The Problem with “Customers.”
Words, and their various denotations and
connotations have more power than we
realize. Trite-isms and clichés like “the
customer is always right” have been
bandied about since the dawn of time (or
maybe since the advent of "customer
service"), but it's the essential M.O. for
anyone working in the service or retail
industries. And “the customer is always
right” is absolutely true in some very specific
instances. Many of us know the struggle of
keeping an inconsolable customer happy,
often at the sake of speaking our minds, so
as to make the sale or get the tip. Think
about the cranky customer sending back
the well done steak, burnt to a charcoal
crisp, and still proclaiming it “too rare.” In
these scenarios, the customer may be
objectively incorrect, but because of the
structure of retail, the server’s job must
keep them happy, accommodating them in
the face of ludicrous demands. It’s how
retail and business operate, and I don’t see
“the customer is always right” going
anywhere any time soon. The problem is
when that mentality migrates to health
care. Indeed, modern patients do have
many similarities to customers. They can
“shop around” in their treatment. They
can use their knowledge to bargain for the
treatment they’d most prefer. They can
post negative reviews on Vitals or
Healthgrade and warn other prospective
patients of making the same mistake.
Where "customer" breaks down is this:
receiving medical treatment isn’t quite
like buying a car. It's sometimes a matter
of literal life and death and in these
scenarios, it’s up to the physician to make
the absolute best judgment call possible
for the sake of the patient...not to
acquiesce to the patient’s demands.
Can We Turn Back?
One common thread in the health care
discussion is the metric of patient
satisfaction and its relationship to funding
and reimbursement. Like any business
performing simple customer satisfaction
surveys, these metrics help in determining
a health care systems efficiency or a
particular practice's strengths and
weaknesses. It’s also indicative of how a
“ Essentially Shared
Decision Making (SDM)
encourages clinicians
and patients to
communicate with one
another using the best
available evidence
when making a
treatment decision.”
Dylan Chadwick
physician is doing (generally) in terms of
their patient relationships. However, the
problem with depending entirely on patient
satisfaction metrics is that the data can
skew very heavily in one direction based
on a few arbitrary factors.
Tanya Feke cites a study in the British
Journal of General Practice in which
more than 980,000 patients were surveyed
across 7,800 practices. The results
indicated that physicians who prescribed
more antibiotics were perceived more
favorably than family doctors who weren’t
as willing to prescribe. When such
arbitrary factors can swing such a huge
door, the idea that these surveys so heavily
control a physician’s level of compensation
become somewhat alarming.
Also one must take into account that
individuals are far more likely to post
reviews about their experience when
they’ve had an “extreme” one, either good
or bad. When they've got an axe to grind or
absolutely HAVE to let the world know
about that transcendent colonoscopy…but
rarely for anything average. This means
that many 4-5 star reviews aren’t being
written simply because the patient doesn’t
feel the incentive because who wants to
review their experience when it was
completely average and unremarkable? (in
a good way). Of course, one way to curb
this dilemma is for physicians to regularly
encourage their patients to review them
after each visit. This can produce more
realistic satisfaction metrics for the
physician as they're getting more well-
rounded patient satisfaction metrics from a
variety of sources.
While patient satisfaction surveys will
always be around, as well as comparisons
between patients and customers, we can
still curb the negative aspects of these
developments, simply by expounding on
the positive ones. SDM is in itself, a great
way to bridge that precarious gap between
“patients as customers” and “patients as
patients.” Because the goal really isn’t to
restrict patient power or patient capability.
It’s to channel that capability into
something mutually beneficial for both the
physician and the patient. Bringing
patients fully into the decision making
process, really bringing them in and not
just creating the illusion of it, should only
increase patient satisfaction. They’re
brought onto the same page as the
physician and any perceived walls of
secrecy or agenda (on both parties)
disintegrates. It encourages participants to
share knowledge and experience, creates
a system of trust, evidence and mutual
understanding and celebrates the...
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