One doctor's view of "patients as cusomters"

Read with interest this opinion piece in the NY Times. In it Dr. Peter Salgo, a doctor,professor, and TV medical expert, bemoans this drive to make patients like customers, saying it encourages those in the medical profession to see us as numbers, not human beings.

It is a most confusing piece, to be honest.

He starts by decrying this shift from patient to customer, claiming:

This may seem a trivial matter, but it is not. You treat "patients" as if they were members of your family. You talk to them. You comfort them. You take time to explain to them what the future may hold in store. Sometimes, that future will be bleak. But you assure them you will be there to help them face it.

OK, well, perhaps I'm too young to have had a doctor like that, being only in my early 40s. I have no trouble imagining my grandfather, the doctor, having such a warm like-family attitude. But can't say I've ever felt I was treated like family. Not even by my dentist, who I've been seeing for literally 25 years.

But then Dr. Salgo loses me in his logic:

You, the patient, are the system's best hope. In the age of seven-minute health care, you need to realize that you employ doctors. That is, your doctor works for you. Although doctors shouldn't think of patients as customers, you can, and should, adopt a business mind-set when shopping for health care.

Huh? Doesn't that seem like a recipe for resentment, and unmet expectations?

And where is it written that a business-like relationships can't include honest communication and empathetic treatment? I have spent many an hour on the phone with upset customers, or frustrated sales people, or in a one-on-one with an over-stressed employee. At no point did having a "business mind-set" preclude my having an empathetic and caring response. In fact in my business listening  and advising and consulting are key personal skills I need to have.

I honestly didn't get the vision of the world this essay painted.

Comments

[doctordel]

Really enjoy your site; the perspective is enlightening.

Speaking as an emergency physician who has been out of residency for only the last 9 months I can tell you that the entire "patient as customer" conversation has left me a little disheartened by what seemes to be the handwriting spraypainted on these white hospital walls. Like someone who just found out he was adopted, the nature of the once-venerated profession and practice of medicine has changed and no one bothered to tell me until I was nearly finished with residency. I suppose the single-minded drive to become a physician, to attempt to epitomize the very best of what human beings can be, has a way of propagating a somewhat naive picture of "the business of medicine" if you don't pay attention. I really want to be the warm, empathetic, and compassionate doctor that all my patients feel they can trust and count on, if only for their short ER stay and we never cross paths again. It shouldn't shock you, however, to learn that hospitals and large corporate groups have a different idea of what they need their staffs to embody: namely, the ability to generate income for them.

There are plenty of legitimate beefs that both doctors and patients have with medicine these days (mandated and unfunded care, misuse of the ER despite patient education, lazy and pompous practitioners, unrealistic demands by those who do not walk in the shoes of those they would demand from, etc...) I just think that we owe it to both patients and doctors-in-training to either leave the patient the "patient"-recognizing all that this embodies-or just complete the transformation from "patient" to "customer" and finally acknowledge medicine as nothing more than another "business" an of all that philosophy consists. Personally, I would prefer the former.

My 7-month old is fussing so I have to go; he doesn't seem to appreciate your blog like I do.

[Elisa Camahort]

What a great comment Doctor Del...thanks for stopping by. I hope you get to retain much of those ideals that drove you to become a doctor, even as the health care industry (and the rest of us) struggle to figure out what to do.