Friday, July 18, 2014
When a well-intentioned, authoritative 'no' is better than an insincere 'yes'
The above title may sound rather controversial at a time when patient satisfaction and improving the health care experience is a hot topic around every hospital administration table. It’s something that I’ve thought and written a lot about and also personally feel very strongly about, because nothing short of total commitment to our patients is required when they are at that low point in their lives. There’s so much room for improvement.
Unfortunately though, as hospitals grapple with the issue of how to make the health care experience a better one, some of the ideas being put forward are rather gimmicky. For instance, I’ve seen name badges saying “Have a nice day” or “What can I do to help you?”, which are probably more appropriate for an auto shop or fast-food restaurant. Physicians and nurses simply shouldn’t be wearing them! An attorney, teacher or even a banker wouldn’t dream of wearing that on their suit, so why should a doctor wear it on their white coat? We must keep our respect as a profession and remember that the main driver of patient satisfaction will be the human interaction between doctor and patient. Everything else is secondary.
There are in fact some very real differences between customer service in hospitals and customer service in other arenas. The mantra in the business world that “the customer is always right” does not hold true for many scenarios in health care, when the patient doesn’t know what’s best for them. This is not meant to sound paternalistic, because patient-centered care is the right way forward, but there are definite limits and boundaries in health care. Making informed choices, yes. Being in charge of their own health care, yes. But the reality is that doctors often do know what’s best based on their professional knowledge. Examples include prescribing the most appropriate medication, recommending a certain type of surgery, and not being over-zealous with pain medications, despite the patient’s wishes. In fact, not doing what they think is right may frequently lead the physician down the path of inferior patient care.
The best, and for that matter most popular, physicians that I’ve observed have actually been far from “customer service” types. Not that they don’t strive to go the extra mile for their patients and provide the best possible care, but they also balance their compassion with a strong personality and strong principles too. They are physicians that know when to say “no” and are not afraid of telling their patients what they need to hear and not what they want to hear. Sometimes what they say to their patients could be construed as bordering on rudeness to an outside listener, but their rapport is good enough to negate any hard feelings. I’ve encountered several dozen physicians like this, most of them the “old-school” types near retirement age, and never fail to hear positive glowing reviews from their patients who truly respect them. These are the role model doctors for me. It’s what we have to remember if we think any patient needs a “yes man” doctor to get good medical care. Patients actually respect a well-intentioned authoritative “no” rather than a smiling insincere “yes” over a long-term relationship. Indeed, in most areas of life, this is the case. It holds true for a family member, friend, or even a politician! A recent article in Forbes magazine discussed this very issue, in a piece titled ”Dr. House Was Right: Give Patients What They Need, Not What They Want”. The article described how patient satisfaction is tied to higher costs, and more concerning—higher mortality. It posed an interesting question between choosing between a nice doctor or a brilliant doctor. The author chooses the latter. However, the 2 don’t have to be mutually exclusive. They can be perfectly balanced. It would be a big mistake if we train the next generation of doctors to be “yes men/women” types in the fear of being seen as giving poor customer service or worried about poor patient satisfaction scores. In our relatively new internet age, when online ratings are available in a second, it’s understandably a worry for many doctors. This has turned medicine into a completely new ball-game that the older generations didn’t have to concern themselves with. Gone are the days when doctors could be safe in the knowledge that they were good at what they did and had patients flocking to them. Will the patient give me a bad review if I don’t do exactly what they want? Should I try to make my patient happy even though I know it’s not good for them?
Patients should know that it may be a mistake to seek out a doctor who pleases them, or use online recommendations to choose them. If you want to find a good doctor, nothing could be better than a solid word of mouth recommendation from a family member or friend.
New physicians should understand that their best peers aren’t necessarily the ones with the best ratings. They should be guided by their knowledge, principles, and stand firm if they believe something is right. As we endeavor to provide excellent care and a better experience, doctors shouldn’t be striving to make their patients happy at every opportunity. We should be striving to make our patients better. With a dose of compassion, empathy and sincerity—the rest will take care of itself.
Suneel Dhand, MD, ACP Member, is a practicing physician in Massachusetts. He has published numerous articles in clinical medicine, covering a wide range of specialty areas including; pulmonology, cardiology, endocrinology, hematology, and infectious disease. He has also authored chapters in the prestigious "5-Minute Clinical Consult" medical textbook. His other clinical interests include quality improvement, hospital safety, hospital utilization, and the use of technology in health care. This post originally appeared at his blog.
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Ira S. Nash, MD, FACP, is the senior vice president and executive director of the North Shore-LIJ Medical Group, and a professor of Cardiology and Population Health at Hofstra North Shore-LIJ School of Medicine. He is Board Certified in Internal Medicine and Cardiovascular Diseases and was in the private practice of cardiology before joining the full-time faculty of Massachusetts General Hospital.
Zackary Berger, MD, ACP Member, is a primary care doctor and general internist in the Division of General Internal Medicine at Johns Hopkins. His research interests include doctor-patient communication, bioethics, and systematic reviews.
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Robert M. Centor, MD, FACP, contributes short essays contemplating medicine and the health care system.
Suneel Dhand, MD, ACP Member
Suneel Dhand, MD, ACP Member, is a practicing physician in Massachusetts. He has published numerous articles in clinical medicine, covering a wide range of specialty areas including; pulmonology, cardiology, endocrinology, hematology, and infectious disease. He has also authored chapters in the prestigious "5-Minute Clinical Consult" medical textbook. His other clinical interests include quality improvement, hospital safety, hospital utilization, and the use of technology in health care.
Juliet K. Mavromatis, MD, FACP, provides a conversation about health topics for patients and health professionals.
Dr. Mintz' Blog
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Ryan Madanick, MD, ACP Member, is a gastroenterologist at the University of North Carolina School of Medicine, and the Program Director for the GI & Hepatology Fellowship Program. He specializes in diseases of the esophagus, with a strong interest in the diagnosis and treatment of patients who have difficult-to-manage esophageal problems such as refractory GERD, heartburn, and chest pain.
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Also known as the Green Journal, the American Journal of Medicine publishes original clinical articles of interest to physicians in internal medicine and its subspecialities, both in academia and community-based practice.
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