Why the patient-as-customer analogy does not work for health care

Recently one of my nurse practitioner students referred to a patient as a customer. She informed me that during her preceptorship the practice gave "customer" patients whatever they wanted.

If patients wanted antibiotics for cold symptoms that started a day before or requested a full body MRI, because a relative was recently diagnosed with cancer, they got it. The rationale was that if their practice did not provide these services, the one down the road would. And without patients, a practice cannot survive.

This idea of providing customer service in health care is a hot topic right now, particularly when discussed in terms of our current fee-for-service reimbursement system. This system reimburses clinicians for more care, but whether or not care is better is a matter of debate.

While I know the old adage, the customer is always right, I am not convinced that this applies to clinician-patient relationships. "Patient" may be considered an old fashioned term, but it does describe an important difference between this relationship and the relationship that exists between a restaurant and a diner, for example.

Restaurants provide a menu, and diners select the items that they would like to consume. The level of commitment from both parties in this transaction is fairly equal. But in the context of clinician-patient transactions, a difference exists in the degree of responsibility a health-care provider accepts that far outweighs that of a restaurant, both ethically and legally.

The practice where my student completed her preceptorship treated mostly patients with private insurance. In most cases, these insurance companies pay for prescriptions and tests without patients experiencing the true cost of these unnecessary expenses.

Although these tests may seem free because these patients do not pay for them out of pocket, they are not free, and we must not forget that everyone who pays taxes or who receives health-care benefits through their employer pays for each and every component of the care that they receive.

I understand that overusing diagnostic tests and treatment is often a byproduct that occurs because health-care providers wish to protect themselves from legal liability. But studies also show that clinicians who take the time to listen and discuss care with their patients are sued less often, even if a mistake occurs.  

It is the health-care provider's responsibility to listen to patients and use all of his or her clinical skills to determine the issue at hand and the options available for treatment. Clinicians should place priority on providing information that will enable patients to make the best decisions possible. Although patients may come to you with certain expectations about the care that they wish to receive, they also seek your opinion, expertise and guidance. 

Is it possible that the patients who received care at the practice that I described above left feeling satisfied? Yes. But did they truly get what they came for?

Patients come to see the healthcare providers for help. The shape this takes depends on the problem at hand and the desired outcome. If patients always knew best, they would not be in your office in the first place.

Julee B. Waldrop, DNP, FNP, PNP, is the Director of the MSN-DNP Program and an associate professor at the University of Central Florida. She provides health care to children at a local community health center.


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