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The Customer Is Always Right" Kills
I'd like to start off this thread by saying "thank you" to the following geniuses:
Joshua J. Fenton, MD, MPH; Anthony F. Jerant, MD; Klea D. Bertakis, MD, MPH; Peter Franks, MD
for their recent article, "The Cost of Satisfaction- A National Study of Patient Satisfaction, Health Care Utilization, Expenditures and Mortality." (Arch Intern Med. 2012;172(5):405-411).
You have exposed the truth, that those of us in the EDs know and have lived. You have found and shown that the business mantra, "The Customer Is Always Right" does not apply to emergency departments or health care. You have shown to be true, that which should be obvious. That although patients should be treated with respect and dignity, they don't always know what's best for them when it comes to their treatment or healthcare, and that:
It is actually a dereliction of our duty as physicians to blindly "satisfy" a patients wishes without standing up for what we know, and have been trained to know, is "best" for them.
For what a patient "wants", isn't always what they need, or what is right. You have exposed this obsession to be exactly what it is: An obsession to line the pockets of hospital administrators with greater profits and bigger bonuses, with NO REGARD to increasing quality of care, with an INCREASE IN MORTALITY as the cost, not to the hospital administrators, but to the patients.
"Conclusion: In a nationally representative sample, higher patient satisfaction was associated with less emergency department use but with greater inpatient use, higher overall health care and prescription drug expenditures, and increased mortality."
"Greater inpatient use" and "higher overall health care and prescription expenditures" and "increased mortality", translates to:
More patients, spending more money and more likely to die
Really, most of all it is just plain sad and wrong, because we've know it all along, and nobody would listen. To the hospital administrators profiting from this:
We have known that when a patient comes to the ED, demanding their fifth CT scan of the abdomen, when they're already had 4 in the past month and they have normal labs and a normal exam and no change in their status that they don't need another one, despite the fact that another one will satisfy their anxiety more than our words, and that another dose of radiation is bad for them. But some have caved in, due to your pressure to "satisfy everyone" at the PATIENTS OWN expense and have done what they were "told to do" to make your numbers look good, for fear of being replaced by "better team players".
We have known that when a patient comes to the ED demanding inappropriate doses and quantities of pain medicines, showing every "red flag" aberrant behavior possible, that often it is not what is best to "satisfy" the patient with active addiction. That sometimes treatment for the disease of addiction is best, most right, and healthiest, yet not most satisfying. Some have caved to your pressures and threats of "canceling contract" and done what is most satisfying, yet WORSE for the patients health. You say, "Oh no, we'd NEVER tell you how to treat your patients", yet you apply pressure every day to do just that.
We have known that, when a patient demands inappropriate treatment with antibiotics for viruses, that a prescription exposes them to the risk of potentially serious allergic reaction, drug side effects and the breeding of MRSA-like superbug infections. Yet many good physicians have caved to your pressures and threats to "get in line", "don't screw up our Press Gainey scores" or "you'll lose your contract", to achieve unrealistic patient satisfaction scores that have NO QUALIFIERS and equate "he didn't give me more blankets" with "a life lost". Your surveys equate "I waited too long on in the ED on Christmas eve to have my stubbed toe checked" with "a fatality that shouldn't have occurred". Your surveys equate "the nurse rolled her eyes at me when I asked for splenda in my coffee" with "an emergency that shouldn't have been missed".
However, in our world of life, death, tragedy, trauma and time pressure, those things are not the same. To you a lost "customer" is a lost customer, even if we were busy saving a life, and too busy to get blankets because, you didn't have money in the "budget" to pay for a "blankets-and-coffee tech". We know there is plenty of money left in the budget. We're not stupid.
Yet a life saved, that otherwise would have been lost, can never counterbalance an unqualified, and unfiltered complaint that may have come from a physician not ordering a test that may have put a patient needlessly at risk.
What you're doing is madness, it's terrible, it's insane and bad for patients. You're pressuring us to do what is in many cases bad for people, for profit. It is wrong.
We know that pressuring for admission, stress testing and a repeat heart cath in a patient who is very anxious and demanding one, yet DOESN'T need one, exposes them to a significant risk of death, renal injury from IV dye, coronary dissection and perforation, hematoma and pseudoaneursym, from an unnecessary procedure, but you don't care. We get it.
You just keep pushing, pushing and pushing because you know doctors are rule followers and will generally "do what they're told". You know that on the surface, the patients love it because it makes them "feel good" even if in many cases, it puts them at risk. You'll maintain course, as long as it makes you mad money and as long as you can pull our strings.
Has the fact that a major medical journal has exposed that this business model (and let's expose it for exactly what it is, a business model) may actually kill people, caused you to panic, hold emergency meetings to change course and reformulate a new model of measuring quality of care that wasn't devised for burger restaurants?
No.
We know, you're making too much money. We get it. Only when the lawyers pick up on it and the class action lawsuits start piling up will you back off. But, we know, "its not a big deal" to you. It's the cost of doing business and you never have to give a spent bonus back. We get it. Times are good for you. Health care is still booming.
Again, "bravo" and thank you to the following geniuses who asked the question and insisted on publishing the results, when they probably could have found a way to make lots more money by offering to bury the results at the request of those who have the most money to lose:
Joshua J. Fenton, MD, MPH; Anthony F. Jerant, MD; Klea D. Bertakis, MD, MPH; Peter Franks, MD
Their article, "The Cost of Satisfaction. A National Study of Patient Satisfaction, Health Care Utilization, Expenditures, and Mortality", can be found here, read it:
http://archinte.ama-assn.org/cgi/con...ract/172/5/405
Also, here's another article that did not find any significant correlation of mortality (increase or decrease) with increased patient satisfaction, but notably found no improvement in the quality of myocardial infarction care or survival, from Circulation, "Patient Satisfaction and Its Relationship With Quality and Outcomes of Care After Acute Myocardial Infarction", here:
http://circ.ahajournals.org/content/...ull#abstract-1
Again, patients should always be treated with respect and dignity. Providing blankets, coffee, tea, snacks and other comfort items are fine, if you commit to paying for patient concierges to provide the service as separate from their health care decision making. However, to have a "Customer Is Always Right" policy, is wrong and dangerous. Why? Because, sometimes what is most "satisfying" from a patient perspective, is not the "healthiest" and only the physician has the training, knowledge, duty and moral obligation to determine what is.
__________________
-The Bird strikes again.
I'd like to start off this thread by saying "thank you" to the following geniuses:
Joshua J. Fenton, MD, MPH; Anthony F. Jerant, MD; Klea D. Bertakis, MD, MPH; Peter Franks, MD
for their recent article, "The Cost of Satisfaction- A National Study of Patient Satisfaction, Health Care Utilization, Expenditures and Mortality." (Arch Intern Med. 2012;172(5):405-411).
You have exposed the truth, that those of us in the EDs know and have lived. You have found and shown that the business mantra, "The Customer Is Always Right" does not apply to emergency departments or health care. You have shown to be true, that which should be obvious. That although patients should be treated with respect and dignity, they don't always know what's best for them when it comes to their treatment or healthcare, and that:
It is actually a dereliction of our duty as physicians to blindly "satisfy" a patients wishes without standing up for what we know, and have been trained to know, is "best" for them.
For what a patient "wants", isn't always what they need, or what is right. You have exposed this obsession to be exactly what it is: An obsession to line the pockets of hospital administrators with greater profits and bigger bonuses, with NO REGARD to increasing quality of care, with an INCREASE IN MORTALITY as the cost, not to the hospital administrators, but to the patients.
"Conclusion: In a nationally representative sample, higher patient satisfaction was associated with less emergency department use but with greater inpatient use, higher overall health care and prescription drug expenditures, and increased mortality."
"Greater inpatient use" and "higher overall health care and prescription expenditures" and "increased mortality", translates to:
More patients, spending more money and more likely to die
Really, most of all it is just plain sad and wrong, because we've know it all along, and nobody would listen. To the hospital administrators profiting from this:
We have known that when a patient comes to the ED, demanding their fifth CT scan of the abdomen, when they're already had 4 in the past month and they have normal labs and a normal exam and no change in their status that they don't need another one, despite the fact that another one will satisfy their anxiety more than our words, and that another dose of radiation is bad for them. But some have caved in, due to your pressure to "satisfy everyone" at the PATIENTS OWN expense and have done what they were "told to do" to make your numbers look good, for fear of being replaced by "better team players".
We have known that when a patient comes to the ED demanding inappropriate doses and quantities of pain medicines, showing every "red flag" aberrant behavior possible, that often it is not what is best to "satisfy" the patient with active addiction. That sometimes treatment for the disease of addiction is best, most right, and healthiest, yet not most satisfying. Some have caved to your pressures and threats of "canceling contract" and done what is most satisfying, yet WORSE for the patients health. You say, "Oh no, we'd NEVER tell you how to treat your patients", yet you apply pressure every day to do just that.
We have known that, when a patient demands inappropriate treatment with antibiotics for viruses, that a prescription exposes them to the risk of potentially serious allergic reaction, drug side effects and the breeding of MRSA-like superbug infections. Yet many good physicians have caved to your pressures and threats to "get in line", "don't screw up our Press Gainey scores" or "you'll lose your contract", to achieve unrealistic patient satisfaction scores that have NO QUALIFIERS and equate "he didn't give me more blankets" with "a life lost". Your surveys equate "I waited too long on in the ED on Christmas eve to have my stubbed toe checked" with "a fatality that shouldn't have occurred". Your surveys equate "the nurse rolled her eyes at me when I asked for splenda in my coffee" with "an emergency that shouldn't have been missed".
However, in our world of life, death, tragedy, trauma and time pressure, those things are not the same. To you a lost "customer" is a lost customer, even if we were busy saving a life, and too busy to get blankets because, you didn't have money in the "budget" to pay for a "blankets-and-coffee tech". We know there is plenty of money left in the budget. We're not stupid.
Yet a life saved, that otherwise would have been lost, can never counterbalance an unqualified, and unfiltered complaint that may have come from a physician not ordering a test that may have put a patient needlessly at risk.
What you're doing is madness, it's terrible, it's insane and bad for patients. You're pressuring us to do what is in many cases bad for people, for profit. It is wrong.
We know that pressuring for admission, stress testing and a repeat heart cath in a patient who is very anxious and demanding one, yet DOESN'T need one, exposes them to a significant risk of death, renal injury from IV dye, coronary dissection and perforation, hematoma and pseudoaneursym, from an unnecessary procedure, but you don't care. We get it.
You just keep pushing, pushing and pushing because you know doctors are rule followers and will generally "do what they're told". You know that on the surface, the patients love it because it makes them "feel good" even if in many cases, it puts them at risk. You'll maintain course, as long as it makes you mad money and as long as you can pull our strings.
Has the fact that a major medical journal has exposed that this business model (and let's expose it for exactly what it is, a business model) may actually kill people, caused you to panic, hold emergency meetings to change course and reformulate a new model of measuring quality of care that wasn't devised for burger restaurants?
No.
We know, you're making too much money. We get it. Only when the lawyers pick up on it and the class action lawsuits start piling up will you back off. But, we know, "its not a big deal" to you. It's the cost of doing business and you never have to give a spent bonus back. We get it. Times are good for you. Health care is still booming.
Again, "bravo" and thank you to the following geniuses who asked the question and insisted on publishing the results, when they probably could have found a way to make lots more money by offering to bury the results at the request of those who have the most money to lose:
Joshua J. Fenton, MD, MPH; Anthony F. Jerant, MD; Klea D. Bertakis, MD, MPH; Peter Franks, MD
Their article, "The Cost of Satisfaction. A National Study of Patient Satisfaction, Health Care Utilization, Expenditures, and Mortality", can be found here, read it:
http://archinte.ama-assn.org/cgi/con...ract/172/5/405
Also, here's another article that did not find any significant correlation of mortality (increase or decrease) with increased patient satisfaction, but notably found no improvement in the quality of myocardial infarction care or survival, from Circulation, "Patient Satisfaction and Its Relationship With Quality and Outcomes of Care After Acute Myocardial Infarction", here:
http://circ.ahajournals.org/content/...ull#abstract-1
Again, patients should always be treated with respect and dignity. Providing blankets, coffee, tea, snacks and other comfort items are fine, if you commit to paying for patient concierges to provide the service as separate from their health care decision making. However, to have a "Customer Is Always Right" policy, is wrong and dangerous. Why? Because, sometimes what is most "satisfying" from a patient perspective, is not the "healthiest" and only the physician has the training, knowledge, duty and moral obligation to determine what is.
__________________
-The Bird strikes again.
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