Patient Complaints

[docB]

Because of the ridiculous import given to "patient experience" (the current buzzphrase to avoid calling it customer satisfaction) our group treats every complaint as a real issue. This has resulted in some truly absurd issues being communicated to the physicians as though they are real, actionable or rational.

To kick things off here's one I got the other day. My group has people in the office call some discharged patients from each doc to look for dirt.
Patient callback - child in ED, spoke to mom "I don't know how he's feeling. CPS took him away." Mom rates experience as negative.
Of note CPS wasn't involved due to anything that happened in the ED. But mom rated her "experience" as negative so I took the hit. Not sure if the caller explained that they were asking about the experience in the ED not with CPS but oh well.

This wasn't mine. From one of my colleagues:
"I was only there for a little while. It felt like an in and out experience." We are taught that patients want be be in and out super fast but some want to stay and chill. The "coaching" on this one was that we should "discuss with the patient their perception of what would be an appropriate time to spend in the ER for their particular problem," i.e. we're now supposed to ask them how long they want to hang out.

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[RustedFox]

Because of the ridiculous import given to "patient experience" (the current buzzphrase to avoid calling it customer satisfaction) our group treats every complaint as a real issue. This has resulted in some truly absurd issues being communicated to the physicians as though they are real, actionable or rational.

To kick things off here's one I got the other day. My group has people in the office call some discharged patients from each doc to look for dirt.
Patient callback - child in ED, spoke to mom "I don't know how he's feeling. CPS took him away." Mom rates experience as negative.
Of note CPS wasn't involved due to anything that happened in the ED. But mom rated her "experience" as negative so I took the hit. Not sure if the caller explained that they were asking about the experience in the ED not with CPS but oh well.

This wasn't mine. From one of my colleagues:
"I was only there for a little while. It felt like an in and out experience." We are taught that patients want be be in and out super fast but some want to stay and chill. The "coaching" on this one was that we should "discuss with the patient their perception of what would be an appropriate time to spend in the ER for their particular problem," i.e. we're now supposed to ask them how long they want to hang out.

Ahem.

The number one source of burnout is....

 

[dadaddadaBATMAN]

Because of the ridiculous import given to "patient experience" (the current buzzphrase to avoid calling it customer satisfaction) our group treats every complaint as a real issue. This has resulted in some truly absurd issues being communicated to the physicians as though they are real, actionable or rational.

To kick things off here's one I got the other day. My group has people in the office call some discharged patients from each doc to look for dirt.
Patient callback - child in ED, spoke to mom "I don't know how he's feeling. CPS took him away." Mom rates experience as negative.
Of note CPS wasn't involved due to anything that happened in the ED. But mom rated her "experience" as negative so I took the hit. Not sure if the caller explained that they were asking about the experience in the ED not with CPS but oh well.

This wasn't mine. From one of my colleagues:
"I was only there for a little while. It felt like an in and out experience." We are taught that patients want be be in and out super fast but some want to stay and chill. The "coaching" on this one was that we should "discuss with the patient their perception of what would be an appropriate time to spend in the ER for their particular problem," i.e. we're now supposed to ask them how long they want to hang out.

For your colleague, create a time dilation, place patient in it, and then utilize it to decrease your door to doc time that they are measuring simultaneously to you delaying patient care unnecessarily for their nebulous satisfaction metric obtained by a non-clinical jackass with a bachelors in hospital administration.

There. Problem solved. Why are you being such an obstructionist?

 

[Dr Mantis Toboggan]

Yeah, this is why this job needs to pay a lot. Right there.

Because of the ridiculous import given to "patient experience" (the current buzzphrase to avoid calling it customer satisfaction) our group treats every complaint as a real issue. This has resulted in some truly absurd issues being communicated to the physicians as though they are real, actionable or rational.

To kick things off here's one I got the other day. My group has people in the office call some discharged patients from each doc to look for dirt.
Patient callback - child in ED, spoke to mom "I don't know how he's feeling. CPS took him away." Mom rates experience as negative.
Of note CPS wasn't involved due to anything that happened in the ED. But mom rated her "experience" as negative so I took the hit. Not sure if the caller explained that they were asking about the experience in the ED not with CPS but oh well.

This wasn't mine. From one of my colleagues:
"I was only there for a little while. It felt like an in and out experience." We are taught that patients want be be in and out super fast but some want to stay and chill. The "coaching" on this one was that we should "discuss with the patient their perception of what would be an appropriate time to spend in the ER for their particular problem," i.e. we're now supposed to ask them how long they want to hang out.

 

[RustedFox]

Awhile ago, I posted on here that I had gone "Full Veers" and no longer cared about any of this nonsense.

I failed hard at that.

Veers, your indifference and ability to not GAF is saintly.

General Veers, the Patron Saint of the ER.

 

[alpinism]

For your colleague, create a time dilation, place patient in it, and then utilize it to decrease your door to doc time that they are measuring simultaneously to you delaying patient care unnecessarily for their nebulous satisfaction metric obtained by a non-clinical jackass with a bachelors in hospital administration.

There. Problem solved. Why are you being such an obstructionist?

What if he created a time machine out of a DeLorean?

Send them back to the future!

 

[RustedFox]

This wasn't mine. From one of my colleagues:
"I was only there for a little while. It felt like an in and out experience." We are taught that patients want be be in and out super fast but some want to stay and chill. The "coaching" on this one was that we should "discuss with the patient their perception of what would be an appropriate time to spend in the ER for their particular problem," i.e. we're now supposed to ask them how long they want to hang out.

I have had this same complaint levied against me.

Oh, you want to STAY here LONGER and have nothing done for you?

I draw a hard line at this.
I'm not engaging the patient or their family in a discussion about "how long they feel they need to be here".

No.

Patients in general have no idea about what is or is not "good" or "bad" for them.

This is reason #459 why I hate them.

Part of the solution?

Health class.

I remember my "health" classes from 7th thru 10th grades.

There was a fat woman who sat at a desk, reading a paperback novel.

She passed out worksheets and textbooks and said: "You need to finish this worksheet by the end of class. All the answers are in the textbook."

And she went on, reading her paperback.

That was seriously my health class for 6 years.

Maybe if we had actual "Health Class" in middle/high school, teaching things like:

"You can't eat fast food every day."

"Being overweight is not a good thing for your overall health."

"A sedentary lifestyle increases your overall chances of death."

... among other UNPLEASANT truths ...

then, we might make a dent in the big, bad problem.

But, you can't let the snowflakes know the truth. They don't like it, and it hurts their feelings.

 

[southerndoc]

I'm sure some of the homeless intoxicated patients would say their ideal time to stay in the ER is infinity...

 

[deleted109597]

I see this as a win. Next time they ever talk about your LOS, you simply point this out. Say you're improving the patient experience, and if they want them out faster they can address it.
I do love how admin makes us the bad guy, no matter what. Gotta tell the patient anything bad? Have the doc do it. Gotta be the bad cop? Have the doc do it.
Give the nurses awards though. They're the real heroes.

 

[bravotwozero]

This is why I sometimes fantasize about checking my retirement savings one day, and having $2.5 mil in it. Then, I barge right into a c suite meeting unannounced, tell them they can shove their patient complaints up their a$$es, give the double 1 fingered salute, and barge right out.

....in the background you hear ‘school’s out for the summer’...


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[MechEDoc]

I do love how admin makes us the bad guy, no matter what. Gotta tell the patient anything bad? Have the doc do it. Gotta be the bad cop? Have the doc do it.

And this is why I hate hospitals. The crap only flows one way and that is downhill.

 

[ShockIndex]

“The customer is always right” economic construct is only valid when the customer has sufficient financial stake in the game to seek out the highest value (quality vs. cost). Attempting to apply this construct to the recipient class of emergency department utilizers is a lesson in futility.

I liked my last EM Department Chair. He is a good guy who genuinely cares about his peeps. However, 3 years ago he put into place operational mechanisms to improve efficiencies to address crowding and seemed to give us a mandate - move the meat as quickly as possible and push-back against non-indicated testing or admissions if needed. Unfortunately, this was not coupled with assurances that he had our backs, or that mechanisms were in place to account for unmet expectations. Within 2 years a third of our department was on a patient relations performance improvement plan.

In retrospect, feeling let down or hung out to dry was probably a little immature on my part. However, our department could have taken more steps to head-off some of these complaints. First, leadership should have insisted that patient relations get off their asses in their back room offices, come down to the ED, and interact with some of our patients in a positive way instead of being phone operators who just record grievances. The Cleveland Clinic did this with patient advocates walking around to rooms, handing out blankets, getting patients coffee, and addressing expectations. It worked get. Second, having a high-acuity ED without performing follow-up calls (by a nurse or tech) the next day is a missed opportunity on many levels. First and foremost, it a powerful risk mitigation tool for patients who are deteriorating. In addition, it provides a buffer and opportunity for patients to vent about unmet expectations without filing an official grievance with the hospital.

These are really simple interventions that are relatively low-cost and may pay for themselves. However, be very careful if your leadership tells you to move the meat without describing the assurances on how they plan to mitigate the inevitable unmet expectations. That is effectively an unfunded mandate.

 

[Groove]

Just detach. Obviously PG scores or customer complaints are a big issue to your current hospital admin which means his or her bonus is riding on it. As long as you aren't an outlier in your group, then I wouldn't worry too much about it. I got a few complaints years back and I used it to work on my bedside manner, which was already very good, but I started doing a better job circling back and sitting down with patients both when I enter the room and when they leave. I introduce myself to friends and family upon entering and shake hands. I touch the pt when I can and I make a point to sit down whenever I can, even if it's just for 1-2 minutes. The pt perceives that you are in the room for a much longer period of time. Anyway, it slows me down just a tad but I actually get more satisfaction out of the encounter. I get a lot more "thank you's" and compliments from families, etc.. Like it or hate it, customer service is part of what we do. It's not going away and we'll never be in a situation where our performance is based solely on our medical management.

The key to job security in the ED is in identifying very early on what metrics or CS components are important to hospital admin and making a conscious effort to focus on them, as silly as they may be. I've found railing against the system or complaining up the chain are largely ineffective and singles you out as a "troublemaker". Your only other option is to look for another gig that doesn't place value on CS quite as much, but that just means they might focus more on other, equally irksome quality metrics.

I feel you though. Customer service...tis the bane of our existence.

 

[docB]

"The doctor gave me a medicine I was allergic to." Chart review reveals patient demanded Dilaudid, was given Dilaudid, had itching, demanded Benadryl, was given Benadryl. Doctor counseled to be vigilant about asking patient about allergies.

"The doctor didn't care about me. He didn't give me the medicine I needed. He didn't explain why my blood pressure is high. He didn't do an MRI to see why my legs swell and his tone was insulting." Dr. Woman responded that the patient's story didn't exactly add up. Dr. Woman counseled to hand out more business cards to ensure the patient knows who their doctor is.

Seriously for a moment, it's frequently pointed out to me that my griping should be given any wight because "This is EM. This is what you signed up for." Well this isn't. When I was in residency we were taught to "counsel patients about appropriate use of the ER." No one thought this is where we would be. I came from EMS where the motto was "I'm here to save your ass, not kiss it." So, yeah, this has been a bitter pill to swallow.

I make a point to sit down whenever I can, even if it's just for 1-2 minutes. The pt perceives that you are in the room for a much longer period of time.

I hear what you're saying. Sitting is a useful technique in some situations. Unfortunately this is now being forced upon us. We are now obligated to "Commit to sit!" with every patient. They're sending spies in to ensure compliance. I just can't. The best I can do is commit to take a knee. I figure that is an even more subservient position so the patients and admins should love it. And truthfully they've wanted us on our knees for years.

 

[deleted1013752]

And this is why I hate hospitals. The crap only flows one way and that is downhill.

But why though? I ask this genuinely. Physicians are uber-educated, very intelligent, well-compensated, and highly mobile. That seems like exactly the class of employee that gets to just say no. I work on the administrative side and I really don't understand why physicians tend to be so acquiescent while other groups are so tenacious.

 

[bky3c]

I always tried to sit in patients' rooms, but most of the time, there was nothing to sit on. The stool and chairs were occupied by the patient's belongings, a visitor, or a vistor's feet. It always felt like requesting the moving of feet or belongings would result in hard feelings, so I usually sat on the trash can lid, but even that was often occupied. In cases where there was nowhere to sit at all, I'd stand to talk with the patient, and then as I started my exam, inexplicably, whoever was occupying the stool would THEN offer it to me. As if I'm going to wheel all around the patient on the stool to do the exam. Maybe that's what they do on tv?

 

[TooMuchResearch]

They want us to sit. They don't put stools for us in all the rooms.

They want us to have meaningful, uninterrupted interactions with patient and family. They make sure our phone rings or we get an overhead page every 4 minutes.

"The doctor gave me a medicine I was allergic to." Chart review reveals patient demanded Dilaudid, was given Dilaudid, had itching, demanded Benadryl, was given Benadryl. Doctor counseled to be vigilant about asking patient about allergies.

"The doctor didn't care about me. He didn't give me the medicine I needed. He didn't explain why my blood pressure is high. He didn't do an MRI to see why my legs swell and his tone was insulting." Dr. Woman responded that the patient's story didn't exactly add up. Dr. Woman counseled to hand out more business cards to ensure the patient knows who their doctor is.

Seriously for a moment, it's frequently pointed out to me that my griping should be given any wight because "This is EM. This is what you signed up for." Well this isn't. When I was in residency we were taught to "counsel patients about appropriate use of the ER." No one thought this is where we would be. I came from EMS where the motto was "I'm here to save your ass, not kiss it." So, yeah, this has been a bitter pill to swallow.


I hear what you're saying. Sitting is a useful technique in some situations. Unfortunately this is now being forced upon us. We are now obligated to "Commit to sit!" with every patient. They're sending spies in to ensure compliance. I just can't. The best I can do is commit to take a knee. I figure that is an even more subservient position so the patients and admins should love it. And truthfully they've wanted us on our knees for years.

 

[TooMuchResearch]

I find the patient has often placed their urinal on my stool. I don't like to sit on it after that.

No, I won't edit any of that. I said what I meant, and I meant what I said.

I always tried to sit in patients' rooms, but most of the time, there was nothing to sit on. The stool and chairs were occupied by the patient's belongings, a visitor, or a vistor's feet. It always felt like requesting the moving of feet or belongings would result in hard feelings, so I usually sat on the trash can lid, but even that was often occupied. In cases where there was nowhere to sit at all, I'd stand to talk with the patient, and then as I started my exam, inexplicably, whoever was occupying the stool would THEN offer it to me. As if I'm going to wheel all around the patient on the stool to do the exam. Maybe that's what they do on tv?

 

[TooMuchResearch]

Are we highly mobile? I lucked out with my job, and now we (family) are firmly planted. If the job goes bad, I'll be in a tight spot.

But why though? I ask this genuinely. Physicians are uber-educated, very intelligent, well-compensated, and highly mobile. That seems like exactly the class of employee that gets to just say no. I work on the administrative side and I really don't understand why physicians tend to be so acquiescent while other groups are so tenacious.

 

[Interpolfanclub]

But why though? I ask this genuinely. Physicians are uber-educated, very intelligent, well-compensated, and highly mobile. That seems like exactly the class of employee that gets to just say no. I work on the administrative side and I really don't understand why physicians tend to be so acquiescent while other groups are so tenacious.

You have to choose your battles. I'm an EM doc, I need an ED in which to work.

FWIW, I have been a medical director for 4 years now now and answer EVERY complaint we get. EVERY SINGLE ONE. I call people back, fill out a grievance response form etc etc. It's a lot of fun. You learn a lot but it wears you out. I find that I get almost no complaints about me directly. I've just learned what pisses people off. But sometimes it's unavoidable when they have unreasonable expectations.

 

[deleted1013752]

Are we highly mobile? I lucked out with my job, and now we (family) are firmly planted. If the job goes bad, I'll be in a tight spot.

When I say highly mobile, I mean that as applied to the group. A person has individual ties to an area, kids in school, a mortgage, a bunch of immobile stuff... but physicians in general have intellect, money, and education. These things make it easier to get a different job, relocate, start a business, write a book, whatever. If you're making $13/hr and have a GED as a med tech, you're not as empowered to advocate for yourself as physicians are.

 

[deleted1013752]

You have to choose your battles. I'm an EM doc, I need an ED in which to work.

No doubt, but that only helps explain why employees in general don't buck the administration. It doesn't explain physicians. It seems physicians have been on the receiving end of BS from payers, admin requirements, PG emphasis, APP infiltration, etc. At least it's certainly easy to get that impression from this forum and 1:1 conversations. Seems like patients everyone in the industry has a lot to say about how medicine should work except physicians.

 

[Piebaldi]

Because of the ridiculous import given to "patient experience" (the current buzzphrase to avoid calling it customer satisfaction) our group treats every complaint as a real issue. This has resulted in some truly absurd issues being communicated to the physicians as though they are real, actionable or rational.

To kick things off here's one I got the other day. My group has people in the office call some discharged patients from each doc to look for dirt.
Patient callback - child in ED, spoke to mom "I don't know how he's feeling. CPS took him away." Mom rates experience as negative.
Of note CPS wasn't involved due to anything that happened in the ED. But mom rated her "experience" as negative so I took the hit. Not sure if the caller explained that they were asking about the experience in the ED not with CPS but oh well.

This wasn't mine. From one of my colleagues:
"I was only there for a little while. It felt like an in and out experience." We are taught that patients want be be in and out super fast but some want to stay and chill. The "coaching" on this one was that we should "discuss with the patient their perception of what would be an appropriate time to spend in the ER for their particular problem," i.e. we're now supposed to ask them how long they want to hang out.

This is becoming ridiculous. We have the expectations of customer service as if we were a business, but as physicians we can't have the requirements, expectations (ie - we actually expect to get paid?), respect, or protection as other businesses.

If things don't change, no one is going to be willing to go into medicine and reason why many docs are going into admin, cosmetics, and out of medicine altogether.

We have MBAs, businesses people who have no idea what they are talking about - and we are stupid enough to let them. We need physicians as CEOs, admins ultimately who KNOW something about being a physician. We have Dr Google patients tell us what to do, MBAs who tell us what to do, the government etc

Where does it stop?

 

[TheSingularity]

I much prefer the nod, agree verbally, then continue to do whatever I want

Just detach. Obviously PG scores or customer complaints are a big issue to your current hospital admin which means his or her bonus is riding on it. As long as you aren't an outlier in your group, then I wouldn't worry too much about it. I got a few complaints years back and I used it to work on my bedside manner, which was already very good, but I started doing a better job circling back and sitting down with patients both when I enter the room and when they leave. I introduce myself to friends and family upon entering and shake hands. I touch the pt when I can and I make a point to sit down whenever I can, even if it's just for 1-2 minutes. The pt perceives that you are in the room for a much longer period of time. Anyway, it slows me down just a tad but I actually get more satisfaction out of the encounter. I get a lot more "thank you's" and compliments from families, etc.. Like it or hate it, customer service is part of what we do. It's not going away and we'll never be in a situation where our performance is based solely on our medical management.

The key to job security in the ED is in identifying very early on what metrics or CS components are important to hospital admin and making a conscious effort to focus on them, as silly as they may be. I've found railing against the system or complaining up the chain are largely ineffective and singles you out as a "troublemaker". Your only other option is to look for another gig that doesn't place value on CS quite as much, but that just means they might focus more on other, equally irksome quality metrics.

I feel you though. Customer service...tis the bane of our existence.

Sent from my Pixel 3 using SDN mobile

 

[killerleaf]

I much prefer the nod, agree verbally, then continue to do whatever I want

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I call that the penguin "smile and wave boys, smile and wave"

 

[EctopicFetus]

Thank god this isnt my reality. Holy jesus. We have one of our docs answer the complaints. Sometimes he passes them along. Some are legit, most arent. i couldnt even imagine being told this bs about LOS etc.

Perhaps it is time to push back on patients should be in a gown within 5 mins of being the room. What i find is if you give administrators stuff to focus on they wont focus on you. They know they get a lot of pay and have to justify it. My solution is to scut them out. I recommend this to all you guys. When they give you bs stuff find some nursing or non doc thing for them to improve.

 

[erdoc00]

I see this as a win. Next time they ever talk about your LOS, you simply point this out. Say you're improving the patient experience, and if they want them out faster they can address it.
I do love how admin makes us the bad guy, no matter what. Gotta tell the patient anything bad? Have the doc do it. Gotta be the bad cop? Have the doc do it.
Give the nurses awards though. They're the real heroes.

Do doctors not realize that this is the point? The game is intentionally unwinnable so that they always have an excuse to penalize the doctors. There is no legitimacy to any of these metrics.

I find it amazing that so many otherwise intelligent people allow themselves to be exploited like this. Every single doctor that participates in a system like this is a chump. I can only hope they at least make you feel pretty while they're screwing you.

 

[erdoc00]

Are we highly mobile? I lucked out with my job, and now we (family) are firmly planted. If the job goes bad, I'll be in a tight spot.

You could get a job anywhere in the country and get on a plane once or twice a month for a week away at a time.

Or you could stay "firmly planted" in a toxic work environment and be a miserable wage slave exploited by a corporation.

VC groups are happy to make money off of your misery and they thrive on the fact that you're too complacent to do anything about it.

 

[GeneralVeers]

I wish I had some anecdotes to share, but I stopped reading any of my survey results or the comments about 8 years ago. The PG survey where the patient stated "It was very cold in the ER!" then rated me a 1, finished me on forever reading it, especially when EMP (now USACS) refused to drop that one from my average.

Now I just don't care. I ignore the appeals from admit to hand out business cards, sit, tell them "We are going to take VERY GOOD care of you" and all of the other nonsense. I just smile and nod when they suggest this, and continue doing things my own way. Want to send a secret shopper? GREAT! you caught me red-handed.

Honestly, don't worry about any of this crap. We have a quarterly bonus tied to PG scores, and I don't pay attention to it at all. Some quarters I get a bonus, others I get nothing. For longevity in this field one has to filter out the unimportant static and not get worked up about the admin nonsense.

I have the shortest length of stay to discharge of anyone (average 75 min). I'd love for a hospital admin to tell me that I need to keep my patients in the waiting room longer just to hang out. Did I mention we are full with holds most of the time?

 

[GeneralVeers]

Another thing, find out if your group has diagnoses that disqualify from getting a survey. On our list:

1. Malingering
2. Drug-seeking behavior
3. Suicidal ideation
4. Acute stress disorder

I love using #4 as a diagnosis on all difficult patients. It's relatively benign-sounding, and of course anyone presenting to the ED is under stress! Whenever I anticipate an unhappy patient I add that diagnosis.

 

[TooMuchResearch]

That would be worse.

You could get a job anywhere in the country and get on a plane once or twice a month for a week away at a time.

Or you could stay "firmly planted" in a toxic work environment and be a miserable wage slave exploited by a corporation.

VC groups are happy to make money off of your misery and they thrive on the fact that you're too complacent to do anything about it.

 

[bravotwozero]

Another thing, find out if your group has diagnoses that disqualify from getting a survey. On our list:

1. Malingering
2. Drug-seeking behavior
3. Suicidal ideation
4. Acute stress disorder

I love using #4 as a diagnosis on all difficult patients. It's relatively benign-sounding, and of course anyone presenting to the ED is under stress! Whenever I anticipate an unhappy patient I add that diagnosis.

I do the same, psych diagnoses excluded from surveys at my shop


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[Groove]

I don't mind the occasional butt smooching for half a mill/yr. It's not worth going out of your way to piss off employer admin and/or hospital admin on a consistent basis. Sooner or later people will begin to plot getting rid of you. You just end up shooting yourself in the foot on a quest for unrealistic idealism and as physicians we notoriously overvalue our importance to the hospital. We are all very, very replaceable. Customer service in the business world is replete with bending over backwards to please irrational, angry clients and customers. Why should medicine be any different? I just keep my eye on the prize...complete financial freedom and optional early retirement.

 

[Groove]

Also, we aren't the only ones dealing with this kind of stuff. I've heard some PCP office stories that would make for equally entertaining reality t.v. when compared to some of our encounters in the ER. Those pt's can get equally nasty in escalating their complaints.

 

[Cath Up]

You have to choose your battles. I'm an EM doc, I need an ED in which to work.

FWIW, I have been a medical director for 4 years now now and answer EVERY complaint we get. EVERY SINGLE ONE. I call people back, fill out a grievance response form etc etc. It's a lot of fun. You learn a lot but it wears you out. I find that I get almost no complaints about me directly. I've just learned what pisses people off. But sometimes it's unavoidable when they have unreasonable expectations.

I miss Carlos D 🙁

 

[bravotwozero]

Customer service in the business world is replete with bending over backwards to please irrational, angry clients and customers. Why should medicine be any different?

I agree with pretty much everything you said in your post except this. The word 'Customer' implies someone who pays for their goods and services. Many of our patients pay nothing and we are legally obligated to see them, because of EMTALA. That's why Medicine SHOULD be different - beggars don't get to be choosers. Although I will concede that my point is moot because things are the way they are. That does not mean that we should all drink the kool aide and accept it as right.

Anywhere else in the business world, if you don't pay, you get told to get lost, instead of someone putting up with your stupid @$$ complaint. Don't believe me? Try pulling this crap at kroger and see what happens.. On the flip side, you think salvation army and goodwill take 'customer satisfaction surveys' from people who take their free donations?

 

[bravotwozero]

Also, we aren't the only ones dealing with this kind of stuff. I've heard some PCP office stories that would make for equally entertaining reality t.v. when compared to some of our encounters in the ER. Those pt's can get equally nasty in escalating their complaints.

Yeah but those patients can frequently end up getting fired from the PCPs practice if they cause enough problems, unlike the ED. Then, instead of going to their PCP, guess where they end up?

'I had to come here for my pain because my primary care doctor didn't want to see me anymore....can I get dilaudid and a warm blanket?'

 

[hundreddaysoff]

No doubt, but that only helps explain why employees in general don't buck the administration. It doesn't explain physicians. It seems physicians have been on the receiving end of BS from payers, admin requirements, PG emphasis, APP infiltration, etc. At least it's certainly easy to get that impression from this forum and 1:1 conversations. Seems like patients everyone in the industry has a lot to say about how medicine should work except physicians.

To elaborate on Groove's excellent answers: I for one put up with this BS because I make so much money.

My goal is not to reform the medical system or "feel empowered" or any of that.

My goal is to save ~$2M while helping my patients as much as possible, or at least not harming them. Financially as well as health-wise.

When I have saved ~$2M, I may not feel empowered, but I will truly be empowered more than I am today, as I will have the option to stop receiving any of this BS.

This logic confuses pretty much everyone who can't think of anything better to do with themselves than work for someone else all day. Eg, my charge nurses routinely watch me eat gratuitous poop sandwiches and they say: "Why do you put up with this?" "You don't deserve to be treated like that!" Etc.

What they don't understand is that my ego is not bound to my doctor/work persona. That persona is not who I am; it is just a conduit. So none of that matters to me. If my ego is bound to anything, it's my goal of never needing to work for anyone else ever again in order to feed my family.

If I made less money such that financial independence was not realistic, then hell yes, I'd either be trying to reform the system or trying to escape to a more lucrative or saner profession. This is, in fact, how I arrived at medicine as a second career; my first career had me swallowing all kinds of (very different) poop sandwiches, but financial independence would have been very hard to get.

 

[GeneralVeers]

To elaborate on Groove's excellent answers: I for one put up with this BS because I make so much money.

My goal is not to reform the medical system or "feel empowered" or any of that.

My goal is to save ~$2M while helping my patients as much as possible, or at least not harming them. Financially as well as health-wise.

When I have saved ~$2M, I may not feel empowered, but I will truly be empowered more than I am today, as I will have the option to stop receiving any of this BS.

So much this! I'm not trying to change the system. Let me get through my shifts with the least amount of work, and least amount of pain.

At this point I've paid off my house, and have net ~ 2.5. I've spent relatively lavishly, but thoroughly enjoyed all my international travel. If I'd been more frugal and lived like a resident I would easily have ~ 3.5 to 4.0 right now.

I don't really feel empowered at all, but I don't have the shear terror of being fired that I used to have. I figure I just need another 1 mill in savings then I can get out of the specialty. Plan is 5 years.

 

[bravotwozero]

So much this! I'm not trying to change the system. Let me get through my shifts with the least amount of work, and least amount of pain.

At this point I've paid off my house, and have net ~ 2.5. I've spent relatively lavishly, but thoroughly enjoyed all my international travel. If I'd been more frugal and lived like a resident I would easily have ~ 3.5 to 4.0 right now.

I don't really feel empowered at all, but I don't have the shear terror of being fired that I used to have. I figure I just need another 1 mill in savings then I can get out of the specialty. Plan is 5 years.

Out of curiosity, how much of your take home pay are you saving/investing? Half?


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[RustedFox]

So much this! I'm not trying to change the system. Let me get through my shifts with the least amount of work, and least amount of pain.

At this point I've paid off my house, and have net ~ 2.5. I've spent relatively lavishly, but thoroughly enjoyed all my international travel. If I'd been more frugal and lived like a resident I would easily have ~ 3.5 to 4.0 right now.

I don't really feel empowered at all, but I don't have the shear terror of being fired that I used to have. I figure I just need another 1 mill in savings then I can get out of the specialty. Plan is 5 years.

I tried so hard to be like you.
Epic fail.

 

[GeneralVeers]

Out of curiosity, how much of your take home pay are you saving/investing? Half?


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Right now about 10k per month after living expenses, student loans and 401K. I will say that I don't have children and don't care if there is one dime left over when I die.

Last few years it almost all went into a huge house that I just sold at a modest profit.

 

[PikminOC]

“The customer is always right” economic construct is only valid when the customer has sufficient financial stake in the game to seek out the highest value (quality vs. cost). Attempting to apply this construct to the recipient class of emergency department utilizers is a lesson in futility.

I liked my last EM Department Chair. He is a good guy who genuinely cares about his peeps. However, 3 years ago he put into place operational mechanisms to improve efficiencies to address crowding and seemed to give us a mandate - move the meat as quickly as possible and push-back against non-indicated testing or admissions if needed. Unfortunately, this was not coupled with assurances that he had our backs, or that mechanisms were in place to account for unmet expectations. Within 2 years a third of our department was on a patient relations performance improvement plan.

In retrospect, feeling let down or hung out to dry was probably a little immature on my part. However, our department could have taken more steps to head-off some of these complaints. First, leadership should have insisted that patient relations get off their asses in their back room offices, come down to the ED, and interact with some of our patients in a positive way instead of being phone operators who just record grievances. The Cleveland Clinic did this with patient advocates walking around to rooms, handing out blankets, getting patients coffee, and addressing expectations. It worked get. Second, having a high-acuity ED without performing follow-up calls (by a nurse or tech) the next day is a missed opportunity on many levels. First and foremost, it a powerful risk mitigation tool for patients who are deteriorating. In addition, it provides a buffer and opportunity for patients to vent about unmet expectations without filing an official grievance with the hospital.

These are really simple interventions that are relatively low-cost and may pay for themselves. However, be very careful if your leadership tells you to move the meat without describing the assurances on how they plan to mitigate the inevitable unmet expectations. That is effectively an unfunded mandate.

The customer is not always right as the education is not the same. The level of responsibility is not the same.

 

[docB]

The customer is not always right as the education is not the same. The level of responsibility is not the same.

You are, of course, totally correct. The problem is that being right does not equate to setting policy.

The idea of making patient's experiences in the ED "outstanding" across the board is demonstrably bad policy regarding the finite resource of emergency services. EMTALA has for the most part eliminated any supply and demand forces in this sector. We are already more convenient that primary care. Don't bother making an appointment. Just call 911 and be shuttled to your walk in visit in an air conditioned taxi that can run though red lights. Go to the ER where the staff are flogged to have you seen moments after your arrival. Want something and the doctor won't give it to you? Threaten to drop a negative Yelp and watch them bend over backward for you. So why would anyone ever go to a PMD?

My point, minus the rant, is that EMTALA forces us to allow the patients to self triage to or away from the ED. They are bad at this. Customer satisfaction makes this poor triage even worse. It wastes the resource.

 

[RustedFox]

You are, of course, totally correct. The problem is that being right does not equate to setting policy.

The idea of making patient's experiences in the ED "outstanding" across the board is demonstrably bad policy regarding the finite resource of emergency services. EMTALA has for the most part eliminated any supply and demand forces in this sector. We are already more convenient that primary care. Don't bother making an appointment. Just call 911 and be shuttled to your walk in visit in an air conditioned taxi that can run though red lights. Go to the ER where the staff are flogged to have you seen moments after your arrival. Want something and the doctor won't give it to you? Threaten to drop a negative Yelp and watch them bend over backward for you. So why would anyone ever go to a PMD?

My point, minus the rant, is that EMTALA forces us to allow the patients to self triage to or away from the ED. They are bad at this. Customer satisfaction makes this poor triage even worse. It wastes the resource.

I really wish I'd have written this.
Bravo.

 

[GeneralVeers]

You are, of course, totally correct. The problem is that being right does not equate to setting policy.

The idea of making patient's experiences in the ED "outstanding" across the board is demonstrably bad policy regarding the finite resource of emergency services. EMTALA has for the most part eliminated any supply and demand forces in this sector. We are already more convenient that primary care. Don't bother making an appointment. Just call 911 and be shuttled to your walk in visit in an air conditioned taxi that can run though red lights. Go to the ER where the staff are flogged to have you seen moments after your arrival. Want something and the doctor won't give it to you? Threaten to drop a negative Yelp and watch them bend over backward for you. So why would anyone ever go to a PMD?

My point, minus the rant, is that EMTALA forces us to allow the patients to self triage to or away from the ED. They are bad at this. Customer satisfaction makes this poor triage even worse. It wastes the resource.

And there are plans to remove the only demand restraints in existence: co-pays and deductibles. So now we will have an EM world with EMTALA, no co-pays for anyone, and no deductibles, combined with decreased physician pay, unchanged liability and leaner hospital environment.

It's going to be great!

 

[Dr Mantis Toboggan]

Yup the nightmare scenario for us (and progressives please note I am selfishly limiting these comments to how it would impact us) would be UHC. Pay down, taxes up, and more patients to see with pressure to do fewer work ups while of course having zero misses and no meaningful tort reform.

 

[GeneralVeers]

Yup the nightmare scenario for us (and progressives please note I am selfishly limiting these comments to how it would impact us) would be UHC. Pay down, taxes up, and more patients to see with pressure to do fewer work ups while of course having zero misses and no meaningful tort reform.

I can't imagine 400 million hypochondriac Americans with no disincentive to call the ambulance any time they need it, and get free unlimited care. It's insane!

I doubt patient satisfaction and complaints will change. Hospitals will have to streamline and will be competing for volume due to the lower payments. They will likely double down on "patient experience" pressure in order to generate as many visits as possible. This will be done with fewer nurses, techs, and other resources.

 

[VA Hopeful Dr]

I can't imagine 400 million hypochondriac Americans with no disincentive to call the ambulance any time they need it, and get free unlimited care. It's insane!

I doubt patient satisfaction and complaints will change. Hospitals will have to streamline and will be competing for volume due to the lower payments. They will likely double down on "patient experience" pressure in order to generate as many visits as possible. This will be done with fewer nurses, techs, and other resources.

We already know what this will look like:

'Misery' for A&E patients facing record-long waits

Patients are waiting hours on trolleys as a beds shortage causes backlogs in emergency departments.

www.bbc.com

 

[EctopicFetus]

I can't imagine 400 million hypochondriac Americans with no disincentive to call the ambulance any time they need it, and get free unlimited care. It's insane!

I doubt patient satisfaction and complaints will change. Hospitals will have to streamline and will be competing for volume due to the lower payments. They will likely double down on "patient experience" pressure in order to generate as many visits as possible. This will be done with fewer nurses, techs, and other resources.

Hospitals lose money in Medicare patients. The goal would be to do nothing. Seemingly, all hospitals would have to be owned by the government and of course with that the hospital will look more like the usps and less like an efficient streamlined business.
I’ll say if you work in em you should be saving your ~57k plus at least 25k a year.
If you aren’t you are putting yourself and family at significant risk.
I save like an animal but I have a db plan to fill up and I save post tax $$$ on top of that too.