Service Table Stakes: Sunday musings…1/11/2026
1) Saddle. As in “back in the saddle” this week. For Beth, to be taken quite literally as she has been astride her horse “Hero” almost every day, riding for fun, fame, and glory. For me? Well, it was back to work, each day astride my trusty stool as I steer through a microscope.
Riding for everyone who came in.
2. Edwin’s. Beth and I joined close friends to celebrate my 66th birthday at a rather unique restaurant named “Edwin’s”. I’m afraid I can’t remember why “Edwin’s” but the story behind the restaurant’s concept I do remember. Once upon a time when BC the owner of the restaurant was a teenager he ran afoul of the law in some way or another. Again, I don’t remember the exact details of this part of the story (it’s findable online as BC is quite transparent about his youth), but I do remember that it was a nonviolent mistake.
When brought before the judge BC was quite contrite. The judge, exhibiting astute powers of character assessment, realized that BC was hardly on a course toward a life of crime. He admonished the youth to stick to the straight and narrow, and warned him that he, the judge, would be watching over him, lest his character assessment be inaccurate. Should he break the law again the judge assured BC that he would face a maximum sentence for both the original and subsequent crimes.
As it turns out, not only was the judge correct in his assessment, but BC silently vowed on the spot that he would find some way to repay the judge. How? After a decade or so managing prestigious restaurants BC left the world of the employed and opened a restaurant almost entirely staffed by the formerly incarcerated. Chefs, waitstaff, hostesses and bartenders, all with time spent behind bars. So, too, the bartenders, valets, and bussers. (See below)
A huge hat tip and “good on ya” to BC, who we know casually, on paying back a man who gave him a mulligan. It was a privilege to dine at Edwin’s.
3) Service. As I get older, and reflect that I have spent my entire working life in the service of others, I find it more and more difficult to tolerate poor service when I am on the receiving end of the continuum. I once wrote an essay in which I stated that every doctor should spend 6 months learning what it means to provide service by working as either a caddy, waitstaff in a breakfast joint, or selling shoes. To understand the serving side of the continuum you should spend time in the act of one-on-one service. It’s harder and harder not to call attention to poor service when I am the one paying for the service.
Of course, how we perceive the quality of the service we receive is dependent on our expectations in any given situation, or at least it should be. For example, if I am buying shoes in person I have an entirely different expectation of what my service experience will be if I am shopping at a DSW outlet vs. Nordstroms. One should make it a point to know the “story” about any place you might seek service so that you are prepared.
There is often a financial correlation between the experience extremes, dismissive to flawless, and we quite naturally expect a level of service that is closer to flawless if we are paying a premium. Many’s the time that you can accurately assume what to expect simply by looking at the “menu”. A “destination” restaurant that specializes in classic French cuisine typically has prices that will curl your hair. Naturally you expect a dining experience commensurate with the quality of the food, and in the overwhelming majority of cases this is precisely what you will get. Dismissive or inattentive service would be unacceptable.
Edwin’s is a case in point where one must do a little bit of research before making a reservation. While the food is, indeed, outstanding, and the prices are full-on fancy French restaurant prices, there are parts of the dining experience that are entirely expected given the main mission of the restaurant, to provide training and employment in an unexpected arena to an unexpected cohort of employees. Here the expectation is about effort and attitude. Or it should be. Ten minutes to take dinners orders at a four-top? You could just see how hard the waiter was trying not to make a mistake. Tiny little white wine glasses for the massive Bordeaux? The guy fairly sprinted to the bar for replacements. We waited a long time for our dinners to arrive.
No way was Chef sending out a plate that was less than perfect. We tipped big.
Healthcare is a more complex experience than buying a pair of shoes or sitting down to a dish of Cocque aux Vin. Much of what is dispensed in the U.S. is done so in the absence of local pricing power: insurance companies and the government effectively set the “price” of care for the vast majority of Americans. Interestingly, the larger the healthcare organization the more likely it is that it is paid MORE for the care provided (a result of the Affordable Care Act), all the while providing a care experience that is typically closer to, say, an Au Bon Pain chain restaurant than The French Laundry, despite receiving French Laundry “fees”.
There are segments of American healthcare that behave more like other retail service spaces like the above-mentioned shoe shopping and dining. Cosmetic plastic surgery, refractive surgery, and veterinary medicine are all cash-pay businesses that must justify the prices on their “menu” by achieving excellent outcomes and a flawless experience. A plastic surgeon will struggle to survive in a market if they do not have excellent results, and those who have excellent results but do not provide a French Laundry experience will find it difficult to charge top of the market fees.
I have spent my entire professional career as a refractive cataract and laser surgeon. Some of what I do is largely or entirely paid for by insurance of some sort or another. However, there are some things that I do that are not recognized by health insurance policies as medically necessary, however desirable a patient might find them. In my case the most common of these are refractive surgeries like LASIK, the intraocular contact lens, and specialized lens implants to reduce or eliminate the need to wear glasses after cataract surgery. These are “cash pay” procedures just like cosmetic plastic surgery procedures, and because of this people expect not only an extraordinary outcome but also flawless “service” along the way.
A refractive cataract and laser practice that does not achieve excellent results or does not treat its patients like visitors to a fine restaurant may very well struggle to justify its prices.
This long-winded dissertation is a prelude to our family experience with a 100% cash-pay medical experience that was very disappointing to say the least. Do you have a pet? If you do you then know that, with few exceptions, veterinary medicine is a cash-pay business. Ever have a pet with an emergency? Man, then you REALLY know that vets are in the cash-pay business. It doesn’t matter how long your family has been seeing a particular veterinary practice (for us it’s been 13 years), or how busy the doctors happen to be on the day your pet has an emergency (lots of open slots in the schedule in our case) you are writing a hella big check just to have them seen in an emergency-prompt fashion.
You are probably looking for me to exclaim that these “enhanced” fees should come along with some sort of enhanced services. After all, they will do the same exact stuff they would do on a scheduled visit, just with a premium added to the bill because your pet couldn’t wait for the next available visit to be seen after they got hit by a car, or bitten by a snake, or whatever. For any resentment at a business model that takes advantage of the emotional trauma suffered by the pet owner I might have, I am actually jealous of their ability to charge for their availability. So nope. What I find unbelievable, bordering (as a fellow healthcare worker) on amoral, is care that falls below the basic level of expectations that every patient or patient-equivalent has a right to expect when seeking and obtaining care on a regular basis. Care that is universally provided whether it is covered by insurance or cash, whether the office is a tiny boutique private practice or a massive medical institution.
Whether doing a facelift, selling a pair of shoes, preparing and serving food, doing cataract surgery, or caring for a dog with an injury, there are basic levels of service that must be provided. Operate in a sterile setting, disinfect a shoe that has been tried on previously, be mindful of food allergies, do everything to ensure the proper implant is inserted. Things so basic that they are “table stakes”, the ante you put up just to be in the game. Even more basic than that is to communicate clearly and accurately with your patient, and to provide ongoing communication if the care is ongoing.
Yup, I’m on the receiving end of the service continuum on this one. There’s no backstory, no feel good story here to explain why our family and our dog have received bad service. Which has resulted in substandard medical care. No apology or explanation. We have a long history with this practice and I was led all along to believe that I was in the equivalent of a fine dining restaurant, and I was charged accordingly. I expected to be treated accordingly. I certainly expected to receive the most basic care and feeding, to be informed of a diagnosis and a plan, not to be gaslit that we had, indeed, been contacted and informed. Table stakes, all. Hardly the stuff of fine French dining.
The older I get the harder it is for me to stomach poor quality service when I am on the receiving end of the service continuum. I was a caddy as a kid. Even as a young man I understood the concept of basic standards of service. Table stakes. It’s been almost 5 days and I don’t feel one bit better about what we experienced at the vet. It’s harder and harder not to call attention to inexplicable bad service when I am paying for the service. Especially when someone stiffs me on a table stake.
It’s becoming less and less likely that I will be able to keep myself from picking up the phone.
I’ll see you next week…
This entry was posted on Sunday, January 11th, 2026 at 4:20 pm and is filed under Uncategorized. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.