You can’t always get what you want
© 2016 Roy Benaroch, MD
“Customer service” is the new buzzword in health care. (Yes, I know it’s two words. Stay with me here.) Health care has become a service industry, like a restaurant or a company that comes to your home to replace a broken windshield. The shrimp is too salty, or the tech left footprints on your floor mat? You complain, and you send the shrimp back, and the tech apologizes and says “yes sir” and vacuums out your car. The customer, as we know, is always right.
Except in health care. Administrators and patients don’t want to hear this, but in health care the “customer” is not always right. And pretending that the customer is always right is costing us a whole lot of money and a whole lot of preventable sickness. We’re customer servicing ourselves into crappy health care, and docs and nurses seem to lack the power to prevent this from getting worse.
I’m part-owner of a few after-hours pediatric health clinics. Our sites are open when traditional pediatric practices are closed. Our patients – not customers– see genuine, board certified pediatricians for things like fever or sore throat or cough or ear pain. Common pediatric stuff. Rarely, we get complaints about or service or ugly remarks on Yelp, etc. Almost all of the negative reviews can be summarized like this: “I paid my money, and I didn’t get an antibiotic. I expect my antibiotic. I am the customer, and the customer is always right.” We don’t get comments about whether our doctors did a good and careful assessment, or whether they made a careful decision about recommendations. Nope, the customer is always right, and the customer wants an antibiotic. And if one isn’t given the customer is darn tootin going to complain about it.
We’ve had similar complaints on review sites about my own medical practice: “I brought in my child with a bad cold, and I didn’t even get an antibiotic! Zero stars for you!” I consider not giving antibiotics when they’re not needed – for a cold — a mark of a good practice. But someone skimming the reviews might just choose to go somewhere else. Perhaps a place that sees twice as many patients per hour, because explaining how to treat a cold correctly takes much longer than a quick antibiotic prescription.
It’s not just antibiotics, of course. In emergency departments all over the country, customer service and positive “reviews” are what drives physician salaries and hiring. You don’t make your patients happy, you’re going to take a pay cut or lose your job. But what if your patients – I’m sorry, customers – want something that isn’t good for them, like narcotics for chronic pain? We know narcotic addiction, driven by prescription products, is now the leading cause of accidental death in the US. But once patients become customers, they’re always right. And once doctors realize that negative reviews are going to cost them a job, what do you think is going to happen?
Of course, docs are being squeezed simultaneously in the other direction. The Feds don’t want us to “overprescribe” narcotics, either. They just want us to treat pain, quickly, and without our customers complaining. How exactly to do that is entirely up to us – we’re the doctors, of course, and no one would ever tell us what to prescribe – as long as we don’t use too much of the only drugs that work. Whatever “too much” is. That’s a secret. We’ll just monitor everything you do via your shiny new electronic medical record that you’re required to use. Which you hate. Please, don’t mind us.
One more example: I have here, mailed to my home, a flyer from my health insurance company. (I guess I shouldn’t tell you which one, but they’re huge, and you can rearrange the letters in their name to spell “Aetna.”) They offer a service, Teladoc, which costs “$40 or less”. Available “anytime, anywhere”, you get 24/7/365 access to “U.S. board-certified doctors” to treat things like “sinus problems, bronchitis, allergies” and “ear infection” over the phone! The doc can diagnose and prescribe medication for “many of your medical issues.” All without, you may have noticed, even pretending to do a physical exam. Or maybe they have a really long stethoscope that they can shove through the little tiny holes in their phones, or a 7 mile long swab to do a strep test. These clowns are going to know whether or not you need antibiotics without an exam, without touching you, without seeing you or without even being in the same room as you. That’s not medicine. It’s dark magic.
But you know what? They program will probably be successful. Because we know that many people don’t want a physician’s judgement – they just want antibiotics and prescriptions. So, with a wink and a nod, “Teledoc” gives us exactly what we’ve come to expect. The customer is always right. $40 out of pocket, and you can bet “Aetna”, or whoever they are, is saving some serious money by paying Teledoc next to nothing instead of paying a real doc to do a real evaluation. Everyone wins. Except you.
As philosopher Mick Jagger famously said, “You can’t always get what you want.” And at least in health care, you shouldn’t. Unfortunately, even if you try, it’s becoming harder to get what you genuinely need.