Random Thoughts from a Restless Mind

Dr. Darrell White's Personal Blog

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Archive for November, 2009

We Don’t Need No Stinkin’ Customers!

Customers? Whadda we need customers for? We don’t need no stinkin’ customers. We got PATIENTS!

Has anybody else noticed the forgotten players in the great American Healthcare debate? You know, the people on the receiving end of the health care? The patients? The only time we see any real attention being paid to a patient, the person in a doctor’s office or a hospital, is when someone in Congress or the White House is trying to come up with the title of a Bill or proposal. “The Patient Protection and Affordable Care Act” is the latest flag to be hoisted above an omnibus that otherwise pretty much ignores everything about the patient, about what it means to be a patient and how it feels to be a patient and what matters to a patient receiving medical care.

I’ve written elsewhere on “Random Thoughts” that medicine is the ultimate consumer-service business. The more you think about that the more obvious it becomes, I think. When a patient seeks medical care there is something that we either need or want, sometimes very badly and sometimes very urgently. We are seeking a service, and like any service industry the patient is the customer in that particular relationship. Very few of us, even doctors, are able to be truly informed customers when we are in the doctor’s office or the hospital; there’s just too much to know about too much, even if we have the time to do lots of research, and even if we are not spending any time researching costs. This is such an unbalanced service provider/customer relationship that innumerable ethical guidelines, regulations, and laws have evolved to mitigate against the provider abusing this knowledge mismatch.

What is it that we read about when patients complain about their experiences while obtaining medical care? Do they complain about outcomes, how they eventually turned out after receiving medical care? Not really, in part because people who get medical care almost always get better in America.  What we hear about, time and again, is what their EXPERIENCE was like. How they FELT about the experience, and what was either good or bad about the experience. And let’s face it, people are much more apt to complain about something they didn’t like than they are to praise something they did. When I look at the proposals to “reform” American healthcare  I don’t see anything that even touches on this in passing, and I see all kinds of stuff that is almost guaranteed to make the experience worse.

All because no one has either the insight or the ball’s to look at this whole issue through the eyes of the most important player in the game, the patient. The customer. It’s all about the process and the price, all evaluated from the provider side of the service relationship with no thought given to the customer.

So what exactly am I talking about? What are some examples, Smart Guy? Well–glad you asked; I just happen to have a couple handy. The “flavor of the moment” in the reform movement is the very large healthcare organization that encompasses both physicians and hospitals, organizations that negotiate with payers as a unified whole, and organizations that specifically pay their doctors a salary (presumably NOT tied to the volume of work done by an individual doctor). There are a number of them in the U.S., and most of them are cut from the same cloth. Let’s call this organization the “World Class Hospital”.

It’s 4:59 PM on a Tuesday and you call your doctor’s office; it’s not yet 5:00 so her secretary picks up the phone. She can see you in 5 weeks. You have an emergency? Why yes, she IS in the office right now, and yes she will be here for another hour,  but she doesn’t have an open appointment even though she’s been your doctor for X years. Go to the Emergency Room if you have an emergency. Make the same call at 9:01 in the morning and you might find an open slot, or you might get an associate, or maybe not. Make the call at 5:01 PM and you never even get your doc’s office. Heck, you sit on hold–press 4 to talk to a nurse.  Do not pass go, do give us $200 on top of any exam fee, and proceed directly to the ER.

So you are directed to the ER, because that’s how it happens in “World Class Hospital”, and you now cool your heels for 3 or 4 hours while waiting to receive care from 3 or 4 doctors whom you’ve never met. But don’t worry, they have your Electric Medical Record so it’s all good. They don’t know YOU, of course, but now they know your CHART, and you and your chart are taken care of by Dr. Stranger and his team. After 3 or 4 hours of waiting they  took another hour to take care of something that your own doc would have covered in 10 minutes, but hey, you’re in “World Class Hospital” and you just received a best-in-class medical outcome. What’s your beef?

Two days later you receive the bill for your successful medical outcome. Amazing how efficient “World Class Hospital” is when it comes to getting that bill out, huh? Your bill is 3 pages long, with all kinds of technical jargon and fancy financial lingo, and My God it looks like you were in ICU for a week. Who are all these doctors who I supposedly met? What are all of these extra charges, these “facility fees”? I just had a little problem that I wanted my doctor to take care of. I have Medicare; it’s supposed to be simple. Isn’t that what all of these new plans are supposed to copy, Medicare? It’s now 30 days later; who are all of these people calling me to ask how and when I’m going to pay this bill that I can’t understand? They sure have a lot of people to call me, what with how hard it was to talk to someone when I was sick.

It’s all about process. It’s all about the system. System and hospital and money before doctor, doctor before staff, and staff before patient. Think about that. You, the patient, are the customer, and you are last in line. Would you stand for this anywhere else in your life? We’ve proven at Skyvision Centers that it’s possible to put the patient first, before the doctor or the staff or the insurance company. You can buy Almay cosmetics at Nordstroms, Dillards, or Kmart. Same price. Just like cataract surgery, it costs the same no matter where you go, and the outcomes are almost identical just like Almay is Almay no matter where you buy it. But you sure feel better buying it at Nordstroms, don’t you? They put YOU, the CUSTOMER first in line. YOU are the most important player in the game.

Healthcare reform, at least what’s in front of Congress now, and the proposals to make more and more of your experience like “World Class Hospital”? Meh…not so much. You’re a patient, after all. Can’t you just hear the discussions behind closed doors, in Congress, in the White House, in the back rooms at United Healthcare et. al. and in the executive offices at “World Class Hospital”: Customers? Whadda ya talkin’ about, customers. We don’t need no stinkin’ CUSOTMERS. Ya gotta CARE about customers. We got it way better…we got PATIENTS!

Nobody cares about patients.

Ahead to the Past

They found me. I knew it would happen; it was only a matter of time.

I’ve been “friended” by high school classmates on Facebook!

It’s funny, but I feel kinda strange about this. Unsettled. It’s a “Rafikki” thing I guess, you know, “it’s in the past”. I’m a little surprised, neither in a good way nor a bad, and I’m a little surprised that I am surprised. I shouldn’t be, though, because Beth has had a wonderful time being rediscovered by her high school friends, and a couple of my college buddies have surfaced on other social media sites like Linked-in. The question now before me is “what now?”

I attended two high schools back in the day, Southbridge High in Massachusetts, and Lincoln High in Rhode Island. My family moved after my freshman year in high school and I graduated in a class of kids with whom I had not grown up. Lincoln High was a happy place for me, and some of the years in Southbridge were equally so. I confess to being curious about the fates of some of my childhood crowd. Actually, I’ve been very curious for quite a few years. It’s actually odd to say that out loud since I’m the guy who keeps writing about not looking back for fear of opening the door to regret. And yet, the curiosity remains.

What to do? It was always so difficult, the task so daunting to track down the players from the past that I could set aside my curiosity quite easily. Who has the time? There’s so much on my plate that I have to take care of. How can I justify the effort? Stuff like that. My father-in-law tracked down all of the members of his Navy Band in order to organize a tribute concert for his retiring Navy Chief. This was about 8 years ago, and he did it by painstakingly searching for his mates on the internet of the time, coupling his search with some rather ingenious detective work on the phone (you don’t want to know!). Bob was retired and the massive time element involved was actually a bonus for him–he needed something to fill his day, he was determined, and he enjoyed the process. Every time I was ever curious about my past the memory of his efforts cured me of any notion that I might do the same.

If Bob did the same thing now he would simply search for his buddies on Facebook, Linked-in, Twitter and the like. In all likelihood he would be one or two degrees of internet separation from everyone on his list. Very efficiently and quickly the task would be complete, which would not have been nearly as satisfying for Bob, I think, but knowing that makes my question a little harder to set aside. What now, now that it would be so much easier to explore the past?

As much as I profess to avoid looking back I DO think of certain people and certain events from my childhood. I grew up in a rather tough mill town, a town that was already dying a slow death, although no one knew it at the time. We were all pretty much the same in those days; the financial gulf between management and line had not yet developed, and white color workers were really more very light blue than really white. If you lived in a house it was small, and your neighborhood was right next door to the town’s apartments and duplexes. We were all foul-mouthed punks, the college-track kids indistinguishable except by classroom number from those kids who would never see a college campus in their lifetimes. The “good kids” different from the “bad kids” only in that they never got caught. What happened to the guys I called my friends back then, the guys I ran with for 14 years until a massive fight severed the ties? Did Neil go to law school? Is Tommy a fabulously wealthy dotcom guy or financial wizard? How about Timmy, my oldest friend, 3 of 4 older brothers dead before 40 from heart attacks? Is Timmy still alive?

You read all kinds of “bad ending” stories about people who went and found old boyfriends or girlfriends on social networking sites. Kinda scary, really. My “girl next door” and I have connected on all of these sites (Hi Maureen!), but our folks still live next door and we’ve never really been UNconnected over the years. I don’t really have all that much curiosity about the girls I dated in the past. To be honest, I was a lousy boyfriend to pretty much all of them, and any re-connection would be more like that movie about the guy who traveled around to make amends with past loves, or the other one about the guy who was haunted by past girlfriends. Not a lot of upside to that particular search. But as in all things there are exceptions and here it’s no different. I AM curious about one girl, a girl who was my closest friend in Southbridge as well as my first love. She was dealt a couple of jokers after I moved, yet she played every hand with dignity and grace. How is she doing now?

As I think about it while I’m writing it’s really about the curiosity more than the connecting, at least for me. I’m still not really interested in visiting or re-connecting with my past, I’m just curious about what’s been going on since I stepped off of the pages of that particular story. I don’t need the view that’s available to me 30 inches away on my screen through Facebook; the view from 3,000 feet, or even 30,000 feet would be plenty. Call me a coward, call me callous, call me the same self-centered SOB I might very well have been back then, but I still can’t see myself reaching out now in order to connect. Perhaps I’ll take a page out of my father-in-law’s book and just do a little detective work, staying one or two degrees of separation away, a kind of “novelization” of my search if you will. In the end it seems to be just as I have preached to my children these many years: if you don’t go where trouble can happen, it’s harder to get in trouble.

Whether you go back to the future, or ahead to the past.

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