Today I received an e-mail from a patient sorely disappointed with the level of care he had received at a large specialty group to which I had referred him. As a physician, I feel personally responsible for the satisfaction of the patients I refer. As a concierge physician, I am fortunate to have the time to investigate the reasons for my patients' misadventures. In this particular case, the specialty group is virtually "the only game in town." My patient will have to travel out of our area to seek care at another medical group in this particular specialty. Among other concerns, I will not be able to refer him to someone I know personally or professionally, something I always try to do. It is my intention to call this group's main office and ask to speak with the office manager. Since the specialty group in question completely dominates our area, I may be tilting at windmills. They have a monopoly of sorts, especially if transportation is an issue (as it is for so many folks). My patient did not specify what type of mistreatment had upset him. I initially thought I should call my patient to gather details, and should speak with the specialists' office manager before writing this blog. After furthur consideration, I'm not sure these conversations are necessary to make my points, though I believe they are of utmost importance in promoting the satisfaction of patients, a worthy goal and a personal quest of mine. I will certainly call both parties at my earliest opportunity, but I think there is benefit to conjecture at this point.
Realizing that this specialty group is "the only game in town," it is tempting to assume that the principals of the group have decided that they don't need to provide a high level of patient satisfaction. They have almost no competition. While there may be a few unhappy physicians around who feel that offering competent medical care is all they are required to do, most physicians I have dealt with, particularly in recent years, are genuinely interested in what has variously been referred to as the human side of medicine, bedside manner, and even plain old "customer service." What I see more and more is that large medical groups struggle to provide a decent level of this elusive "customer service." Though not all doctors walk on water, I have often heard, "I really liked the doctor, but I hope I never have to go back to that office." Chances are, the nice doctor would be pained to know that his or her staff left a patient so unhappy. Or the doctor may be conflicted, knowing the staff is not giving patients a warm fuzzy feeling, but not having enough clout to replace uncaring staffers in the large group practice. Especially since that large group practice has allowed that doctor to have a normal lifestyle, trading control of the office for free time to be with family and friends. I think it is likely that my patient's dissatisfaction was the result of well meaning people who are missing the chance to bring a touch of warmth and joy into their patients' lives. The potential reasons are legion, but I'll bet number one on the list is too much work, leading to burnout, leading to callousness and a bad attitude. Add lack of support from management, grumpy managers, favoritism, illogical operating procedures, and a host of other managerial maladies, and you have the makings of a serious Office Maladjustment Disorder.
It's a given that no one wants you to tell them how to run their business. But a lot is at stake here. Patients suffer pain, they suffer indignities. They should not have to suffer indifference. They are in medical offices, not the Department of Motor Vehicles. Medical office staff with direct patient contact should not think they are too important to be kind to patients. They should not be people with ice water in their veins. In the movie The New Centurions, George C. Scott is a police officer who quotes Kilvinski's law to a rookie officer: "Treat everybody the same...be civil to everyone, be courteous to nobody." That is not good enough for a medical office. There is an old French aphorism summarizing the mission of medicine: "To cure sometimes, to relieve often, to comfort always." People who cannot appreciate this sentiment should not be tolerated in the hallowed province of medicine.
What can we do about this? I am reminded of a question I once read and that impressed me: "if everyone complained every time they were dissatisfied, would we have any quality issues?" Initially on reading this, I pictured a world full of complaining grumpy people walking around in bad moods. But the likely result of universal but legitimate complaining would be better service and better quality products. I believe that, after careful reflection ("walk a mile in his shoes"), we should politely complain when we are unhappy with a product or service. More likely than not, the manager or business owner will appreciate legitimate complaints that are thoughtfully expressed. If our criticisms are perceived as purely constructive, they can be very powerful. Think of them as studied random acts of kindness. We have the power to change the world. A good place to start may be your doctor's office.
And as far as the causes for my patient's dissatisfaction and my conversation with the office manager... stay tuned.