This week’s medical blog Grand Rounds will focus on posts having to do with “customer service” in health care. A problematic concept, it seems to me.
As a physician I never considered my patients as buyers or consumers. People came to me as their doctor, or I visited them in the hospital, and I thought my job was to identify if something was wrong and, if so, to identify the exact nature of the problem and then take care of the person as best I could. I didn’t contemplate the situation with a business mind-set.
As a patient I don’t think in shopping terms when I visit my doctors or my physical therapist, although I do sometimes pay significant bills. Even for lab services, such as at Quest Diagnostics, I don’t feel as if I’m making a purchase. Sure, I’m annoyed when there’s a long wait or my results are inexplicably delayed. And I sometimes prefer one technician to another. I might mind the costs, and if there’s an error in my bill I’ll challenge that. Still, I don’t perceive myself as a health care customer.
In medical journals a patient typically is called a person, an individual, a subject in a clinical trial or (unfortunately) a case. But in some blogs and other sources I’ve been reading lately, most often having to do with health care delivery or IT, consumers pop up constantly. A good example occurs in a recent article in the journal Health Affairs, “Evidence That Consumers Are Skeptical About Evidence-Based Health Care.” This study generated a small brouhaha (in my opinion undeserved) about the public’s alleged blind faith in their personal physicians’ advice.
In reviewing that story, what most surprised me most about the paper was not so much the study’s findings (limited) or sponsorship (by the National Business Group on Health), but its language. The term “consumer” or “consumers” appears in the article’s title, no fewer than 5 times in the 125-word abstract and a noteworthy 39 times in the main paper excluding captions, tables, and references.
My point, which is really a question, is whether people who seek out or need health care should be referred to as consumers or customers. My gut feeling is that neither term is appropriate. But then again, I don’t believe that medicine can be or should be run as a business. Here’s why:
If physicians are in a position that they might be influenced by a profit motive, they’re less likely to make decisions based in evidence and are more likely to make recommendations that include income-generating procedures and treatments.
If people receive medical care from physicians who might generate greater income by recommending particular treatments, procedures or referrals, they may not receive the most appropriate care. What’s more, they are less likely to trust that their physicians are providing sound advice. The upshot is that when expensive medical care is needed – say, for the sake of this discussion, in the case of a young person with a curable leukemia — some individuals may be less trusting of physicians if they think they are motivated by money and may decline helpful and even life-saving treatments. So the profit motive, or even the appearance of a possible profit motive, has the potential to lessen the patient-doctor relationship and undermine good care.
What’s worse, though, and even more off-putting, is that in a financial transaction for medical care — in which a person with or without an illness is referred to as a “consumer” in a business called the health care industry — what’s really happening is that the illness, and maybe even the patient who has an illness, is rendered a commodity.
Ultimately this is the greatest downside of medicine as a business. No. I don’t think patients should be considered as customers or clients by any other name.
Okay, let me see if this helps. Last week I visited a clinic that was doing a well-child check open to the community. An intense amount of planning went into it, and every staff person in the clinic was pumped and excited about it. The problem was that the entire set-up was facilitated to help the STAFF — and as a result, only the staff understood the check-in process, the various stations, and the general patient flow. The individuals bringing their children in were faced with complete chaos and handed a totally incomprehensible form (set up to facilitate data entry, not patient understanding). At no point was the word “Welcome” spoken or written.
These parents were, indeed, consumers. As were their children. Despite the well-meaning attitudes of the doctors, nurses and other care givers, the people who came were not being given a proper greeting or instructions and many of them had angry, upset and frustrated expressions on their faces.
One thing that can happen when you look at people as “customers” is that you can create an environment where they are relaxed, able to communicate (and ask questions) and become full participants in the process. When you see them as “patients” or “illnesses” or “intakes” you start to lose the human element.
Finally, health care works best when it takes into account the circumstances of the individuals involved. When a doctor or a nurse has the attitude that “I’ve got the solution, if only they would listen to me” they’ve lost touch with the art of healing.
Jonathan,
I don’t mean in any way to suggest that a person who enters a clinic shouldn’t be treated with appropriate consideration and respect. Quite the opposite —
But I don’t think a customer-seller relationship is essential to good (or excellent and efficient) medical care. Rather, a business mind-frame can (1) reduce the quality of care and (2) demean the patient, for the reasons stated.
ES
Dr. Schattner:
Do you have empirical data on how a business mind-set can “reduce the quality of care” and/or “demean the patient”? Based on the extensive research we have done, our clients report that it is our customer-focus which puts them at ease and most empowers them. Particularly in medically underserved populations like ours, patients respond that it is unusual that they are treated with respect, greeted warmly and given the chance to ask questions.
Of people that rated our care as “excellent” 84% of our customers said “Doctor listens to you” is an important factor in why they come to our clinic. 82% reported that was important that “staff are friendly and helpful” and they “felt safe and comfortable.” Another 81% reported that it was important that the “doctor/dentist listens to you”. Every one of these factors is about “customer service” and every one of those creates an environment where our patients can receive the highest quality care.
I think this debate comes down to one of semantics. If you think of “customer care” as something you get at a used car dealership, than clearly you will oppose its principles in the health care setting. If you think of “customer care” as a refined approach to ensuring good outcomes, then it’s different.
–Jonathan Streeter