Ruminations On Hot Dogs & Emergency Medicine
I was told once, at the start of my career in EM, the difference in being a "customer" versus a "vendor" and that this would dictate how I was treated throughout my career. I had no idea how important this was, and how much it would permeate every nook and cranny of my job, and the system I had to navigate.
You see, a spine surgeon for example, is a "customer" of the hospital. He brings a practice, patients and therefore money to a hospital. If he leaves, the practice, the patients and the money go with him. The spine surgeon is the guy that walks up to the hot dog stand and every night orders 100 hot dogs. We don't always have to like him, but "By golly!" he pays half of our quarterly bonus! This customer must be kept happy, at all costs. He's a high roller, making him rich can makes us rich,
and there's not that many of him out there. "The customer is always right," and the customer will be treated accordingly.
Customer a-s is always kissed.
A patient, also is a customer. A patient brings with him a goody bag of the hospitals favorite treats called an insurance card. It is this goody bag that he gives as currency in exchange for a hot dog. If the patient leaves the hospital, he takes the goody bag with him. This goody bag could contain a lump of coal, or more often a few hundred dollars. Hell, sometimes we've gotten goody bags with tens of thousands of dollars in them (chest-pain admit, heart-cath, plus big facility fees), or hundreds of thousand dollars (complex spine surgery, trouble with vent weaning, prolonged ICU course) hiding in them! This customer doesn't always tip big, and doesn't
always buy lots of hot dogs, but damn it, there's TONS just like him out there. We can afford to p-ss off a couple here or there, but on balance, if we keep most happy, and keep them coming, the numbers will add up. Once again, "this customer is always right," and the customer will be treated accordingly. Customer a-s is always kissed, ESPECIALLY when they carry goody bags full of surprises.
An Emergency Physician is, well...a vendor. He's the guy selling the hot dogs at the stadium (myself included). His job is primarily to keep the goody-bag bearing customers happy, and to keep the lines a movin'. His job is an important one, no doubt, but it's
different. He comes to the hospital with no goody bag of his own and no practice, patients or business to bring. Sure, we'd like to rent a space to somebody with a hot dog cart, 'cause after all, a big juicy hot dog does keep
the customers happy after all. But we don't really care if it's Nathan's Hot Dogs, Hebrew National, or Tap Dance Coney, as long as the customers like it. And you know what, after all, if Tap Dance Coney gets tired of tap dancing, or gets tired of following all of our stupids sanitation policies, it's cool. We'll just call Nathan's, Hebrew National, Outhouse Dog, or who gives a rip, we'll bring in someone not even fully trained to cook hot dog. After all, the others have been drooling over the contract and have all been promising to do it for cheaper. After all, the customers just want a halfway decent friggin' hot dog, service with a smile and to get back to watching the damn game.
A smart vendor knows his place, knows who's who, and what everyone's role is. A smart vendor knows that it's a privilege to be given the opportunity to
have access. After all, it is access to the "customers," that pays the vendor's bills. A smart vendor never loses sight of the fact that even though the customers sometimes can be very difficult and demanding, they put food on his table. A smart vendor that shows up early, leaves late and wears a polite smile in the face of adversity will be able to pay his bills, and may even do very well if he can grill a halfway decent dog. A vendor, however, will never be treated like a "customer," and
definitely never like the high roller. If a vendor gets to big for his own britches, well...we'll just get a new one who'll fit in the pants.
