Customer Service

Gosh, a whole lot of huffing over a little word!


OK, now grab a paper bag and breathe slowly and steadily into it.  I know it’s hard to hear that word.  I am sorry to have caused such trouble.

Some folks misunderstood my last post, thinking that I thought patients should only be considered customers, or that they should be referred to as customers.  I never said that, nor did I imply it.  I simply said that patients are customers.  They are.  Medical care is not free, and it is being paid for by the patient (directly or indirectly).  Medicine is a business that has been so mismanaged that we are now in a crisis over its financial side.  The trouble is the cost of care.  Cost implies money is used, and trading money for services or goods is what business is about.

We’ve been spending our dollars on healthcare like a person irresponsibly running up a credit card bill they can’t pay back.  The pain doesn’t happen now, it happens down the road when the collectors knock.  We can’t order whatever tests we want or prescribe gazillion dollar drugs without remembering somebody will have to pay the bill.  Ignoring the business of medicine has gotten us into deep doo-doo.

This fecal vortex is not limited to the financial side of the business; we have also neglected customer service.  Doctors have “waiting rooms.”  What other business admits up front that it won’t serve you in a timely manner?  I suppose we could call airports “delay zones,” but I doubt the airline industry would accept that like we have in medicine.  Whenever I post on doctor/patient interaction, I am flooded with stories from patients who are treated poorly by doctors and their offices.  People are there for good medical advice, right?  No, they are there to be cared for, and a huge part of that care is determined by how they are treated in the office.

Early in our practice, we decided we wanted our practice to be like the department store, Nordstrom’s.  Perhaps in the present day I’d more compare it to the grocery store, Trader Joe’s.  These stores do not focus on having the lowest price, the biggest sales, or the best advertising.  Instead, they focus on the customer experience.  They want people to have a different experience when they come to their store.  The staff is helpful and courteous; they make their store to meet the needs of their customers, not expecting their customers to adapt to their store.  When people leave these stores, they feel good about their experience.  They feel like they were the center of attention and got their needs met.  They are extremely loyal to these stores.

I want my patients to feel the same way when they leave my office.  I want patients to brag about our office and how well they are treated.  To meet our patients’ needs, we have a walk-in clinic every morning from 7:30-8:30, every evening from 5:00-7:00, and Saturday morning from 8:00-11:00.  Our patients love this.  It fits their needs.  They don’t have to call to make an appointment; they just show up.  We do have tight rules around this to prevent abuse; we don’t see chronic problems, nor do we see things that are at all complex.  The visits are limited to “quick sick” problems.

Oh yes, it also is hugely profitable.  We make over 25% of our revenue from this.  That is good business: making a profit off of making people happy.  We identified a need of our patients and met it.  Because of its popularity, the wait times for our walk-in clinics are sometimes longer, but because we are meeting their overall needs of availability, people rarely complain and usually enthusiastically thank us for doing this.

Does this customer-oriented approach mean that we say the “customer is always right” and so give antibiotics when not appropriate, or give in to demanding patients?  No.  It’s actually the opposite.  Since we are meeting our patients’ needs, they seem all the more willing to listen to us when we tell them they don’t need an antibiotic, or that they do need to come back for another visit because the problem is too complex.  They believe us when we say we care about them because we run our business in a way that sends that message.

One doctor who took offense to my last post objected to my classification of medicine as a business, saying: “No, sir, it is not business, it is care, and I am truly disappointed you want to defend it as business.”  That’s like saying a restaurant is not a business, it is the provision of food.  Healthcare is care.  I don’t disagree with that (read the rest of my blog if you don’t believe me!).  It is also a business.

I won’t call my patients “customers,” but I will treat them that way.  I will treat them like I owe them something because they have paid me.  I will treat them like they deserve a good experience when they come to my office.  I will listen to their needs and do my best to meet them.

Doing so is good care.

Rob Lamberts, MD, is a primary care physician practicing somewhere in the southeastern United States. He blogs regularly at Musings of a Distractible Mind, where this post first appeared. For some strange reason, he is often stopped by strangers on the street who mistake him for former Atlanta Braves star John Smoltz and ask “Hey, are you John Smoltz?” He is not John Smoltz. He is not a former major league baseball player. He is a primary care physician.

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10 replies »

  1. You make a lot of great points. Only thing I would add is that having a great experience makes it much more likely that patients will actually be receptive and will follow through on their commitments for follow-ups.

    I know of a couple private medical practices that have really focused in on this and it’s a pleasure to even visit their offices.

    It’s not a big wonder that people hate going to the hospital in general. It’s partially because of what they fear but also because of the same reason they hate going to the DMV: lack of customer service.

  2. What a great example of providing moments of magic for your customers! I always tell companies and organizations that they are in the business of taking care of people. And those people can be called customers, clients, patients, guests, etc. The one common goal is to treat your “customers” well so they will keep coming back and you’ll stay in business. Being sensitive to patients needs can promote a positive experience and a lasting relationship. Shep Hyken, Author of Cult of the Customer (http://www.hyken.com

  3. Boy, that patient as a “customer” designation – I am becoming tired of how often market and marketing metaphors are used in the US. That the doctor-patient relationship is much more complex (to a large extent due to the 3rd payer, isn’t that a “customer” as well?) becomes obvious when considering the issue of inappropriate patient demand (superfluous testing, poor treatment choices based on advertising or internet research, avoiding the psychiatrist, drug abuse/seeking) – should a doc just give in order to treat the customer like royalty?

  4. Nah, not so much an obsession. It’s actually a very a nice hat. I’m now wearing a sombrero, just so you know.

  5. I actually gave the hat to my daughter. I am not a hat guy, but the folks at THCB like this picture, so they use it. It has become a object of obsession to some.

  6. For what its worth – I like the hat. No respectable business person would be caught dead wearing that hat. So you have that going for you. 🙂

  7. twa: If there was a surplus of docs, then doing good medicine and decreasing patient visits would be bad business. Because there is a shortage, this is not a problem. I do my best to see people as infrequently as is necessary.
    Good business does not imply high charges either. I think it’s good business to give freebies. If mom is in with one kid and wants me to check another’s ear, I will without charge. That builds loyalty. Docs who seem to be all about money are going to alienate patients and so end up losing their trust. This is bad business.
    Margalit: Not at all logical. We see lots of uninsured patients and do what we can to help them and keep their charges down. SInce I am not strapped for cash (due to efficiently running the office), I can afford to give away care if I want. It’s about efficiency more than it is about milking out every dollar.

  8. Is the logical derivative of this argument that patients that cannot pay, either directly or indirectly, should not expect “good care”? Or perhaps a sliding fee scale of good to poor care, based on ability to pay?

  9. I can’t tell you how many interactions I have had with the health system where the customer services basically amounted to “well you lived didn’t you? What’s the big deal?”. So I really appreciate your recognition of the need to address the patient’s experience with a caring and customer service orientation.
    Having said that, while I certainly don’t want to be seen as agreeing with a certain very tired doctor, I think I see a different angle on this “medicine as business” and “patients as customers” discussion. A danger of this is the notion that while in most other areas of business “more is better”, in health care it is most certainly not.
    Healthcare done right means less business. And so there is a natural conflict when we try to apply many business and customer oriented solutions.
    Also, I will add that while I believe you are probably a very fine and caring physician – I fundamentally do not want a doctor who is also a business man. I want a doctor whose sole focus as a professional is clinical excellence. I’m not saying that you can’t be both, but I think it is not optimal.

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