Patient as Customer?

Part of my work is what I call health or medical “consumerism” — recognizing, talking about, and creating guidelines for patients as they regard cost of their healthcare. From nuances in purchasing health insurance, to understanding how those dollars get allocated, to ideas for saving money and even appealing health insurance payment rejections — that’s what I call health or medical consumerism. I’ve defined it in a previous blog post.

So I was interested in this week’s article by Dr. Scott Haig, printed in TIME Magazine called My Patients are Not Customers. He describes his frustration with hospital administrators, labor unions, and the “incursion of business practices into our profession” where patients are defined as customers the concepts of customer satisfaction and patient well-being become confused.

His conclusion: “The answer is simple: we’ve lost sight of that boring and corny moral imperative to do what’s right for those in need, to love your patient as yourself. That approach has always driven good medicine. Not customer satisfaction.”

What’s refreshing to me is that Dr. Haig does not seem to have lost that idealism that probably sent him to medical school to begin with; the idea that as a doctor he would help people, make them better and save their lives.

What’s fascinating to me is that Dr. Haig seems to have missed that point that, as a doctor in private practice, his Job #1 is to be a business man. If he can’t be a good business man, then he won’t stay in practice. If he doesn’t understand the basics of business, such as making payroll or paying the rent, then he won’t be able to keep on doctoring.

What’s sad to me is that the world of health and medical care has changed in the past 20+ years, and while many of us long for the Marcus Welby-esque past, we’d like that paired with the advances medicine has made in the interim.

But my bottom line is that Dr. Haig had better wake up and smell the reality of today’s medicine. No matter how much we long for how things used to be, healthcare is not about health or care; it’s about sickness and money.

That’s what’s paying his mortgage — and frustrating us all.

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    • bev M.D. on July 29, 2007 at 9:06 pm

    Actually Trisha I agree with Dr. Haig. When my hospital encouraged employees to call patients first “guests” and then “customers”, I even wrote a letter to the administration explaining that that attitude cheapens the relationship and the bond that many of us hold sacred between a sick person and we who care for them. It actually encourages caregivers not to “care” so much. Especially since many sick people are understandably grumpy; it’s easy to overlook that when you think of them as patients, but not so easy if you think they are ungrateful or impossible- to-satisfy customers. It’s a psychological and often unconscious reaction.

    I know you are stating current reality, but there are many doctors who wish to just practice medicine and NOT be business people. There are solutions to the health care system that can accomplish that – e.g. the multispeciality clinic model where docs are on salary, etc. I am not espousing these, just pointing out that the current profit-driven system does not have to exist in perpetuity.

  1. I understand your points, Bev.

    But this is how I see it — the tenets of good customer service (listen, listen, listen and provide the products or service needed to the best of one’s ability) will serve the provider as well as the patient.

    If customers don’t exist, then businesses don’t either. If patients didn’t exist then doctors and practices wouldn’t either. The relationship needs to be a balance of respect in both regards. No matter what label you give a patient, s/he at least deserves respect.

    As you and I both know, there are way too many doctors who don’t listen, who jump to conclusions, who dismiss their patients’ medical complaints, who are arrogant and condescending…. And that’s the kind of doctor who needs to get a clue. Once again, the tenets of good customer service will serve the provider as well as the patient.

    For those doctors who truly do respect a patient, then the label shouldn’t really make much difference.

    By the way, I worked in higher ed for five years, and we had the same discussions. Many professors hated the idea of considering students to be customers. But the best of them didn’t seem to care about labels one way or the other. They had already established that mutual respect model.

    I agree about looking at different delivery models, such as salaried doctors. Unfortunately the great majority of doctors don’t have that option, even if they would prefer it (and yes, I realize that many do). And patients are left to deal with the reality of today’s profit-based models.

    And the thing is — salary vs other forms of payment also ties in to huge malpractice insurance costs and for the younger ones, student loans that are astronomical. I can’t even imagine how frustrating it must be to just want to practice medicine and not be a business person.

    My bottom line is that I can’t change systems — the only thing I can do is advocate for patients as individual patients and help them master the maze. So when I see commentary that doesn’t serve patients in the reality of today’s environment — a la Dr. Haig — I feel as if I need to reply to it.

    I’m glad you commented 🙂 I value your opinion.

    Trisha

    • bev M.D. on July 30, 2007 at 6:11 pm

    Trisha;

    I realize you are dealing with today’s reality, not hope for the future. But has it come to this???!! (see link):

    http://www.latimes.com/features/printedition/magazine/la-tm-status25jul29,1,1914759.story?coll=la-headlines-magazine&ctrack=1&cset=true

    I realize this is in California, which we all know is “different”. (:

    bev

  2. I too am frustrated by Dr. Haig’s commentary, and in the attempt to articulate why, I have tried to think of an analogy that perfectly describes today’s doctor-patient relationship. I find that I cannot. It’s too complex.

    Here’s one that comes close, though. Imagine you’re a doctor and one day your old, loyal, influential, and promptly paying patients, the Dursleys, bring in their young charge, Harry Potter, for a checkup. Seems a scar on his forehead has been aching lately. Harry, you find, is a nice enough fellow (though perhaps a bit too sullen and self-absorbed for your tastes) and you’d like to help him. You examine him and decide the pain is probably psychosomatic (he’s a typical 17-year old with a persecution complex bordering on paranoia, but you’re sure he’ll outgrow it; they all do), but he does have a nasty-looking scar, and to be on the safe side it would be best to order an MRI.

    However, the Dursleys are not anxious to spend the money on Harry. In fact, it is only with the utmost reluctance that they’ve taken responsibility for Harry at all, and from the very beginning Harry has been far more trouble than he’s worth. The Dursleys want to keep up appearances, but the bottom line is they want you to do the bare minimum. They make it plain that they expect you to take care of this problem quickly and cheaply, perhaps with some cold compresses and maybe a Tylenol. If you don’t, Mr. Dursley has subtly suggested, he can see to it that your hospital privileges will be reviewed (Dursley, a well-to-do local businessman, is on the board of trustees). An MRI, you fully realize, would be considered by the Dursleys to be entirely out of the question.

    So here’s the question, Doctor. Who is your customer?

    Hint: It ain’t Harry.

    The doctor’s customer is the entity that determines whether he/she remains professionally viable. And today that’s the big insurers and the feds; it is decidedly NOT the patient. Both insurers and the feds have made it absolutely plain that controlling costs is their biggest (only?) priority, and so doctors who are not seen as helping to control costs are often in grave professional jeopardy. Obviously, doctors can’t primarily be agents for cost control and agents for their individual patients at the same time; they’ve got to choose. Those who make the wrong choice may not be practicing physicians for long.

    So perhaps that explains Dr. Haig’s poorly articulated (my opinion) frustration. It IS frustrating when the entities that expend every conceivable exertion to make sure you’ve made cost control the driving goal in your professional life then issue for-public-consumption memos, mission statements and press releases indicating that they want you to put the patient first. It leaves you hanging.

    The solution is the one Trisha advances on her websites and blog. Individual patients, by taking their medical destiny into their own hands, by empowering themselves with knowledge and with knowledgeable personal advocates, can instill in doctors like Dr. Haig (i.e., the inarticulately frustrated ones) the backbone necessary to do the right thing. Trisha calls it medical consumerism; patients making themselves the REAL customer again. It’s healthy for the patient; it’s the only thing that has any hope of rescuing a medical profession that has sold its soul (though to be sure, only under great duress).

    – DrRich
    http://GUTHealthcare.com

  1. […] My Patients are Not Customers (which I’ve blogged about previously — see this post) […]

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