Monday, August 2, 2010

Patients, Clients and Customers

I have been having a lot of problems with the private pain clinic I work with.

These have been going on since I joined them, but have come to a head recently. Part of this has been to do with one of the "Customer Service Representatives" who worked mostly for me, quitting. I am assured that her departure was purely personal and not related to work but I suspect the fact that it was clear that increasing she was doing everybody else's work as well as her own had something to do with it.

Problems have included frequent no-shows, huge gaps in my schedule with no effort to fill them, coming work to find out that they have forgotten to book patients, finding out that they have booked patients when you clearly told them months ago you weren't going to be there, not cleaning the rooms in between patients and the most recent egregious folly where a patient I had been lead to believe had no showed had been sitting out in the waiting room for over 2 hours, necessitating a return to the clinic over lunch to apologize profusely to him, and try to assess him in the remaining 45 minutes before my next scheduled patient. Wbat was more amazing was the first thing I was asked was whether I just wanted to reschedule the "client"?

There are a number of reasons why the front desk at our little clinic are so bad including the fact that our clinic pays them less than any other doctors office pays and substantially less than an equivalent unionized position in the hospital. (Keep in mind when I say unionized, that our province is not the Socialist Worker's Paradise.) The main reason I have come to a conclusion is that:

1. Instead of being called receptionists they are called "Customer Service Representatives".
2. Instead of patients our clinic has customers or clients. Increasingly we talk about customers.

The first I can deal with simply. A receptionist is someone who receives. This implies the establishment of a relationship with some responsibility on the behalf of the receptionist. Customer Service Representative brings to mind what you get nowadays when you deal with the phone company. Yeah not a pretty picture is it?

Client/customer vs. patient is an interesting lesson in semantics. To break it down, a client is someone who seeks a service from a provider. Providers of course want to provide the easiest and less expensive service for the greatest price. This is human nature and capitalism. Partially (very partially) is the right of the customer to take his services elsewhere. Even this is limited. 25 years ago, you dealt with a single phone company, single cable company etc. Even with the somewhat artificial competition in those areas, there are still de facto monopolies with very little competition.

A patient on the other hand is someone who seeks help from a provider. This is usually a service that the patient believes will have a positive aspect on his health. While the provider naturally like the provider in the provider-client picture wants to provide as little service for as much money, there is an ethical framework applied here. For example if we believe a service is not in a patient's best interest, we don't offer it often to the displeasure of the patient. Imagine on the other hand, the cable company telling somebody he doesn't really need HD. Further while we would all like to get paid as much as possible for as little work as possible, in the doctor patient relationship, we actually try to help the patient regardless of ability to pay and given the choice of therapies, we actually chose what we think is best for the patient not what will pay us the most money.

When I started in Medicine, there was a move afoot to change patients to clients. This fortunately never took root in the medical community although it did to an extent in the paramedical community. Client is an interesting word because while it implies a slightly more equal interraction than does patient, it still implies some degree of responsibility and professionalism by the provider.

Consequently what used to be called patients or clients are now referred to as customers or consumers. The semantics of this are clear. While as with patients and clients, a business relationship is established, customers lose most of the rights that patients or clients have. Sort of like the cable company example above. This is why the people involved in the planning and delivery of health care services increasingly talk about customers and consumers rather than patient or clients.

Now I know I am being naive and the ideal doctor patient relationship doesn't always happen in medicine, but it is still the ideal. We do these things partially out of a sense of ethics drummed into us by role models during our training but also due to outside pressures like licensing bodies, hospital QA committees and of course our friends the personal injury lawyers. This is opposed to the provider customer relationship which is reduced to a business transaction.

But you can see that when we go from receptionists dealing with patients to "Customer Service Reps" dealing with customers and you can see that it is inevitable that this old school physician is going to get a little pissed off.

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