Blog | Monday, April 25, 2016

Patient-centered service

American health care has a customer service problem. No, customer service in the U.S. is terrible when it comes to healthcare. No, the customer service in the U.S. health care system is horrendous. No, health care has the worst customer service of any industry in the U.S.

There. That seems about right.

What makes me utter such a bold statement? Experience. I regularly hear the following from people when they come to my practice:
• “You are the first doctor who has listened to me.”
• “This office makes me feel comfortable.”
• “I didn't have to wait!”
• “Where's all the paperwork?”
• “Your office staff is so helpful. They really care about my needs.”
• “This is the first time I've been happy to come to the doctor.”
• “It's amazing to have a doctor who cares about how much things cost.”
• “You explain things to me.”
• “You actually return my calls.”

Each of these things is said as a sincere compliment, with a degree of wonder in their voices. People simply are not used to getting any customer service. By these compliments, I must assume that the majority of people's experience with a physician's practice is:
• They do not feel listened to by their doctor.
• Doctors' offices are uncomfortable.
• Visits usually involve long waits and extensive (and pointless) paperwork.
• Office staffs are usually unhelpful and don't act like they care about people's needs.
• People are never happy to go to the doctor's office.
• Doctors seldom pay attention to the cost of the care they give.
• “Care” from doctors is often poorly explained, and so patients often leave confused.
• Attempts at communication are seldom fruitful.

Add to this the ridiculous wait times, the unreasonable and confusing cost of care, and the plunging morale that people routinely face in medical practices, and you get a frightening picture of a system supposedly dedicated to helping people. What other industry has such a damning set of “normals.” Airlines? Cable TV companies? DMV offices? I have to confess, this makes my job much easier; it's a very low bar to cross. Basically, people are amazed that I don't totally suck. That makes me glad for me and my patients. That makes me really sad for most people.

The obvious question that arises from this is, how did the service that people expect to receive from their doctors get to be so terrible? Shouldn't professionals who dedicate their lives to helping others, even saving lives, be even remotely concerned about the way these people are treated?

As always, the answer lies more in the system itself than in the people working in that system. The simple truth is that in our system the patient is not the customer; the third-party payor is the customer. The product sold at hospitals and doctors' offices is not health care, it is CPT and ICD codes, for which they are paid proportionate to the number and severity of those codes. The patients, instead of being the customer, are the raw materials from which codes are extracted. This means that the best business practice for healthcare providers is to extract as many codes from the most patients in the shortest time possible. So the system rewards the exact things people don't want from their doctors.

You get what you pay for.

There is one piece of evidence that convinces me that the system is the corrupting force that wrecks customer service: me. I spent 18 years in that system and have now been outside of it for the past 3. Since working in a system where I am paid directly by my patients:
• I am always thinking about improving the experience my patients have in my office because they can always leave me.
• I am constantly trying to save them money. Part of this is to justify their “extra” payment to me, but much of it is simply because it is what they want. Making them happy keeps them coming back.
• I have centered my practice around communication and access because that is what my patients (my customers) value the most.
• My office is clean and comfortable. We routinely offer people coffee or tea. I often talk to patients in my office (they sit on a comfy couch), not in the exam room.
• I make it a point to explain things to people so they are comfortable and confident in the care I give. I tell people, “if I can't explain why you need to take any medication, don't take it.”
• I put a priority on getting to know new patients to understand their priorities.
• People almost never have to wait in my office (except when they come early).
• We always tell people the cost of what we are doing and of the medications we are prescribing. When people can't afford medications, we do whatever we can to bring the cost down. One of my nurses dedicates many hours to getting free medications from drug companies for low-income patients.

I do these things for 1 simple reason: my patients are my customers. The more customers I have, the better income my business gets. My patients won't stay my patients for long if my service gets anywhere near the norm for doctors' offices. There is a bonus, of course: it's the nice thing to do. My business model makes being nice an asset, not a liability.

I've read rants by doctors who rail against the idea of patients being customers. If the patient is the customer, they argue, then aren't we obligated to give them antibiotics or pain medications when they ask for them? Doesn't this obligate us to follow the oft-quoted maxim, the customer is always right? This, of course, is total horse hockey (for both regular business and healthcare). Good service is simply good business. But more than that, good service as a physician has a much bigger effect. This is what I've seen over the past 3 years:
1. Treating my patients with courtesy and respect make it far more likely that they will show the same to me. They seem to like me more.
2. That respect (and affection) makes it more likely they will listen to what I say.
3. This means that compliance with medications and other treatments is far higher than it ever was. I am able to hold off on antibiotics and handle pain medications much better.
4. People don't avoid coming to see me, and so I can catch problems earlier. This has had life-saving consequences on several occasions.
5. When I show respect for people's time and money, they are much more trusting of me. People open up to me more about things they don't say to others. They believe I really care, and my office doesn't contradict that fact.
6. Because I care about their lives, they have taken a much higher interest in my life. They encourage me to take days off, ask me about my family, and basically treat me as a person who they care about. Because they do. They value me because they believe I value them. This makes me much happier.
7. Good service also makes my staff much happier, as they are beloved by my patients and highly valued by me. This too improves the overall care people get in my office.

In short, good customer service makes being a good doctor much easier and much more enjoyable.

Of course, I've had people come to me hoping I'll be a Pez dispenser for Percocet or Zithromax. These folks are disappointed when I instead take the time to discuss the proper use of these medications. Some leave me. But many who have come with this intent in mind have been so surprised at being treated with caring and respect that they listen to what I say and continue in my practice.

The vast majority of people truly want a doctor they respect and actually like. This may come as a shock to many of my jaded colleagues who routinely face the ire of people stuck in waiting room purgatory, ignored or disbelieved by doctors, and treated as objects instead of people. They think that people are angry because they don't like doctors. They view the people on their schedule as, at best, the hungry masses they must placate and, at worst, as their adversaries they must conquer. Then they wonder why their patients are so unhappy?

The past 3 years has taught me otherwise. People want to like their doctors. We just haven't given them any reason to do so.