Category: Service

Privileged Patients in Medicare

Privileged PatientsPrivileged patients do not wait for healthcare in Canada like everyone else.   Privileged patients bypass

  • waiting rooms
  • wait lists for imaging
  • delays for consultation

Like Nexus cardholders zipping past airport security, privileged patients get seen in a different line.

The old sarcasm is true: you go into healthcare to get great care for yourself and your family.

We console ourselves that only unique cases get preferential treatment, rare exceptions.  Just as long as ordinary people do not get treated like privileged patients.  While we do not like it, we can live with a few getting special privileges.

Privileged Patients We Can Tolerate (sort of)

  • Professional athletes
  • Worker’s compensation patients (WSIB)
  • Federal politicians
  • People able to travel to USA (or Quebec) for tests
  • Visitors from outside Canada

But we cannot bear the thought that our fellow Canadians, our next-door neighbours, might be getting treated like privileged patients.

Privileged Patients You Do Not Tolerate

  • Doctors
  • Nurses
  • Family members of doctors and nurses
  • Donors who give big gifts to hospital foundations
  • Hospital board members
  • Minor celebrities
  • Local politicians
  • Close friends of health care workers
  • Police
  • Fire
  • Ambulance workers
  • Hospital employees (especially with their badges on)
  • Even Lawyers acting lawyerly get treated and kicked out of EDs as fast as possible.

The list goes on…

Managed care requires armies of managers to keep it fair and equitable.  Even with legions of managers, ‘professional courtesy’ still guarantees your neighbours could be one of the privileged patients.

In a system with intolerable waits and inconvenience, we find ways to give great service to our most privileged patients.  Why not extend the service to all?

 

We Serve Patients Because It Is Hard

moon speechIt’s easy to talk about customer service when patents are nice. Our real motivation surfaces when patients demand narcotics, CT scans, or useless antibiotics.  Patient threats, intimidation, and entitlement wear down the fiercest advocates of patient service.

Unless we commit to great service for our toughest customers, we will start to question whether any patients deserve our attention.

In the 1960’s race to the moon, John F. Kennedy said,

“We choose to go to the moon in this decade and do the other things, not because they are easy, but because they are hard, because that goal will serve to organize and measure the best of our energies and skills, because that challenge is one that we are willing to accept, one we are unwilling to postpone, and one which we intend to win, and the others, too.”

Why bother?

1. Patients matter.

Nurses and doctors entered training to help patients.  Nearly 100 years ago, Peabody complained that new physicians relied too much on science and had lost “an interest in humanity”.  It’s been said recently that medicine has become “far more interested in diseases than the people who suffer from them” (A. Miles, 2009). Cassell’s classic book on medicine advocates for ‘person centred care’. “The Nature of Suffering and the Goals of Medicine“ (Oxford University Press, 1991, 2004).

2.  Great service improves outcomes.

Waiting kills patients; over 400 articles demonstrate increased morbidity and mortality from waiting, just in the ED.  Qualitative aspects of service are harder to measure, but things like patients’ trust in their providers improves outcomes, too.  Trust requires great patient service.

3. Medico legal claims drop.

Long waits increase the chance of being sued. Again, waits get reported because they can be measured more easily than qualitative experience.  Virgin media found customers more satisfied with polite service that didn’t fix a problem than rude service that did.

Expectations

Some of us entered medicine thinking we would be textbooks of physiology, that we would have respect, and have grateful patients.  Instead, we trained in a field with ineradicable uncertainty, a society that leans toward general disrespect for all kinds of title and authority, and patients we often cannot help.

We choose to care for patients, not because it is easy, but because it is hard…

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(photo credit: rice.news.edu)