Patient-Centered Service

Patient-Centered Service

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flying cadeuciiAmerican healthcare has a customer service problem.  No, customer service in the US is terrible when it comes to healthcare.  No, the customer service in the US healthcare system is horrendous.  No, healthcare has the worst customer service of any industry in the US.

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 healthcare, 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 one 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 three years has taught me otherwise.  People want to like their doctors.  We just haven’t given them any reason to do so.

Rob Lamberts is a primary care physician in Augusta Georgia.

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13 Comments on "Patient-Centered Service"


Member
Maegan_House
Apr 13, 2016

Dr. Lamberts – I strongly agree with you. The customer service aspect of health care has been declining rapidly. Most physicians that work for the system seem to not care and just rush through patient after patient. I agree completely when you said “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.” Doctors in the system, are worried more about how much the insurance company will pay them, instead of listening to the patient’s concerns. This is not how a doctor should be, a doctor is supposed to help and heal the patient, not treat them like they’re just worth the money they will be getting paid. From personal experience, I feel like I receive better customer service when I go see a doctor who owns his own practice. Like you, they treat the patient’s a lot better since the patient’s have the option to not come back. I am currently in college as a Pre-Med undergrad and this was a great article and I thoroughly enjoyed reading it!

Member
Roger Collier
Apr 1, 2016

Rob — My impression from your earlier posts is that one reason you can offer better “customer service” is that you have many fewer patients than the typical family practitioner (as well as — if I’m remembering right — refusing to deal with insurers or government payers).
Can you tell us (1) how many patients you have; and (2) on what basis they pay you and how much? (3) how your office staffing compares with that of a typical family doc? (4) how your take-home income compares with that of the “typical” non-hospital doc? [No, I’m not with the IRS!]
What you are doing has obvious attractions. The question is whether it is scalable or just a very tiny niche market.

Member
Apr 1, 2016

1. 700 patients and growing at about 20/month. 2. They pay monthly (no office visit copays) and pay between 30 and 60/month based on age (although I’m increasing by $5 in June to improve cash-flow). 3. I have 2 MA’s. My daughter answers the phones part-time, but is bored most of the time, so I think she’s not actually needed. No billing staff at all. Much more efficient. 4. Take-home is still about 1/2 of what it was prior to doing DPC (Was over $200K), but the $5/month raise should add an additional $3000/month, so you can do that math. Is it scalable? That’s the big question. I certainly think I can get my income up to where it once was, and can focus more on adding services like getting a diabetes educator (part time, probably), go after small businesses with an NP or PA, and there are a bunch of other things I’m considering once I can start putting money back toward savings. My hope is that I’ll get significantly over 1000 patients, and that will begin to make this thing truly appealing to doctors. The key is to do this and still maintain the level of service my patients are used to. If I can get my income good enough and get the volume of patients to where it rivals my old practice, then this scales. This is exactly the thing I’ve been focusing on. My goal is to create a model that scales and then totally disrupts the status quo. Ambitious, but not unreasonable. Never thought I’d get to 700, have only 2 nurses, no office manager, have very happy patients, and feel I still have room to grow.

Admin
Mar 29, 2016

Healthcare has the worst customer service?

IS it Horrible? Why?

via TweetBot

Admin
Mar 29, 2016

Patient-Centered Service? The simple truth is that the third-party payor is the customer.

via TweetBot

Member
Steven Findlay
Mar 29, 2016

Related to this article, see the May issue of Consumer Reports magazine–out today–as well as CR’s latest ratings of primary care group practices in 8 states, at this link: http://www.consumerreports.org/doctors-hospitals/new-doctor-ratings-in-8-states/

The April issue of Health Affairs, out next week, also has several pieces on physician quality and ratings/report cards, and patient engagement.

Admin
Mar 28, 2016

Rob –

I think you’re wrong.

American healthcare doesn’t have the worst customer service. People just go around saying that because we’re all frustrated.

American healthcare saved my life. Twice.

I think that qualifies as pretty decent customer service!!!!

Member
Mar 28, 2016

That’s not what I am referring to when I talk about customer service. Customer service involves things like wait times, people communicating with you, returning your calls, making you comfortable. There can be high quality care in our system, but it is often done in a way that no other industry could do. People wait for hours in doctors’ offices, routinely don’t get lab or x-ray results. For a service industry, the service is horrendous. It CAN be good at times, but most folks would put our industry at the bottom when it comes to service (not care itself, but the package in which that care comes).

Admin
Mar 28, 2016

Intimidated into silence by your new profile picture …

Member
Mar 28, 2016

I’m very thoughtful and contemplative.

Member
Tom Emerick
Mar 29, 2016

Health care in America results in about 400,000 avoidable deaths every year. Alas.

Admin
Mar 29, 2016

Tom, as a stats guy, you should know that number is questionable. I’m not going to challenge it now .. But it’s sketchy.

Member

John Irvine, you are being very very kind in your restraint.