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The ‘Customer’-Physician Relationship

Medicine is subtly shifting from an emphasis on what is ideally best for the patient to an environment where hospitals are marketed from survey results and physicians are instructed on how to encourage customers to check the ‘Excellent’ box when rating their care. The danger in primarily viewing a patient as a consumer is that well known adages like ‘the customer knows best’ can gravitate toward motivations based primarily on the profit motive rather than the apparent benefits of collaboration, patient voice, and better service.

The philosopher Immanuel Kant reminds us to ask whether we are treating persons (customers) as a means to some end (profits) or as ends themselves (patients). When push comes to shove at medicine’s financial margins, decisions tend to lean toward monetary gain. Efficiency and profits are needed components of every venture (even Kant says not to use people as a means only but as a means as well as an end). Yet this move from taking care of patients to customers—while promoting friendlier hospital environments—may be damaging to the health care system in the long run.

The Hippocratic Oath has been condemned for promoting a ‘guild-like’ environment and its ancient author set aside in the hope of adopting the examples of other tightly managed industries (ironically, some business academics call for managers to take on the guild-like professionalism of the medical field). While some combination of treating patients as a means and as an end is probably acceptable, it seems that the customer/consumer metaphor is being adopted wholesale.

To Hippocrates, a physician’s first consideration was to use his/her art for the patient’s well-being—a re-emphasis that can benefit all stakeholders. Otherwise, this move to make the medical environment more patient-friendly has the potential to make it ultimately more vulnerable.

Written in conversation with Cory Wilson, M.D.

  1. Dr. Tim Greco
    January 15th, 2011 at 13:38 | #1

    The subtlety missed is that the HCAHPS and AVATAR patient satisfaction questionnaires, held as absolute truth, are fundamentally flawed. People respond to a question of “I want my doctor to include me more in the decision making” on a 1-5 scale, but what do they mean? Does it actually mean they are upset because we wouldn’t give them an antibiotic for the child’s viral illness? Or worse, we give persons a Tylenol and send them home without a $10,000 workup, somehow trivializing their fears. Perhaps some specifics from the patients would help the system correct what should be corrected to provide safer and better care. The emphasis now is to make the patient happy—a very different goal indeed. The tool and hence the metrics, are broken. Still, they have become absolute in their power in evaluations of an institution’s excellence . . . and that is published without explanation on the Internet.

  2. Mike K.
    March 22nd, 2011 at 00:03 | #2

    The shifting emphasis in medicine from the patient’s best interest to an environment where hospitals are marketed for their customer service does not have to be mutually exclusive. In fact, a balanced coexistence would be in the best interest of both parties. Promoting a friendlier hospital environment is not necessarily a bad thing. From a business standpoint, it makes sense, as it will help eliminate the fear that many people have of hospitals. The medical industry is largely non-profit and is not entirely run by the government, yet. However, it runs like any other profit seeking organization. I do not see the marketing of a hospital’s ability to satisfy their ‘customers’ as being an issue if a physician only treats people as a means to some end (profits).

    In the real world, it is impractical to expect a physician to form a meaningful relationship with every patient. Not only will this create an enormous emotional burden on physicians, but affect their decision-making skills. Additionally, the primary concern of a patient ought to be the physician’s ability to provide the best medical treatment; excellent customer service is icing on the cake. A physician can retain the motive for profits as long as there is an equal or greater balance of a desire to care for a patient’s well-being.

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