sick people out there. And they’re right.

Unfortunately, that also goes for the indigestions that are, in fact, heart attacks, the weak and dizzy that are, in fact, strokes, and many others who need care but are afraid to go to the ER.

Still, for once, patients and medical professionals found themselves on the same page. We all agree that staying alive matters more than waiting, discomfort, and privacy.

It’s an entirely different world in the not-hot spots, where medical professionals are getting fired, or they get their hours cut. As the pandemic of the century unplugged the U.S., our unprotected and overworked medical professionals cared for patients while risking their lives, endangering their families, and getting fired if they spoke up.

COVID-19 did a lot of harm to many people: patients, families, health care workers. But there’s a silver lining. This pandemic reminded us that medicine is not retail, and patients are not customers. After years of kowtowing to Press Ganey (PG), we remembered that there are things more important than patient satisfaction, like patient safety and saving lives.

These are some comments from my health care friends.

“Press Ganey is just one more vulture picking at the remains of the U.S. health care system.”

“The tool is designed to sell more of itself.”

“I like the airline comparison. Did the plane get you there? Did you live? Did you take your bags with you? (important body parts that you weren’t there to have removed).

“COVID-19 life is a true war zone. Press Ganey is life at the office paintball match.”

“Press Ganey has no place in medicine. The business model of medicine needs to be put to sleep (I hear a propofol/etomidate/potassium combination satisfies the humane aspect). We need to restart taking our practice back from CPAs and MBAs.”

“The pandemic exposes how useless PG is. Most people care if they are treated kindly and if they f***ing live or die. I’ve never been thanked more by family members. It’s weird. I had a cantankerous guy last night, and it was almost a relief that things seemed more normal …”

“Pre-COVID value: rectal exam at an ophthalmologist’s office. Post-COVID value: wearing a steak thong in an alligator pit.”

“We started calculating 95 percent CIs on PG scores at my shop. I highly recommend this. You can be about 95 percent confident that an individual is either amazing or terrible. Or in between.”

“The only patient satisfier question should be: ‘Did you die?'”

Stay safe, and see you on the other side. Hopefully, both of us wiser.

Rada Jones is an emergency physician and can be reached at her self-titled site, RadaJonesMD, and on Twitter @jonesrada. She is the author of Overdose.

Image credit: Shutterstock.com

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