Hallway Four

In my hospital, Hallway Four is where the crazy people go. This is a glimpse of their lives and mine.

The customer is always right when…

Posted by Amy on October 4, 2007

 A few weeks ago at work I was taking care of an elderly lady from a nursing home.  I deemed that she was stable, started the workup and went about my business.  An hour later, I got hammered with three critical patients, including a CHF’er on the brink of intubation and a couple of unresponsive overdoses.  During all of this, a nurse paged me and said that the daughter of the elderly lady was there and wanted to talk to me when I had a chance.  I, unfortunately, had no such chance for about 45 minutes.  When finally I tore myself away from my downhill-spiraling patients, I found that the daughter had just left, “stormed out”, according to the nurses. 

I called her at home a few times and finally got through a few hours later.  I apologized for missing her, but explained that I had been taking care of a few really sick patients.  She was not amused or impressed and the next day filed a complaint about me to the hospital.  I don’t think anything will come of it (her mother was fine, by the way) because I didn’t do anything wrong (and wouldn’t change a thing even if I could – my three critical patients all pulled through nicely).  But, the whole thing was a bit upsetting because I really do try to offer good “customer service”. 

Later, I remembered a Chinese restaurant menu page that I had seen in Greece that offered some words of wisdom regarding “the customer is always right” philosophy. 

I’m thinking of posting it outside the ER. 

11 Responses to “The customer is always right when…”

  1. […] In the ‘why didn’t I say that’ category goes Hallway Four: The customer is always right when… « Hallway Four […]

  2. Ten out of Ten said

    Emergency medicine has taught me that alot of people are really really self-centered.

  3. Heather said

    Nice. And there’s really nothing to be done about “customers” like that. I just tend to tell myself to feel sorry for them — they likely have a really difficult life with no friends and the like. I feel better about pitying them then being mad or upset about it.

  4. Erik said

    When exactly did they stop being patients and start becoming customers, clients, or consumers of health care services?

    If you’re my patient, I have an obligation to care for you. But if your my customer, you purchase my services for a fee and I do what you tell me.

    I tell the furniture store what color chair I want, when to deliver it, and, and what room it should go in.

    I tell my patients what medicines to take, what blood work to get done, and what others doctors they should see. In my mind, that is not a customer. Customer Service and patient care are 2 totally different things.

    Good care should not require an apology.

  5. Erik,

    I absolutely agree, and yet with such an emphesis on patient satisfaction, it’s hard not to get sucked in to worrying about the customer service part of the job. I think that, most of the time, being a good doctor and providing good customer service go hand in hand. It’s the times when one is forced to choose (like in the case outlined in this entry) that we obviously have to choose to be a good doctor and not a sofa salesman working on commission.

  6. I can’t stand bogus complaints! I don’t know why they bother me so much. You do the best you can and it still isn’t good enough for some. I usually end up wondering why I try so hard. I like the sign.

  7. William said

    I couldn’t disagree more. Though I do understand your complaint. They have always been customers and consumers of health care services. A patient does not loose his or her individuality simply by having the label “patient” applied to them. They are the customer because they are the ones choosing where to spend their health care dollars. If they don’t feel valued, as well as being helped, they will vote with their wallet and find another provider. Its as simple as that. As for maintaining the best priorities, I think Hallwayfour hit it pretty much on the head.

  8. Sines said

    So true!

  9. Yaron said

    I don’t know what she wrote in the complaint, so I may be off-base here, but I think what probably angered her (or what would have angered me in her place) was the lack of response.
    From her point of view, she went to the hospital to pick up her sick mother, told the nurse that she wants to talk to the doctor in charge, and then… nothing happened and she was totally ignored.

    You are of course completely right that the other patients had a higher priority, and taking care of their real medical problems was much more urgent than giving the daughter a status-report.

    BUT you could have told the nurse to deliver back a message that you won’t be available for a while due to some emergencies.
    The nurse probably wouldn’t have had to go look for the daughter to deliver it, since it’s likely that after a while the daughter would have came back to her anyway to ask what is taking so long. In those 45 minutes she probably did that at least 3-4 times.

    And in this case what she probably heard was along the lines of “Yes, I told the doctor you wanted to talk to him. Yes, he heard me. No, I don’t know what he’s doing or why he didn’t get back to you”. This can very understandably anger people.

    Most (Though admittedly not all) people would be fine with hearing that the doctor is busy treating other patients in critical condition, and can’t be available right now. What most people aren’t alright with is feeling completely ignored, like they’re not even important enough to get a “sorry, busy right now” reply.

    Erik, it’s customers all the time.

    when you go to a furniture store the service you expect is getting furniture, that’s what you’re buying. You may pick the furniture yourself, or you may get a home designer, who you approach as a customer, to tell you what colour of chair to get and what room to put it in. Interior designers have customers too. So you get the instructions for proper home design you got from the designer, or instructions you came up with by yourself, and give those to the furniture store.
    You’re customer both cases, you just expect different services.

    When you go to a doctor, you don’t go to buy drugs, that’s what pharmacies are for. You go to get medical advice. You (as the patient) don’t know what your problem might be, or how to diagnose it. So you do what the doctor tells you, because that’s the service you, as a customer, came to get from the doctor. Medical advice, diagnosis, and treatment recommendations.
    So the doctor is like that interior designer. You go with a problem, shares it with the professional, and receive instructions on how to proceed. Interior designers have customers. So do doctors.
    After getting instructions from the former, you become a customer of other service providers like the furniture store, to which you pass over the instructions. After getting instructions from a doctor, you become a customer of other service providers like labs, other doctors, and pharmacies.

    It’s exactly the same thing. I’m a customer, it’s just that sometimes I’m a customer buying chairs, and sometimes I’m a customer buying diagnosis and medical care. It’s not an inherently different relationship just because the product is different.

  10. sultan of swage said


    An interesting use of analogies but one that quickly and completely misses the fundamental difference between consumer goods and services and medicine which are the stakes involved. You make an attemp in your post to commodify medical advice as it is dispensed in the emergency setting but you completely ignore the element of our profession that separates what we do from what your average (or above-average) interior designer does. The wrong color broche will clash terribly with a silk window treatment likely requiring an expensive redesign but nothing more painful than another withdrawl from your bank account. The wrong medication or diagnosis and the consequences may include any of the following: death, permanent disabilty, loss of function, permanent scarring, protracted complication course, devastated family, ruined lives, prematurly ended careers, motherless children, crushing depression…etc… Not to mention the daily life-reaping stress that the doctor endures and its subsequent effects.

    As a customer you hope that your expectations are met and, if so, you are satisfied.

    As a patient, you place your life in the hands of others and rely on their ability and their compassion. Then, if their expectations are met, you are alive and healthy. Ideally the patient’s and doctor’s expectations are the same and this is when the notion of “customer service” can legitimately enter the conversation but only as a facilitator of expressing compassion, which should be the foundation of any medical practice anyway.

    Just because there are health care delivery options that our patients have the opportunity to exercise does not mean we should shift our approach to them to that of a customer. They have always been and will always be so much more than that: they are our patients.

  11. Yaron said

    Sultan, the stakes involved don’t make a “fundamental” difference.

    A fundamental difference would be one of quality rather than quantity. The difference between doctors and other service providers is that of quantity, and even that only sometimes – if the doctor does not succeed in providing the required service (identifying and treating the medical problem) the damage can be larger and more critical than for the interior designer.
    But in both cases I go to them with a problem, expecting them as professionals in the specific field to treat the problem, and they succeed, or fail, to handle the problem.

    Yes, the wrong medical diagnosis can cause death, or it can just cause me to go on sniffling for one more week than I needed to.

    Wrong work by the interior designer can cost me money, yes, but depending on the circumstances may cost me socially, may hurt my job prospects, drive me to a crushing despair, and so on.

    So these extreme interior-designer bad scenarios are a bit of a stretch, sure. But how many people who go to see a doctor do so for something which is life threatening rather than just inconvenient? Not that large a percentage as well.
    More so in ER situations, by far, I agree. Are you claiming that patients in ER are not customers but patients that go to other doctors are?

    But let’s ignore the interior-designer example. I agree there’s a matter of scale here.
    What if I go for a construction engineer to design a new bridge for me? An architect to design a house or a celebration hall? A mechanical/electrical engineer to design a plane? An electrician to install a new electrical outlet in my house so I could later plug in my TV? An auto-mechanic to fix my worn brakes?

    There are cases of each and every one of these being done badly, resulting in people dying, being hurt, or becoming crippled for life. Sometimes many people. Again, and again, and again.

    Or, heck, do lawyers also not have customers, and the relationship is not one of a service provider? If the lawyer doesn’t do a good job, it can ruin people’s life as well. Actually, here it can ruin people’s lives even if they do their job very well.

    In all these cases, then, are these all professionals that don’t have “customers” ? Or, if they do, what’s the difference between them and doctors, then? Since it isn’t in the possible worst-case scenarios.

    I’m a customer. To the auto-mechanic I go to get my car fixed, to a doctor I go to get my health fixed. In each case I know what I’m asking for, what I get if the service I want is provided, and what may happen if it isn’t. Just because in some cases the doctor may be more likely to get me killed, or more likely to rid me of a great annoyance and limitation, doesn’t change the basic nature of the relationship.

    Compassion in a doctor is truly excellent. And Important. I want doctors with compassion. But because compassion can make them better doctors, in some cases, also doesn’t change the nature of the relationship. I also want compassion for nannies and baby-sitters. It’s often appreciated in good bartenders. Psychologists and wedding counsellors. Social works. Lawyers in some fields. There are many professions where compassion is helpful, or even required, and all of these professionals have customers.

    Patients is a word for the customer of a doctor, or for someone a customer brought to the doctor for treatment if the customer is not the patient themselves.

    does not mean we should shift our approach to them to that of a customer.

    Now I’m curios. How exactly do you think should a doctor’s treatment of a “patient” be different than that of a “professional medical expert”‘s treatment of a “customer” ?
    Does a patient deserve something a customer doesn’t? A customer deserve something a patient doesn’t? Something should just be done in a different way?

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