Random Thoughts from a Restless Mind

Dr. Darrell White's Personal Blog

Cape Cod

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.

6 Responses to “We Don’t Need No Stinkin’ Customers!”

  1. November 20th, 2009 at 6:15 pm

    Colin Hill says:

    I am finding it very fascinating to view the debate about health care in your country from my Canadian publicly funded health care bed. Great article.
    Calgary Colin

  2. November 21st, 2009 at 7:59 am

    darrellwhite says:

    What the heck are you doing in a hospital bed?

  3. November 22nd, 2009 at 9:53 pm

    Colin Hill says:

    Metaphorically speaking of course…some people say I will end up in one if I keep up the Crossfit but I say not likely.

  4. November 23rd, 2009 at 2:50 pm

    Brian Y says:

    Interesting thoughts bingo……having worked in the industry, I saw first hand how said “world class hospital” would put athletic trainers at local high schools for pennies of what they were worth, charging the school districts hardly anything, knowing they would pressure athletic trainers to “refer” as many high school athletes as possible to “world class hospital” to recoup dollars lost by placing trainers at the schools.

  5. December 8th, 2009 at 2:29 pm

    international online pharmacies says:

    Are you a professional journalist? You write very well.

  6. December 8th, 2009 at 8:49 pm

    darrellwhite says:

    Nope…just another knucklehead with a keyboard! Thanks.

Leave a Reply