The Customer Service Diagnosis

David C. Mooth, MD
Medical Director
Clay County Hospital
Flora, Illinois

One of the long neglected aspects in the healthcare profession is customer service. We have resisted being placed on the same level as Nordstrom's or Disney, the leaders in the customer service industry, by excusing ourselves. We say that we are in the business of saving lives, not retailing overpriced shirts or running an amusement park.

However, the time has long since faded when a patient would humbly say, "Whatever you say, Doc," and really mean it. Patients and their families expect TLC. It is no longer sufficient to arrive at the proper diagnosis and treat appropriately.

There is an analogy in the airline industry. We expect the airline to get us (and our luggage) from point A to point B safely. When they do this, it does not elicit any words of praise or thanks from us. What sets one airline apart from another is the level of service they render in terms of meals, comfort, efficiency, etc.

Similarly, patients expect us to get the right diagnosis and to render the right treatment. Frequently we will remain unacknowledged when we perform this part of our job flawlessly. This usually becomes an issue in the patient's mind only when a misdiagnosis or a this becomes an issue in the patient's mind and a bad outcome occurs.

Certainly, there is a difference between us and Nordstrom's. We do have times when we must deal with lives that hang in the balance minute by minute. The outcome in these cases is very dependent on the quality of our technical skill. In these cases, the patient has very simple expectations: he wants to live and he wants you to do what it takes to meet that expectation. We like these patients because this is what we have trained for, and we are in control. We can treat these patients as patients.

However, in less critical patients, such as the parents who bring in their healthy appearing child who had a fever earlier today, the situation becomes more complex. Now agendas and expectations need to be discerned. We may not think that their concern is an emergency, but they obviously think it is, or else they would not have shown up at three in the morning. Such patients (and their families) behave more like customers than like patients. In order to have a satisfactory encounter with them (from their standpoint), we need to address not only the disease process (or lack thereof), but also the unasked questions. We must go out of our way to try to elicit all the questions they may have and to answer them.

One simple test as to whether a person who presents to the ED is a patient or a customer is to see how vertical they are. The more vertical their position the more like customers they are.

When a patient presents in cardiac arrest or in respiratory distress they generally arrive on gurneys in a horizontal position. Prompt action is mandated and they are more likely to go with whatever you recommend. As they improve they become more vertical and thus become more like customers. Once the emergency is past, then the extra blanket, the timely meal or the extended explanation makes more of a difference in how they perceive their care. Giving choices and options as appropriate becomes a great way to assure satisfaction of the vertical patient.

Remember that individuals accompanying the patient, whether POAs or family, or simply the attendant from the Care Center are always vertical. Frequent updates, explanations of the results and discussion of options is always appropriate. These individuals will be an important lens through which the patient and many others will view the encounter.

One last issue that affects patient perception of the encounter is our willingness to explain tests and treatments in laymen's' terms. I used the term "decompensate" when discussing a patient's condition to the family, but only one person out of the group of fifteen or so had the courage to ask what I meant. I apologized, and rephrased my statement in terminology that does not take four years of medical school to understand. The family appreciated that quite a bit. I just wonder what else might have slipped by them.

Too often a patient or their family will simply nod their heads in agreement when they really have no conception of what we are saying. Describing what is going on and what you are thinking in laymen's terms helps tremendously.

When a Patient is Really a Customer:

• Give choices if at all possible
• Take time to explain tests and treatments in layman's terms
• Do not interrupt the patient for the first minute of the encounter
• Treat all family and attendants as customers
• Take time to explain the medications you prescribe, the intended effect and possible side effects
• Try to anticipate questions and concerns