Doctors and Customer Service

Because The Physician Executive is leaving Maryland, headed to the Great American Desert, he has been spending an inordinate amount of time talking to other companies' customer service experts. When a customer calls to cancel their service, they usually are shuffled off to some of the better folks at handling customer service issues.

My response to this experience is to wonder how, for a service economy, you can't get any. Service, that is. Maybe health care is not doing so badly after all.

Gas and electric handled my departure with grace. Dish Networks offered options that didn't make sense and made me feel like a heel. Verizon (as usual) transferred me to four different people before they hung up on me when I expressed some frustration with the process. After going through three more people and a total of 1 1/2 hours on the phone, I finally understood that they intended to extract as much money from me as possible with lame justifications of service contracts for internet service, which now apparently renew annually instead of just expiring after the one-year term.

And we worry about transparency in health care?
We feel we are not getting good outcomes?
We worry that physicians do not provide adequate customer service?

Of course, there are lapses in any industry as large as this. No single company could hope to go through even a year without a significant lapse in customer service. I know there are stories out there... But overall, my impression is that physicians, nurses, pharmacists and all other allied health staff are generally professional. Do not forget that it is frequently a physician's job to refuse care; as in narcotics, excessive testing and unnecessary treatments. Somehow we manage to convince most of our patients that there is a better way.

We use the principles of shared decision-making, patient-centered care and self-management to come to reasonably satisfactory solutions. Using the parlance of customer service, the customer's experience is necessarily negative to begin with, since many clients are sick, afraid and upset due to their illness or condition. As an industry, we generally manage to treat people with compassion, caring and a modicum of dignity.

We drop the ball sometimes, especially in hospitals where the urgency of care sometimes leads to a neglect of personal propriety. When we need access to someone's neck veins in a hurry, we don't worry about what body parts are really naked. Privacy has always been an issue around the break room (and HIPAA is inadequate to the challenge). We have trouble dealing with drug-seekers and malingerers, who represent a betrayal of the compassion and skill with which we approach sick people (i.e. difficult patients are difficult.)

Apart from the odd scalpel-throwing surgeon or consultant-on-a-soapbox, I can't think of too many instances of internal customer catastrophes. In other words, we even manage to treat each other with some respect the vast majority of the time.

Customer service skills (or bedside manner, as it used to be called) are distributed as a bell curve in any random population; some do better than others. But overall, as a profession, as a group of professions and as an industry, don't we really do better than folks like Verizon and the cable company? On a risk-adjusted basis (adjusting for the fact that most patients are grumpy about even having to be a patient) we may, in fact, be stellar.

Not every problem needs fixing. Sometimes, no matter where you sit on the bell curve, your eyes are fixed on improvement. But little by little, we raise expectations and diminish our ability to provide any return on investment or effort.

We can lose sight of the fact that, compared to the level of service received in retail, business services, financial services, hospitality, IT and others, health care does reasonably well. We can lose sight that the law of diminishing returns dictates that significant improvements from here will be prohibitively expensive and pack only a small punch. Sometimes, the emphasis on customer service can belittle a worthy industry and its workforce.

Personally, I think we are doing well, and our weaknesses come to rise from the expectations that grow as a consequence of our success.