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la gringa

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am i the only one who gets really annoyed when a female patient asks for a female dr? usually citing "religious reasons", even though no religion dictates that you can't see a male physician.... even worse is that some of the nurses buy into it and make me look like the bad guy if i say no... while most are 100% in agreement w/ me. you're in an EMERGENCY department, for chrissakes...
 
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RafaTech

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She could just be the female attending that always gets asked to pick up the patient by the male attending for those reasons
 

SeekerOfTheTree

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People and their misconception that we are getting our rocks off by doing pelvics on random women.
 

member11223344

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I don't really mind at all...and (gasp) I kind of like doing pelvics and being good and quick at them. So siphon the vag bleeders my way! That was definitely one of the top ten creepiest things I've written.
 

ghost dog

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am i the only one who gets really annoyed when a female patient asks for a female dr? usually citing "religious reasons", even though no religion dictates that you can't see a male physician.... even worse is that some of the nurses buy into it and make me look like the bad guy if i say no... while most are 100% in agreement w/ me. you're in an EMERGENCY department, for chrissakes...

I don't know about that one playa...

How about some middle eastern countries where Islam is very prevalent ? I would imagine that it may not only be the patient requesting a female MD, but the husband as well ?

I agree 100 %. If you're in the ER - it better be for a damn good reason.

If the setting were that of an elective nature, why then, choose away....
 

la gringa

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i practice in the US... was more of a problem in a large city, but still following me in a smaller one.... i feel it's a big ole dump a lot of the time, and totally inappropriate in the ED.

not to mention there's usually a huge drama factor involved, and i'm one of the most independent, liberated women around... i have to hide my desire to smirk when women tell me they're relieved they have a female doc. i'm a DOC.... a damn good one... and my gender has absolutely nothing to do with that.
 

sese

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I've also gotten similar requests.

In residency, I would decline for the same reason, just as when a male pt asked for a male physician.

Now that I'm in the community in a diverse area with many patients from the Mid-East, I tend to cave in. Maybe it's the religion factor, esp when some women come in with their head and arms/legs completely covered.

There's an older male attending that I've observed asking female PA's to do the pelvic exam portion of the visit.
 

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We've had it occur more than a few times in our shop in NYC with both males and females of different religions. If there are same-gender physicians available, then we will try to accommodate otherwise we tell them that this is the ED and you will get whichever physician that happens to be available. It's their choice to stay or leave at that point.
 
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AmoryBlaine

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I will risk being called an a**hole by saying I am fairly intolerant of this sort of request.

We practice medicine, we are not perverts. I do not think patients should direct their care like this unless there are extreme circumstances involved.
 

RustedFox

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Agree w/ Blaine. This is medicine. We don't practice "religion", we practice objective, scientific reality. There's no white magic to it.

I get angry whenever I see a hospital name with the word "Saint" or any variation thereof mentioned in the title.

Mysticism is for those who can't do the math.
 

docB

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All of this can be solved in 3 words:

"Patient declines pelvic/rectal".

This. :thumbup:

To my way of thinking the ED is there for emergencies and if you really care who does your exam it is less likely to be an emergency. Moreover if it is an emergency but your belief/desire to chose the gender of your examiner is so strong you will risk the consequences then you have that right similar to a JW refusing blood.

As we grow ever more subjugated to the whims of customer satisfaction we will likely be required to staff to provide for these requests.
 

la gringa

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Agree w/ Blaine. This is medicine. We don't practice "religion", we practice objective, scientific reality. There's no white magic to it.

I get angry whenever I see a hospital name with the word "Saint" or any variation thereof mentioned in the title.

Mysticism is for those who can't do the math.

i agree too.... but being a female, i'm always on the receiving end of these requests. i've never had a competent/noncrazy/nondrunk patient have an issue w/ me being a woman (other than the husband of a muslim female patient, who politely declined to shake my hand...).

it becomes problematic in single coverage situations AND when your ED is large and busy. i shouldn't have to abandon the pts i am seeing, who were triaged to my area, for the religious beliefs (proported belief fwiw - per my muslim physician friends tell me this is NOT an absolute and esp in the case of an EMERGENCY, a medical exam is CLEARLY not applicable to any gender issue)... or really, ANY belief that doesn't involve refusing care. you can refuse whatever you want (JW's for example), but to expect nurses/physicians to rearrange everything so that a male physician doesn't look at your vag/whatever is an unreasonable.

if i do end up with a female pt who says anything about being "glad the dr is a woman", i assure them it was a random assignment, that i am here to be their PHYSICIAN (no gender there!) and that some of my male partners do have smaller hands than mine.
 

Arcan57

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Reasonable attempts to accommodate patients are good. Catering to a fast food, super-size it, "I want to pick my doctor, pick different doctors to do different parts of my exam, not pay my bill, be seen within 15 min, be discharged within 15 min, for free, get a sierra mist and a meal tray to go, and by the way, let me give you my real address so you can send the Press Gainey survey to my house (but not the bill)" mentality.

You are not a luxury Cartier watch concierge. (Now cue ED director/administrator to reply with post that says, "Times have changed, Yes you are")

La Gringa, you're right to be irritated, for what my 2 cent opinion is worth.

End of rant.

As long as there are still massive profits to be made in delivering emergency care, the job is going to revolve around customer service. I'm perfectly fine with the approach you described in your post, but if your group have enough customers (um, patients) complaining (and giving you bad PG scores) then it could imperil your contract. If you're out in the community, your job is largely going to depend on two numbers: your PG rank and your LWBS percentage.
 

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From a patient's perspective (not in the emergency department), I prefer a female doctor for routine pap smears or other gyn stuff. It has nothing to do with thinking the male equivalent is a perv or anything else and I'm totally cool with a male doctor checking out my ankle or removing a mole. Just a preference since I think a vag exam is different. This is hard to justify in the ED though....

I agree with Birdstrike. In the ED, accommodate if you can and then if you can't, the patient can decide whether or not they want to continue with the exam.
 
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I agree with Birdstrike. In the ED, accommodate if you can and then if you can't, the patient can decide whether or not they want to continue with the exam.

This is the crux of the OP's issue. Sometimes in the ED accommodating this request is merely difficult and unfair to one doctor or another and other times it is really really difficult and it impacts the care of other patients. The ED is just not the place where gender preference should be causing those issues.

For example, if there is a female doc in the department to do your exam but it means another patient will have their discharge delayed by 20 minutes is that fair?
 

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This is the crux of the OP's issue. Sometimes in the ED accommodating this request is merely difficult and unfair to one doctor or another and other times it is really really difficult and it impacts the care of other patients. The ED is just not the place where gender preference should be causing those issues.

For example, if there is a female doc in the department to do your exam but it means another patient will have their discharge delayed by 20 minutes is that fair?

...and if that patient's discharge is delayed by 20 minutes and it takes 10 minutes to turn the room over, then your grandma is going to have to wait an extra 30 minutes before her chest pain gets evaluated.
 

primadonna22274

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Oh my goodness this thread struck a familiar chord for sure...I've been called to do countless pelvics for women all over the ED...even when I am singly responsible for fast track my attendings don't mind asking me to check their vag bleeders on the main side. Heck. I've had a hospitalist call down to the ED to ask if we can send up "one of your female PAs" to the floor for a pelvic. Ugh. Note to self: when I am an attending physician, I will not ask the PA to do my job...wait, never mind, that's probably a lie. ;)
 

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I've been saying for awhile that we have enough patients who have GYN issues that we should just hire a PA with OB/GYN experience and have them just do those patients. Maybe not a great idea at a teaching program (as much as I've had enough of pelvics, I know those patients are part of my training.)

But seriously, during daytime hours I'd estimate that we have from 3-6 patients in the GYN rooms at any given time. I think it would work out financially to pay a PA to cover those patients.
 

med2UCC

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I personally hate when someone requests a female physician. I'm a woman and I've seen male doctors for most of my 46 years and really couldn't care less. It also drives me nuts because I do 2 days a week in family practice and I'm constantly having people ask if they can' join my practice because "I would love to have a female family doctor". I invariably politely decline to play. I've had people tell me that I was a fool to go into practice with an older male physician because all my patients will leave when he retires (because they all must be men, of course). Fortunately, most of my old men seem to like having a female doctor half their age (sadly my colleagues were right when they guesstimated the average age of my practice). I think the whole gender thing in medicine is silly in the extreme. You need to see a doctor; I'm a doctor 1st and a woman distinctly second. Would you refuse to see a male accountant? A male lawyer? Refuse to learn from a male professor? Then stop playing the silly games and let's get on with it! The sole exception I make is in the case of rape. We have a few nurses trained in rape exam and they come in for them (since it ties up the ERP for a loooong time and we usually only have 2 docs on {and I work 2 single coverage shops, and there are times even at the main hospital when you're on your own} - it's just not fair to the other doc if you disappear for 2+ hours).
That being said, when I'm on I frequently end up seeing all the vag bleeds and vag itches. Oh well, it's a living. Cheers,
M
 

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I know of one male patient who always demands a female doctor and won't let me shadow his visit because I'm male. And, no, it's not about modesty or prurient interest. Nobody's figured him out. Childhood trauma, I guess.
 

GeneralVeers

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Birdstrike,

No one hates "customer service" and demanding patients more than I do. No one hates hospital admin, and their ridiculous "patient satisfaction" goals.

The problem is that these are realities, and likely to get worse as hospitals try to attract an ever-shrinking population of privately insured people.

Although I agree with you, I've decided that having a job and a paycheck is more important than principle, and so I have sold out, and pretend to go through the motions of "customer service" all the while hating every moment of it.
 

Arcan57

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Birdstrike,

No one hates "customer service" and demanding patients more than I do. No one hates hospital admin, and their ridiculous "patient satisfaction" goals.

The problem is that these are realities, and likely to get worse as hospitals try to attract an ever-shrinking population of privately insured people.

Although I agree with you, I've decided that having a job and a paycheck is more important than principle, and so I have sold out, and pretend to go through the motions of "customer service" all the while hating every moment of it.

This.

If you are considering EM or are still in residency, listen to GV because what he says is true. If it gets engrained early enough, there is less cognitive dissonance and less of a sense of betrayal. Just like the not being able to eat on shift during a JC survey or the additional minutes of watching the hourglass icon that seems to accompany every change in electronic ordering/charting, it's part of the job.

It's not particularly fair:
1)If a patient gives you all "good"s on a PG survey, that corresponds to the 1st percentile rank. Any ranking other then "very good" might as well be crap. Which will last until every figures out how to game the system so everyone is getting very goods and your percentile rank will plummet again.

2) The majority of EDs are understaffed (administration keeping fixed costs as low as possible), yet the increased left without being seen % that accompanies severe spikes in daily volume are considered unacceptable. If your ED is staffed to see 150/day and you see 200 but 12 walkout instead of 3, you're threatening the CEO and CFO's bonuses.

It is life in most community EDs though, and like dealing with rude consultants it's another thing we have to have a thick skin about. Also, if you are choosing a job I would ask about PG rankings as it is essentially impossible for a doctor to have a great PG score in the setting of a hospital that doesn't. And it's cheaper on paper to admin to fire the current group then to staff to appropriate levels (just like firing the coach on an underperforming team).
 

la gringa

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the thing that irks me most about PG is that ADMITTED PATIENTS AREN'T SURVEYED FOR THE ED!!!

save an asthmatic from getting tubed? doesn't matter for PG if you didn't see that ankle sprain fast enough.

properly diagnose all of grandma's injuries after a fall? discuss things well w/ the family and caregivers? yeah, that takes a while. but grandma almost always gets admitted. the 4fer with snotty noses WILL get a PG. and they waited a WHOLE HOUR!!

ugh, i'm gonna stop now.
 
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WilcoWorld

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the thing that irks me most about PG is that ADMITTED PATIENTS AREN'T SURVEYED FOR THE ED!!!

save an asthmatic from getting tubed? doesn't matter for PG if you didn't see that ankle sprain fast enough.

properly diagnose all of grandma's injuries after a fall? discuss things well w/ the family and caregivers? yeah, that takes a while. but grandma almost always gets admitted. the 4fer with snotty noses WILL get a PG. and they waited a WHOLE HOUR!!

ugh, i'm gonna stop now.

You let four children with a cold, two of whom felt warm, wait for a whole hour? Inexcusable.
 

la gringa

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i am clearly a heartless b!tch... i also thought mom might own tylenol and/or a thermometer, or at least a bulb suction. wrong again.
 

Arcan57

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i am clearly a heartless b!tch... i also thought mom might own tylenol and/or a thermometer, or at least a bulb suction. wrong again.

I can see the complaint on the call-back now, "The wait was too long and more could have been done. I haven't made an appointment with their PCP yet." The good news is that there is a decent chance they will come back at some point during this illness because their pediatrician gave them an abx script today and they're still not better.
 

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I love the ones who demand a script for Ibuprofen and/or Acetaminophen so that the state Medicaid can pay for it. That way they save money for the 6-pack or cigs.
 

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I love the ones who demand a script for Ibuprofen and/or Acetaminophen so that the state Medicaid can pay for it. That way they save money for the 6-pack or cigs.

Do any of you guys do this? My ex-wife is a PA who works in a private GI practice, and gets these demands all the time. She tells them to go pound salt; give up a pack of your smokes for the week, and go buy your own OTC meds.

I understand, private practice is a completely different animal.....
 

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All kidding aside, I don't think you're obligated to be the pelvic specialist in your ED. If you're available, fine. If you're busy, or can't do it for whatever reason, then you're just plain "not available". The nurses and other docs should respect this. You'll try to help out but you can't guarantee it. It is not the job of, or right, for the nurses in the ED to volunteer you in triage for every female patient that has any pain between the knees and xiphoid process. Just because you are "in the building" does not mean you're "available". You could be running a code, multiple codes, have 60 seconds left in your shift, tired of doing pelvics or have a cramp in your dominant hand. WHATEVER. The doc can tell the patient, "We tried to accommodate your request, but there is no female physician available at this time. I will respect your request that I not perform your pelvic exam." Then he puts in the chart, "Patient refused pelvic for personal reasons. Requested female physician. Not available at this time."

GAME OVER.

You do not get to pick your doctor in the ED. For elective procedures and elective outpatient evaluations, fine, pick a female OB-GYN. If you're dying of some pelvic catastrophe: not so much.

(I know a pelvic is part of the physical exam, but when did it become a life saving treatment? When's the last time you know of a patient dying because they didn't get a pelvic exam?)

Move on. Order an ultrasound, CT, prescribe some antibiotics. Adapt. Whatever. Respectfully document that the patient didn't allow you to do your job as you were trained.

The patient does not have the right to your 24/7/365 iphone GPS tracking coordinates and a real-time "I'm available for Pelvics in 7 minutes" status update on your Twitter, Linkdin, Facebook and that MySpace account you just won't admit you still check from time to time.

Reasonable attempts to accommodate patients are good. Catering to a fast food, super-size it, "I want to pick my doctor, pick different doctors to do different parts of my exam, not pay my bill, be seen within 15 min, be discharged within 15 min, for free, get a sierra mist and a meal tray to go, and by the way, let me give you my real address so you can send the Press Gainey survey to my house (but not the bill)" mentality.

You are not a luxury Cartier watch concierge. (Now cue ED director/administrator to reply with post that says, "Times have changed, Yes you are")

La Gringa, you're right to be irritated, for what my 2 cent opinion is worth.

End of rant.
ED administrator here to say NO YOU ARE NOT! I agree with everything being said here. I truly believe that no one has a justifiable reason to refuse care based on gender - you obviously are not at death's door if you fear a man seeing you undressed. So document it and move on. If that person is crazy enough to file a complaint I am going to defend your right to not be treated like an idiot. I am a woman and for my private gyn needs I prefer to see a woman. Nothing to do with sexism but everything to do with anatomy - a woman has the same plumbing I do and gets it when I talk to her. But if I were having an gyn emergency and walked into an ED then I wouldn't care if Wiley Coyote was assigned to me. If you know what's happening and how to fix it then you have my full cooperation - just get to it!! I am often asked if it's "weird" having had my co-workers see me as a patient ( fainted dead away on the floor one morning) and I laugh every time. They're just breasts and everyone has seen a pair by now!
 

AmoryBlaine

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And to any non-medical women who stumble across this thread, I would like to emphasize the extent to which male physicians get their jollies from doing a pelvic exam.

It's 0.0% Always.

I understand it's the worst thing that is going to happen to you that day, but for us it is beneath the level of conscious thought.
 

TrumpetDoc

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All kidding aside, I don't think you're obligated to be the pelvic specialist in your ED. If you're available, fine. If you're busy, or can't do it for whatever reason, then you're just plain "not available". The nurses and other docs should respect this. You'll try to help out but you can't guarantee it. It is not the job of, or right, for the nurses in the ED to volunteer you in triage for every female patient that has any pain between the knees and xiphoid process. Just because you are "in the building" does not mean you're "available". You could be running a code, multiple codes, have 60 seconds left in your shift, tired of doing pelvics or have a cramp in your dominant hand. WHATEVER. The doc can tell the patient, "We tried to accommodate your request, but there is no female physician available at this time. I will respect your request that I not perform your pelvic exam." Then he puts in the chart, "Patient refused pelvic for personal reasons. Requested female physician. Not available at this time."

GAME OVER.

You do not get to pick your doctor in the ED. For elective procedures and elective outpatient evaluations, fine, pick a female OB-GYN. If you're dying of some pelvic catastrophe: not so much.

(I know a pelvic is part of the physical exam, but when did it become a life saving treatment? When's the last time you know of a patient dying because they didn't get a pelvic exam?)

Move on. Order an ultrasound, CT, prescribe some antibiotics. Adapt. Whatever. Respectfully document that the patient didn't allow you to do your job as you were trained.

The patient does not have the right to your 24/7/365 iphone GPS tracking coordinates and a real-time "I'm available for Pelvics in 7 minutes" status update on your Twitter, Linkdin, Facebook and that MySpace account you just won't admit you still check from time to time.

Reasonable attempts to accommodate patients are good. Catering to a fast food, super-size it, "I want to pick my doctor, pick different doctors to do different parts of my exam, not pay my bill, be seen within 15 min, be discharged within 15 min, for free, get a sierra mist and a meal tray to go, and by the way, let me give you my real address so you can send the Press Gainey survey to my house (but not the bill)" mentality.

You are not a luxury Cartier watch concierge. (Now cue ED director/administrator to reply with post that says, "Times have changed, Yes you are")

La Gringa, you're right to be irritated, for what my 2 cent opinion is worth.

End of rant.

I'm shedding tears of joy reading this reply.
 

la gringa

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I'm shedding tears of joy reading this reply.

as did i.

next shift, the mother of an adult patient asked me for MORE cream and sugar for her coffee.

a police officer watched me do my full exam, then 15 minutes later was demanding to know when THE DOCTOR was going to come see the patient.

today, a patient's friend railed into me about POOR CUSTOMER SERVICE b/c she was giving jobless friend a ride and her babydaddy had to go to work.
 

pinipig523

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as did i.

next shift, the mother of an adult patient asked me for MORE cream and sugar for her coffee.

a police officer watched me do my full exam, then 15 minutes later was demanding to know when THE DOCTOR was going to come see the patient.

today, a patient's friend railed into me about POOR CUSTOMER SERVICE b/c she was giving jobless friend a ride and her babydaddy had to go to work.

Sounds like County.... are you sure you don't work with me anymore?
 

8654Marine

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as did i.

next shift, the mother of an adult patient asked me for MORE cream and sugar for her coffee.

a police officer watched me do my full exam, then 15 minutes later was demanding to know when THE DOCTOR was going to come see the patient.

today, a patient's friend railed into me about POOR CUSTOMER SERVICE b/c she was giving jobless friend a ride and her babydaddy had to go to work.


I hear ya.

I got stopped on the way to Trauma bay by a family member demanding I get a cup of water. This is while they're yelling for the doc in the trauma bay. I say that I'm not the waiter and that someone will be by to help.

Later, the ED director has the nerve to discuss this patient complaint.

All I could think was "Really...?"
 

la gringa

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pinipig -

imagine dealing w/ county type patients about half the time, but being expected to meet community type metrics and patient satisfaction.... actually most of the county type patients are very appreciative, but the few that give trouble make one insane.

actually the 2 main "complaints" i've gotten are from working class people who thought i 1. said too much and 2. didn't say enough about what was going on. i did nothing WRONG... in fact did far more than i HAD TO.

you can't win.
 

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Love reading this thread. I'm made to feel guilty every time a nurse or another doc asks me to see X pt with pelvic complaints even though I'm not up next for pts. And I understand some of the responses about "customer service". But gynecology is not why I went into EM. I dread the pelvic exams just as much as the male docs. I want the sick pts too. So even if I am "available" is it fair that I have to see all the non-sick vag bleed/itch/pain'ers. Glad to see I'm not the only one who feels this way :)
 

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Birdstrike,

No one hates "customer service" and demanding patients more than I do. No one hates hospital admin, and their ridiculous "patient satisfaction" goals.

The problem is that these are realities, and likely to get worse as hospitals try to attract an ever-shrinking population of privately insured people.

Although I agree with you, I've decided that having a job and a paycheck is more important than principle, and so I have sold out, and pretend to go through the motions of "customer service" all the while hating every moment of it.

GV, while you are right that the current trend is for payment to be linked closer and closer to customer (PG) scores, this may not be a zero sum game. It cracks me up whenever an hospital administrator (or anyone else in medicine for that matter) says "this is just the way it is going to be from now on". Seems like we hear this in medicine about some major issue every ten years or so only to be proven spectacularly wrong a few years later...
Customer service is part of medicine in some way shape or form (you can't treat patients like dirt) but there are rumblings on how far this roller coaster can be taken.

Check out Fenton et al. Annals of internal medicine, February 13, 2012.
Summary conclusion is;
"In a nationally representative sample (N=51946), 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."

Can't wait for some shark to realize their is potential for a class action with worsened clinical outcomes linked to PG and those that tie billing to customer service. "You mean to tell me treatments were guided by monetary incentive instead of actual outcomes"..... While lawyers are more that happy to sue the average MD, they know the real money is in the upper echelon administration/corporations themselves. Blood is in the water and sooner or later the sharks will smell it.

The study was a correlation study only (controlled for age and major comorbidities), but it isn't a stretch for most physicians to see how these outcomes are related (ever had a parent push you for antibiotics they probably didn't need only to come back with a rash the next day?) Additionally the Annals of Internal Medicine isn't a throwaway journal (It has a higher impact score than Annals of EM) and articles like these are popping up more and more in the literature.

The business model fails in medicine. Sometimes what the customer wants is precisely part of the disease. Hold out GV. You may not have to sell yourself out forever. The suits will ride this sinking ship to the bottom before they will pony up the expenses for another paradigm shift and "that is just the way it is going to be in medicine from now on folks...."
 
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