Boob Tube or Death Trap?
January 17, 2010
Upright and Steady
February 3, 2010

Delivering health care, including medical care, is, to some degree a service business with many of the same issues that hotels and restaurants deal with. Patrons visiting a vacation destination need to feel good about the investment of time and money that they make to expect that they will return again someday or give a favorable review to their friends. People in this line of work refer to it as the hospitality industry. One key difference between the hospitality industry and health care is that people show up at restaurants and theaters during their leisure time, not because they may need to out of illness. Nevertheless, both types of industries rely on customer satisfaction to some degree to stay in business.

What constitutes a satisfied visit to your doctor? Is it how well he or she explains things? What schools they went to? What the waiting room looks like? How long you wait to be seen? I imagine you could come up with an impressive list of things that you find important. Of course, it would also be fun to have doctors make their list of what they believe creates satisfied patients and see how well it matches with yours. Even though us doctors don’t routinely consciously stress about what each patient thinks after the visit is over, especially when the waiting room is full, in the back of our minds we still harbor some angst over whether or not we are performing up to our patients’ satisfaction. Not only are we human and want to be liked, but we don’t want to lose customers to some other doctor down the street and have him think he does a better job.

For some time now, I have been mulling over an article I read back in September 2009 in The Spine Journal about measuring patient satisfaction in 624 individuals with chronic low back pain. If you were to make a guess as to what characteristic of the doctor visit correlated the most with a satisfied patient what would you say? Well, if you said that the doctor prescribed a narcotic pain killer then you got the right answer. The one measured feature of the whole visit that was most likely to create a satisfied customer that will likely come back again had to do with whether or not a strong opioid-based substance was part of the equation.

What is it about this transaction that makes it resemble great customer service in a five star hotel? Is it a sign of validation, empathy, or concern for what you are going through? Is failing to prescribe a narcotic for chronic low back pain a sign of disrespect or a lack of concern? Is this the gold standard by which the industry must now be measured?

As a physician dedicated to fighting chronic pain and improving function by embracing the mind-body connection, I have to take notice of what my customers want. If I’m not prepared to comply with what research suggests makes people happy, then I sure better be prepared to state my case to garner their trust and faith about how I can help. In other words, if my plan is something other than another prescription for Vicoden or Oxycontin, then I bloody well better have a good explanation of why I have a better alternative.

As a member of society, I feel compelled to challenge the bar that we set for ourselves. Can’t we become even more satisfied with our physicians if we can glean from them the necessary insights to gain our own independence and no longer need their help with things like our back pain? Wouldn’t you like your doctor even more if he or she could help with your problem to the point that you no longer needed to see them for prescriptions? If that answer is “yes” then I think you need tell him or her so. Otherwise, doctors will continue to fulfill their customer service duty of prescribing narcotic pain killers with no impetus to do anything else.