Customer satisfaction is all the rage now in emergency medicine. You see, there was a time when certain doctors in this country had the title of "primary care physician." Their job was to take care of coughs, hypertension, sprained ankles, odd belly and back pains, fevers, and other uncomfortable melodies that weren't true emergencies, but still should get looked at. The world was at peace because people knew their "PCP" and could see him whenever one of these evil humors arose. That time was marked by a true doctor-patient relationship. Then several bad things started to happen.
Television gave people the impression that doctors could fix all ailments in a matter of minutes using fancy equipment, lasers, and flashing lights. "That blue pill" was all you needed to be healed. Survival from cardiac arrest was near 90%. The lay public saw these miraculous wonders on TV and demanded the same from their doctors.
Next, an evil entity called CMS decided that primary care was no longer necessary and cut funding to the point that many PCP's closed shop. Those that remained had waitlists that extended three months. Without family docs, patients needed a place to go where they could get their humors re-aligned in a timely manner. That place was the emergency room.
If you look at the statistics for hospital admission for most emergency departments, you'll see that only 10-20% of patients are admitted to the hospital. The rest go home. Already, you start to feel the cognitive disconnect as you realize that most of the non-admitted patients must not have emergencies if they getting sent home. The good news is that in many non-urban settings, patients have insurance and companies are willing to shell out high dollar amounts for emergency services. The hospital administration sees patients more as customers who can spend hundreds of dollars for viral colds and mechanical back pain. The ED becomes a cash cow that generates good revenue. And for the suits on the top floor, they will do everything they can to get those insurance dollars rolling in, whether it be valet parking, promises of short wait times, legions of nurses who don't see patients yet listen to complaints, and other customer service initiatives.
Woh to medical student who went to emergency medicine for the thrill of intubations and codes. Alas, those procedures are rarities in the field. As the doctor, you're now in the center of customer care. You are the greeter, cashier, and manager rolled all into one. Your promotions and salary will be hinged to customer satisfaction surveys. You'll realize that your worth as a physician will have little to do with how well you know Tintinalli, and more with your customer service skills.
At first you'll complain. You'll cope, you'll adapt. Eventually you will learn the tricks to high Press-Ganey scores such as fetching warm blankets, walking the patient to the door, giving discharge instructions yourself, and making sure the television set works. And if your scores are high enough, you'll get that bonus and promotion. You'll get that high salary despite only three years of residency and working three days a week. You'll stop complaining because defense mechanisms will kick in and allow you to go in every day to keep the life style going.
And maybe, you'll even get to see an emergency every once in a while.
