Patients: Customers or Partners?

The Healthcare system is an exceptionally intricate system, as is the human body and mind. Imagine attempting to synchronize thinking, behavior, and actions of thousands of physicians, nurses, personal care assistants, case managers, social workers, bed managers, and finally, most importantly, patients, including their families. One patient alone may present a challenge if he/she has numerous comorbidities or multiple acute issues requiring medical attention. Managing medical problems in the setting of possible psychiatric and social issues poses an additional barrier to overcome. We can see there are several areas or persons through which errors can be made and that effective communication plays a crucial role in the management and safety of patients. Additionally, how we treat patients i.e. as customers or partners plays a significant role as well.

Patients have been referred to as customers recently, which may stem from the increasing competition in healthcare and hospitals attempting to attract and keep patients. As reimbursements tie into patient satisfaction, hospitals have begun to think of and treat patients as customers. Some facilities have even incorporated amenities similar to hotels to establish a relaxed environment. The healthcare world is moving towards a more patient- and family-centered care model, which involves patients and families making decisions about their care, almost like a partnership.

However in a customer-focused affiliation, the customer is “always right”, giving the customer a slightly higher stance. For instance, if you walk into a store, be it a department store, clothing store, a restaurant, or a coffee shop, you usually know what you want and if it is not delivered to your satisfaction, you can exchange or return it, and expect good customer service. If patients are thought of customers in the same manner, we would expect them to be able to “purchase” or “order” whatever tests and consultations they please and conduct their management as they want it. I have come across similar situations where based on their online readings or friends’ encounters, they request (and at times demand) expensive, unwarranted tests. In a purely customer-driven health care system, I would do so, but in the real medical world, such tests and patient management is carried out with numerous team members’ heads put together and extensive thought processes that go into decision-making.

Are the concepts of patients as customers and patients as partners entirely different parts of a spectrum? To many, the terms “customer” or “client” and “provider” reduce the patient-doctor relationship to strictly business and blunt the compassion and trust that was once the main focus in medicine. The disconnect between patients as consumers also stems from the fact that the physician, through his/her expertise, has an inherent power over the patient, with the understanding that the patient’s well-being is the focus. If the patient were a true consumer he/she would not deem the physician responsible for his/her health.

A common example is a patient requesting narcotics for pain, at dosages considered harmful by the physician, but the physician prescribing them regardless, in order to attain higher patient satisfaction grades. A partnership between a patient and a physician on the other hand is more of a two-way street. A frequent example in the outpatient setting is obesity associated with low back pain. I usually recommend weight loss and physical activity, knowing that the change will not happen overnight, so I let the patient tell me his/her goals about amount of weight loss over the next few months, hours of physical activity they plan on undertaking every week, and dietary changes they are able to make. I do not tell them to lose a certain amount of weight, what to eat every minute of the day, or the type of activity they should undertake, as long as they are taking a step towards changing their lifestyle and have a feasible plan n place. We work as partners.

The trend towards consumerism is undeniable; if a patient is dissatisfied and/or does not feel respected at one hospital, he will go somewhere else (taking on a customer role). However, can’t providers be respectful and concomitantly deem patients as who they are- patients? Why does respect have to be tied to treating patients like customers? The huge difference between customers and patients is that customers go places willingly, more than likely for something pleasurable. Patients go to hospitals willingly (most of the time), but more out of necessity, a fear for their life possibly, an experience that is not expected to be pleasurable. Strangely the “pleasurable experience” seems to be the focus now of new hospitals and wards/rooms. Perhaps the key would be to think of patients as both partners and customers as care transforms.

Photo by: tpsdave / CC0