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Recently I wrote about the problems with maintenance of certification requirements. One of the phrases I repeatedly read when I was researching the piece was “the patient as customer.” Here’s a quote from the online journal produced by Accenture, the management consulting company:

Patients are less forgiving of poor service than they once were, and the bar keeps being raised higher because of the continually improving service quality offered by other kinds of companies with whom patients interact — overnight delivery services, online retailers, luxury auto dealerships and more. With these kinds of cross-sector comparisons now the norm, hospitals will have to venture beyond the traditional realm of merely providing world-class medical care. They must put in place the operations and processes to satisfy patients through differentiated experiences that engender greater loyalty. The key is to approach patients as customers, and to design the end-to-end patient experience accordingly.

Except for one thing. Patients are not customers.

The definition of a “customer” is a person or entity that obtains a service or product from another person or entity in exchange for money. Customers can buy either goods or services. Health care is classified by the government as a service industry because it provides an intangible thing rather than an actual thing. If you buy a good, like a car, you voluntarily decide to shop around and get the best car you can for the price. Even a vacation, especially a vacation package or a cruise, is a good. A nice dinner, while a good in the sense of the food, is also a service. You buy the services of the cook and servers.

Here is why the patient shouldn’t be considered a customer, at least not in the business sense.

1. Patients are not on vacation. They are not in the mindset that they are sitting in the doctor’s office or the hospital to have a good time. They are not relaxed; they have not left their troubles temporarily behind them. They have not bought room service and a massage. They are not in the mood to be happy. They would rather not be requiring the service they are requesting.

2. Patients have not chosen to buy the service. Patients have been forced to seek the service, in most cases.

3. Patients are not paying for the service. At least not directly. And they have no idea what the price is anyway.

4. Patients are not buying a product from which they can demand a positive outcome. Sometimes the result of the service is still illness and/or death. This does not mean the service provided was not a good one.

5. The patient is not always right. A patient cannot, or should not, go to a doctor demanding certain things. They should demand good care, but that care might mean denying the patient what the patient thinks he or she needs. The doctor is not a servant; she does not have to do everything the patient wants. She is obligated to do everything the patient needs.

6. Patient satisfaction does not always correlate with the quality of the product. A patient who is given antibiotics for a cold is very satisfied but has gotten poor quality care. A patient who gets a knee scope for knee pain might also be very satisfied, despite the fact that such surgery has been shown to have little actual benefit in many types of knee pain.

Many hospitals are now focusing on what they call patient-centered care, which, because they are businesses, means that they are focusing on keeping customers by providing good customer service. Customer service is defined by Wikipedia as the provision of service to customers before, during and after a purchase. And, of course, service in this case refers to the intangible assistance the customer is buying. Good customer service, then is … what? Providing a good product? Having a real person on the other end of the help line? Doing anything the customer wants?

Turns out the definition of good customer service changes depending on the industry you’re in an and what product you’re selling:

We all know that good customer service is crucial, but once you get down to trying to define what goes into it, not everyone is on the same page. To some, good customer service is as simple as solving problems and offering solutions in an expedient manner. To others it means overall pleasantness and politeness from those who represent the frontlines of the company. Others define it as when a company is willing to give their customers anything and everything that they want — you know, the customer is always right approach — no matter how unreasonable some of those demands may be. There isn’t a right or a wrong, because the factors of what makes customer service “good” also depend heavily upon what specific things a particular customer may hold valuable or their expectations from what industry competitors do.

The factors that make customer service good depend upon the individual values and expectations of the customer. Here is one way in which health care is very much like being a waitress: you take all comers. Health care workers are exposed to all the varieties of humanity, temperament, background, values, and expectations. And all this within the context of a situation in which the customer doesn’t want to be there and wishes he or she didn’t have to buy the service.

The patient is a person, not a customer. We must approach each patient with humanity, not customer service.

Shirie Leng, a former nurse, is an anesthesiologist who blogs at medicine for real.

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