By ROB LAMBERTS, MD

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

Customer.

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.