"Customer Service" vs. ED Abuse

[docB]

jbar makes a good point an another thread about not making the ED too cushy so as not to attract malingerers:

Stop giving them movies. There will always be people who abuse the system, but if you can identify factors that encourage abuse in the your ED those should be eliminated or reduced. No TVs, no automatic food for everyone who walks in the door. It's like feeding bears, they keep coming back.

The problem is that more and more of us in the private practice EM world are being held accountable for scoring high on patient satisfaction surveys. So the question is: How do you satisfy patients and cut out the frills that keep the malingerers coming back?

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[southerndoc]

Easy... tell 'em to come back on the nights one of your newbie partners is working.

 

[The Janitor]

Complimentary NG tube and three-fingered rectal exam with every tenth visit?

 

[GeneralVeers]

When I first got to MLK as an intern, free food was handed out to all patients. At mealtimes (7AM, 12PM, 5 PM) a person would come around with a chart loaded with meal trays, and automatically hand them out to every person who was in a bed or gurney. Naturally the homeless population realized what was going on, so we'd see a remarkable surge in patients at around 6 AM, 11AM and 4PM. One of the few good things the Navigant consulting firm did for the hospital was to eliminate this policy. After my 3rd month, we had to specifically order meal trays for patients who needed them. The homeless who came in pretending to have chest pain just so they could get their free meal and leave were often angry, and would swear and yell if they could no longer get their meals.

I would be inclined to have tiers of service in the ED. Most rooms would have no TV, no free food, no toys, etc. I would then have 1-2 rooms that could be used for patients willing to pay $50 for the privilege. These rooms would have cable TV, recliners and movies on demand. I think it would be a great way for EDs to augment their income.

 

[FLTDOC1]

As I remember from my college business classes - a customer is defined as someone who pays for goods or services..

 

[macdaddy23]

I had a patient on Christmas eve from the nursing home cry when I said she did not need to be admitted for her (chronic)abdominal pain. She cried to all of the nurses, me and the EMT's who brought her back because she was not going to get the nice presents they give out to patients in the hospital on Christmas.
One of the nurses wanted to give her one of the soaps one of them were selling but I would not let them because I thought it would "feed the bears".

I think it is nice that the hospital does this but there are definitely people who take advantage of it. One of the docs said she did the same thing last year(looked it up, was true).

 

[roja]

Ah. My favorite point of arguement with one of my fellow red headed ER doctor friends:

Patients are NOT customers. The commodification of health care, particularly in the US, has generated an incredibly ridiculous concept of patients as customers. Patients are NOT customers. They don't have to be seen in the order they came in (although we try) and they don't get to order of a menu of what they want, with substitutions.

this doesn't mean that patients shouldn't be treated nicely.

Healthcare is not a privelage. it is a right, and treating patients as 'customers' does a disservice to all patients, including the ones making 'demands.'

/soapbox rant

 

[WilcoWorld]

As I remember from my college business classes - a customer is defined as someone who pays for goods or services..

As such, many ED patients are not customers...

Roja, I suspect I'll agree with your reasoning, but I'd be interested in reading an expanded explanation of why treating patients as customers is a disservice to the patient.

 

[The Janitor]

I'd be interested in reading an expanded explanation of why treating patients as customers is a disservice to the patient.

What people want isn't necessarily what they need.

 

[Farmer Jane]

It also reduces health care professionals (physicians, PAs, RTs, RNs, etc.) to waitstaff. Of course it's important that I smile, am compassionate, offer water, order a meal tray (I work with patients who are being admitted from the ER to the floor, so they're usually hungry). It is not, however, all that I do. The whole concept of Press-Ganey and their ilk completely ignore the healthcare aspect of what we do.

 

[Flopotomist]

Customer satisfaction should be important, and therefore customer surveys assessing satisfaction SHOULD be done. However, customers are people who pay, therefore only patients who have paid their bills in full should be surveyed.

 

[EM2BE]

Customer satisfaction should be important, and therefore customer surveys assessing satisfaction SHOULD be done. However, customers are people who pay, therefore only patients who have paid their bills in full should be surveyed.

Expanding on that, only patients who have paid their bills in full should be allowed to file a lawsuit (unless of course someone left something inside of them).

 

[roja]

As such, many ED patients are not customers...

Roja, I suspect I'll agree with your reasoning, but I'd be interested in reading an expanded explanation of why treating patients as customers is a disservice to the patient.

I was trying to be brief and it is an issue that I tend to get very passionate about.

Not treating patients as customers does not mean that one doesn't strive to treat people well and make them as comfortable as possible.

The concept of customers is based in a capitalistic ideology. A customer is someone who buys goods or services. The undercurrents of that are that because sthey are paying, they have rights of demanding and that thier own perceptions of timing, service etc are correct. However, we all know, that is not true. Emergencies change the 'order'. The laundry lists of things wanted are not always best for them.

They might not need thier tonsils out TODAY. Or maybe even ever.

By approaching health care (and patients) as a commodity, we turn thier satisfaction and wants into the first priority and have lost sight of the true priority of health care: to do what is best for our patients.

so, patients may want things they don't need or that might be harmful to them. And by pulling resourses away from other patients, who might be sicker, etc, there is potential to harm others. My hospital doesn't need tv's in the rooms. We need more nurses. and cvp monitors. and bipap machines that stay in the ED. We need a CT scanner in the ED. These needs are more important than the *wants* of patients.

Not to mention the demoralization that occurs when health care providers begin to feel that thier focus has to be on patient satisfaction, it warps the purpose of health care.

 

[GeneralVeers]

Expanding on that, only patients who have paid their bills in full should be allowed to file a lawsuit (unless of course someone left something inside of them).

I've always found this paradox fascinating. The EMTALA law requires us to see and effectively treat every patient, but does not place any obligation on the patient to pay one dime. That same non-paying patient then has every right to sue, even if it's a nuisance.

 

[WallowaWanderer]

Customer satisfaction should be important, and therefore customer surveys assessing satisfaction SHOULD be done. However, customers are people who pay, therefore only patients who have paid their bills in full should be surveyed.

I hear you there . . . demanding freeloaders suck. I do agree with you . . . if you get your care for free, then you shouldn't expect the same luxuries as someone who pays.

But consider this. I've never paid my health care bill in full. It always gets discounted down for me due to my wealthy privilege. I was hospitalized once during medical school for several days. The hospital sent me a bill for 51,216.00. I paid 6,631.00 (well, my insurance paid on my behalf). So, I paid 13% of my bill. If I wasn't fortunate enough to get medical insurance through school or through a job (there are tons of crappy jobs without medical insurance), then I would have to pay 10 times as much as someone who has insurance. Is that not the most ridiculous system you've ever heard of? We (and that's the collective "we as a society") tax people without insurance (who are on the whole less privileged) ten times what we charge those who have insurance. We make it hard on people who do want to pay their bill. Let's say I didn't have insurance in that situation: I could have scraped together 6 G's, and probably would have to avoid a black mark on my credit report. But there's no way I could have come up with 50,000 dollars.

 

[brianmartin]

The answer is universal coverage.

 

[EM2BE]

The answer is universal coverage.

ignorance


/redirecting thread back to original subject. If you want to discuss this fact, go to the other threads that address this.

 

[docB]

The answer is universal coverage.

The answer to what?

 

[VA Hopeful Dr]

The answer to what?

That's easy: what can we do to ensure it takes me 800 years to pay off my loans?

 

[EM2BE]

That's easy: what can we do to ensure it takes me 800 years to pay off my loans?

 

[GeneralVeers]

If I wasn't fortunate enough to get medical insurance through school or through a job (there are tons of crappy jobs without medical insurance), then I would have to pay 10 times as much as someone who has insurance. Is that not the most ridiculous system you've ever heard of? We (and that's the collective "we as a society") tax people without insurance (who are on the whole less privileged) ten times what we charge those who have insurance.

Life isn't fair. In every single society there have always been those with wealth and privilege. If I work hard and get an education, I will have more "wealth" than someone who drops out of college or decides to have unplanned teen pregnancies. There are always the "undeserving rich" and the "undeserving poor", but for the most part I think it works out equitably.

 

[CueDoc]

decides to have unplanned teen pregnancies.

couldnt have said it better myself, well maybe i could, i would have left the "decides" or the "unplanned" out, one or the other

 

[Jeff698]

So, Roja...

Let me see if I understand you correctly:

You're saying our patient's think they're at Burger King when they're really on Southwest Airlines?

As a reminder, Southwest Airlines former CEO Herb Keller famously said "the customer ain't always right". Here's a link on why he, and others, this: http://www.digalist.com/list/192

Take care,
Jeff

 

[Jeff698]

BTW, Roja...

Amen.

Take care,
Jeff

 

[GeneralVeers]

couldnt have said it better myself, well maybe i could, i would have left the "decides" or the "unplanned" out, one or the other

I used the word "decides" intentionally. It's representative of someone's decision to engage in irresponsible behaviors that have negative consequences in their lives. At some point each of us must take responsibility for those behaviors and choices.

 

[enfuegoEP]

If patients are customers does that give a business the right to refuse service? And what if we enforced the old "no shirt, no shoes, no service?" The ED would be empty and we could post on sdn all day