Tag: attitude

Grumpy Tech Meets Grumpy Customer – What Do Patients Want?

Virgin-Media-logoMedicare assumes fixing patient problems is crucial, and being nice, less so.  We prefer polite, but don’t believe it’s essential.

Jill Dean, CEO of Brand Biology, gave a presentation “Grumpy Tech Meets Grumpy Customer.  This Can’t End Well … Or Can It” at a recent customer experience conference. (Thank you, Bruce Palmer, for tipping me off to this!)

Check out the 30 min. presentation on YouTube.

Virgin Media sends out technicians to help customers with cable service problems.

Techs arrive at customer’s homes harried and edgy.  Customers call when they have problems; when they are frustrated. Like healthcare, both provider and customer are often frustrated long before they meet.

Virgin tried to figure out what drives client satisfaction:  technical skill or pleasant service.

They asked customers to score service on a scale from +100 (happy customer who would recommend to others) to -100 (unhappy, no recommendation).  They found that when technicians:

Fixed the problem and were friendly and polite, customers scored +74

Fixed the problem and were neutral in tone, customers scored +26

Fixed the problem and were rude, customers scored -44

Did not fix the problem and were friendly and polite, customers scored 0

Did not fix the problem and were neutral in tone, customers scored  -64

Did not fix the problem and were rude, customers scored -87

 Rudely fixing a problem was worse than being nice but not fixing the problem at all.  

No doubt, if “fixing the problem” equals saving life, people prefer having their problem fixed.  However, only a tiny percentage of people seek care for life-threatening problems.  Canadian emergency departments send 89% of patients home without life-threatening diagnoses.

We need to align system incentives so that everyone works to provide great customer service, not just fix problems.  We should aim for every patient to recommend us to their friends.

Physician Autonomy: an Historic Relic?

Physician autonomy was sacrosanct; even enshrined in the Warsaw declaration.  

Lately, it’s negotiable.

Ballooning costs of care and medico-legal risk make more doctors call for clinical practice guidelines (CPGs) to protect them, simplify complex decision making, and justify not ordering unnecessary tests and treatment when patients demand them.

Looking for something solid on which to make clinical decisions, physicians elevate evidence based medicine as a weapon against bureaucrats’ cost cutting and so-called expert opinions.  But, the weapon also slices off physician autonomy.

Battle-lines form, with cost on one side, autonomy on the other, and evidence held hostage by whoever can show it best supports them.  Patient centeredness, another hostage, usually hangs from physician banners.  National associations weigh in; things get nasty.

When physicians call for CPGs, are they calling for limits to their autonomy? 

Doctors usually say, “No.  We can ignore the CPGs when indicated.”

If so, it seems CPGs afford little protection from lawsuit.  If standard care is to ignore CPGs when indicated, how can doctors rely on CPGs to decrease medico-legal risk?

Having CPGs, but ignoring them at will, seems to be the worst of both worlds: loss of autonomy without decreased risk.

While the aroma of clinical autonomy lingers, any trace of operational autonomy in hospitals or large groups disappeared long ago.  Even so, some physicians discussing system decisions still say:

Every physician should be involved in every decision

Every change idea should be shared at the earliest possible moment with every MD

Consensus with all physicians should be reached before any change

Are we in a post-physician-autonomy age?  How does this impact professionalism?  Is autonomy something that’s earned or protected?  Is autonomy the wrong question?

Responsibility, accountability, and autonomy are inseparable.  Some want to remove physician responsibility  as a way to decrease physician influence; others want to remove responsibility as a way to decrease risk.  Some insist on keeping accountability, but work to remove responsibility and autonomy.

Should we forget about physician autonomy and only ask what’s best for patients?

Avoiding Patients – How Docs Defend It

Paternalism

I convinced myself I was dying of prostate cancer last year.  Turns out, I was drinking too much coffee.

Patients often seek help for things that turn out to be pretty simple.

They laugh afterwards.

Phew!

Thank God it wasn’t cancer.

Many physicians sincerely believe that their staff can safely dismiss a patient’s concern over the phone, or put off seeing a patient for days (or weeks!).

By the time someone has ramped up the courage to seek help, his anxiety has peeked; he can’t take it any longer.

Patients finally give in and get seen; like Lightning McQueen finally going to buy some tires in Cars:

Lightning McQueen:  All right, Luigi, give me the best set of black walls you’ve got.

Luigi:  No, no, no!  You don’t know what you want!  Luigi know what you want!

Avoiding Patients

When patients want to be seen in the office that day, physicians argue that:

  • They know it’s not a serious problem.
  • They know it can wait.
  • They know the patient will be fine.
  • They know best.

Patients often think they need medical help when there’s nothing medically serious going on.

But, unless physicians get radically committed to understanding and meeting the perceived needs of patients, medicine will lose the privilege of caring for patients’ concerns or be tolerated begrudgingly until some better option comes along.

How soon would you like to see your family doctor if you called for something that really worried you?  Do you like getting a “We know best” attitude?  Do you like having to worry while you wait for an appointment?