Does the Doctor Really ‘Feel’ Me

Glancing at the clock on the wall, I ponder why they make me show up early for my appointment. I could be at work doing my job. Instead, I am forced to wait. My appointment is now a half hour late. If this was college, I would have already left the class.

I would have left the professor a kind note (anonymously…of course) that he was late–we, students, needed to get to another class. Unfortunately, I am forced to grit my teeth and bear the circumstance since I’m caught in a healthcare monopoly. I wonder if my doctor really understands how to be customer-focused like the rest of the world. Why doesn’t he grasp the realities of the future?

Many people feel that Armageddon has descended on America with the passing of the US healthcare reform bill.  Health problems continue to climax. According to the Henry J. Kaiser Family Foundation, U.S. health care expenditures surpassed $2.3 trillion in 2008 which was over eight times the cost ($253 billion) in 2003. In fact, health care cost grew faster than inflation and the growth in nation income.

Government bureaucrats, insurance lobbyists, patient advocates, media pundits, and health experts fight battles of how to get the health care issues solved for the future.  In fact, President Obama has gambled his presidential legacy on healthcare reform.

The winds of disruptive change have wrecked havoc to the current medical industry as traditionalist fight to keep the status quo. Joan Liebler and Charles McConnell, authors of Management Principles for Health Professionals argue that the current trends are demanding changes in patient care and administrative support.

The market and cultural drivers are all around us. Government officials impose stricter laws. Insurance companies force hospitals and medical organizations to control and reduce costs. Sadly, physicians and medical experts face ethical dilemmas of who to serve first, corporate mandates or their patients.

Yet, smarter patients are demanding more from health professionals in ways that place the customer first. Unfortunately, many organizations struggle with how to address the health professional’s moral mandate to the patient during these periods of constant and forced change.

What is the difference between a health professional implementing a patient-oriented strategy versus a customer-oriented strategy? Is it possible to have both? If so, how.

© 2010 by Daryl D. Green

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36 thoughts on “Does the Doctor Really ‘Feel’ Me

  1. In health care today, patient-oriented and customer-oriented strategies are rarely one in the same. In most cases, the payer, or customer, is not the patient, but the insurance company or Medicaid/Medicare. With this, reimbursements for services have decreased, leading the physician to try to fit in more and more patients into their work day. Dugdale, MD et al states in the article, “Time and the Patient-Physician Relationship,” that, “as fees become more discounted, income preservation demands that a greater patient volume be accommodated.” In order to maintain a large patient volume, the physician must ensure that no time gaps exist between patients. They accomplish this by scheduling patients at a known set time before the physician can actually see the patient, leaving the patient sometimes waiting for long periods of time to be seen. With the further decrease in reimbursements that is currently being put forth, physicians will have to shorten time with patients even further and increase the number of patients seen in a day. Some physicians have found a solution to this problem by moving to a cash for service or a concierge based practice, making the patient the customer, allowing for more patient time.

    Reference:
    David C Dugdale, MD, Ronald Epstein, MD, and Steven Z Pantilat, MD. Time and the Patient-Physician Relationship. J Gen Intern Med. 1999 January; 14(S1): S34-S40.

    • Taralyn,

      Excellent start! I followed your logic. How do you convince the patient that he or she is not the customer but the insurance company? That appears pretty problematic!

  2. A patient-oriented system attempts to maximize the outcomes of patients whereas the customer-oriented system attempts to maximize the satisfaction of the patient. This, of course, is assuming that the customer is also the patient. The outcome of the patient is simply whether they get better or not while patient satisfaction is a combination of factors. For instance, a study done by Dr. C Jenkinson suggests that physical comfort, emotional support, and respect for patient preferences are the most important factors in patient satisfaction.1 Inherently, I also think there is some overlap with satisfaction and outcome as satisfaction is based partly on whether the patient got better or not. Thus, I think both can and do exist in the practice of medicine today. The most common method for choosing a physician, according to a study by Howard and Hoerger, supports the fact that both exist.2 Future patient’s choose their physicians based upon word of mouth which is both dependent on outcome and customer satisfaction. I believe a successful practice incorporates both strategies and finds a distinct balance favoring the patient-oriented strategy. While this balance may shift in time as patient preferences change, I think the emphasis on outcomes will remain as the top priority for physicians.

    Reference:
    1. Hoerger, TJ, and Howard, LZ. Medcare. 1995 Apr;33(4):332-49. Center for Economics Research
    2. Jenkinson, C; Coulter, A; Bruster, S; Richards, N; Chandola, T. “Patients’ experiences and satisfaction with health care: results of a questionnaire study of specific aspects of care.” Qual Saf Health Care 2002;11:335-339 doi:10.1136/qhc.11.4.335.

  3. The patient has been relegated to a façade consumer, or essentially a freeloader. Americans are paying $0.14 per healthcare dollar spent on covering the price of services rendered by physicians. This essentially forces the physician to cater towards insurance companies for revenue and patients have to suffer (in time) of the physician visit. As price ceilings are emboldened in the form of reimbursement rate cuts, the availability of services decreases as a natural function of supply, leaving a greater number of patients without care, perpetuating the problem. As stated by Dr. David Gratzer,” We need true free-market reforms, not free-market reforms in name only”. Patients need to take more control of their payee relationship, such as with Health Saving Accounts, emboldening their decision making power as consumers. Until a free market economy of Healthcare delivery is returned to America and interstate insurance commerce is instilled, we will endure an infinite struggle to accommodate patients. Many Americans are weary of the idea of capitalism being the cure for medicine; however, Americans need to recognize we have lived in a capitalist economy with a failing quasi-socialist Healthcare system since the inception of Medicaid.

    Ref:
    Gratzer,M.D., David. “The Cure: How Capitalism Can Save American Health Care.” The Heritage Foundation. Manhattan, NY. 18 OCT 2006.

    • Phil,

      Outstanding passion! You opened it up with: “The patient has been relegated to a façade consumer, or essentially a freeloader.”

      How to you stop the progression of cultural shifts in how US patients view themselves now? I mean….most people (in my professional circles) view themselves as customers in the medical industry. They are value conscious and information savvy.

      In the past, most patients would accept the physicians assessment of their medical problems as gospel. Today, patients are researching the internet, asking more questions, and getting second/third opinions. In this scenario, the patient holds the insurance company as an enemy, not a friend.

      How will your market driven solutions change this?

  4. I believe that a health professional implementing a patient-oriented strategy is one that focuses on the patients health and wellness over all else. On the other hand, a health professional implementing a customer-oriented strategy focuses on satisfying the demands of the payer (insurance).

    In most business, the person receiving the product/service is also paying for the product/service. Healthcare is a rare system, in that, the patient is rarely the actual buyer or customer. It is the 3rd party paying for their visit (insurance or government assistance). At first, this worked perfectly with physicians being reimbursed fairly. Eventually, physicians were getting paid less and less for their services provided. This resulted in trying to maximize the number of patients they see.

    In addition to earning less, patients tend to miss appointments due to increased means of transportation and choices. This results in a further loss of revenue for the medical practice. To make sure this doesn’t happen, physicians are forced to overbook their patients and spend less time with them.

    At its current state, I think it is nearly impossible to have both a patient-oriented and customer-oriented strategy for ones medical practice. The general public mostly assumes that a physician overbooks his appointments for greed; however, they must understand that this is not the case. If patients were to see their physicians on-time every time, this must mean that the physician is cutting off some visits pre-maturely affecting clinical outcomes or he is simply seeing a lesser amount of patients per day. With the way the healthcare system is, the latter hardly happens without a negative financial effect on your medical practice. So, I believe, that is not possible to have a customer-oriented strategy without affecting the patient’s overall health and wellness; however, it is being forced upon physicians currently.

    1. Beauchamp TL, McCullough LB. Medical Ethics: The Moral Responsibilities of Physicians. Englewood Cliffs, NJ: Prentice-Hall; 1984.

    2. Roulidis ZC, Schulman KA. Physician communication in managed care organizations: opinions of primary care physicians. J Fam Pract. 1994;39:446-451. Managing Managed Care Contracts

  5. Hi Palak,

    Excellent points!!! One of your points caught my eye:

    “The general public mostly assumes that a physician overbooks his appointments for greed; however, they must understand that this is not the case.” How do you make the public understand this?

    Based on the overall theme from the discussion, the majority feel that the insurance company is the customer. Yet, the patient feel they are indeed the customer.

    I see…a train wreck!!!!

    PLEASE….define what customer is. In fact, define stakeholder too.

  6. In business the importance of developing relationships and networking is vital. In the case in health care, the Doctor Patient relationship is as equally important. According to Kurtz and Silverman there are 4 Basic Models of the Doctor Patient relationship: Paternalistic, Consumerism, Laissez-faire and Mutuality. These 4 models have different implications for both the patient and the medical profession as a whole. A customer centered approach would be most similar to the consumerism model in which the health care provider does everything to provide the patient with what they want. The old adage that “The Customer is always right” is perhaps one of the most widely referenced quotes in American business. However recent events such as the medically induced death of Michael Jackson, Drug Addiction and excessive plastic surgery have perhaps raised the question that just because the patient (customer) wants something, does that mean that they are right; and that furthermore the Physician should meet their demands. Fortunately many times both the goals of the physician and the patient are the same and thus a customer strategy and a patient strategy can coexist. The Paternalistic approach is most similar to a patient oriented strategy because the Health Care provider regards the patient as if they are their guardian, and they are to care for the patient with the outcome being the most important aspect of the relationship. This approach also neglects the aspect of price which is a dominating force in a customer focused strategy. In the customer focused world, price and value dramatically affect consumer preference and behavior; if the customer is not satisfied, refunds and discounts are standard; however these are somewhat unheard of in the patient centered strategy currently observed in health care.

    1. Kurtz SM, Silverman JD, Draper J (1998) Teaching and Learning Communication Skills in Medicine. Radcliffe Medical Press (Oxford)
    2. Gombeski Jr., William R. et al. Competency Counts. Marketing Health Services; Spring 2010, Vol. 30 Issue 2, p26-29

  7. In order to sustain a successful practice, a balance must coexist between the patient-oriented and customer-oriented strategy. Physicians come out of medical school with a multitude of debt, which must be remunerated by making enough money to pay off the debts, provide for a family, and pay co-workers and utilities in order to maintain a practice. Without the proper income, none of this would be possible; therefore, there is a customer-oriented strategy that must be implemented. In an article written by Carolyn E. Reed M.D., she states that “In the corporate model of health care, the patient is a customer and the physician is a retailer.” Unfortunately in today’s society, there is a negative connotation that is associated with patients being customers, which undermines the strong physician/patient relationship that commonly exists.

    More importantly, there must also be a primary emphasis on the general welfare of the patient, or a patient-oriented strategy towards healthcare. Doctors must take care of the patient to the best of their ability, but must do so within the limitations of the insurance company or the resources of the hospital. It is very important for the physician to maintain a proper balance between the patient-oriented and customer-oriented strategy, but there is always going to be a primary focus on the patient.

    Reference:
    Reed M.D., Carolyn E.. “Patient Versus Customer, Technology Versus Touch: Where Has Humanism Gone?” Ann Thorac Surg 2008; 85:1511-1514. doi:10.1016/j.athoracsur.2008.02.053
    © 2008 The Society of Thoracic Surgeons

  8. The dichotomy that complicates American health care is the existence of the “customer” and the “patient” as separate entities. On the patient side of things, care and comfort are paramount with emphasis in personal involvement. On the customer side there is a struggle between the primary consumer (insurance companies) and the physician. The more patients that are cycled through and the more “insurance friendly” tests performed, the more total income generated. In creating a successful practice, these two strategies can and must exist in congruence. To do this effectively physicians should focus on building value, not cost. Porter and Teisburg offer the strategy of focusing a practice on certain diseases and conditions while expanding on quality of care. This allows for a focused business plan that generates value based on expert knowledge and drives competition based on quality of patient care. This can be applied even in a “sub-specialty” where a surgeon repairs only knees or in a primary care setting where a physician accepts primarily diabetes patients. Molding the practice in this way would maximize patient satisfaction and provide significant value for the care provided.

    Porter, Michael E., and Elizabeth O. Teisberg. “Redefining Competition in Health Care.” Harvard Business Review: On Point June 2004: 1-15.

  9. A patient oriented strategy relates solely to the patient, their health, and their well being. A customer-oriented strategy relates to satisfaction or dissatisfaction of the patient’s encounter with the health professional. The health professional has to have good customer service skills in order to retain their patients.
    According to a survey on the preferred form of address, the term ‘patient’ was preferred 85% of the time by women and 83% of the time by men. The term ‘customer’ was preferred by only 1 survey participant. Health professionals are running a business, but they are also providing health care. I believe the relationship between a health professional and a patient is different than a relationship between a customer and a store employee. The relationship is more personal
    While treating the patient, the health professional always has to keep the payer, or the insurance company, in mind. If insurance won’t cover a specific test or procedure, the health professional, keeping the patient’s well being in mind, may opt for a substitute that is covered. The patient’s best interest is considered and good and proper customer service is implemented by taking the time to find an alternative and affordable treatment option.
    Reference:
    Nair, B.R. (1998). Patient, client or customer? The Medical Journal of Australia, 169, 593.

  10. The healthcare market appears to be progressing, currently shifting from a seller’s market to become more of a buyer’s market. There is a delicate balance of patient versus customer evaluation when providing the service of healthcare. Before beginning, let us define patient-oriented strategy as “patients becoming active participants in their own care and receiving services designed to focus on their individual needs and preferences, in addition to advice and counsel from health professionals”(1). Let us define customer-oriented strategy as effectively satisfying a customer’s needs “effectively, affordably, and conveniently” (2).

    While it may be logical to view healthcare as a business transaction (customer-oriented), the shortsightedness of this direction can sometimes lead ineffective results. For instance, I believe that a customer approach might miss the holistic view of a patient’s underlying causes to symptoms. Furthermore, this approach might be selling a new treatment (reverting us backwards to a seller’s market) to the customer instead of attempting to truly understand and involve the patient in their own care. An article in Forbes discussed one such dilemma: “Each specialist he saw seemed to have another possible remedy–yet he was still not well.”(2).

    How to approach both angles of patient and customer-oriented healthcare might be resolved by early physician training in both business and medicine. I contend that currently there is some balance of these approaches in healthcare, but physicians who are also educated in business might be able to recognize the encroachment of customer-oriented strategies overshadowing patient-oriented strategies, reaching a more 50/50 equilibrium.

    REFERENCES:
    1. Expanding Patient-Centered Care To Empower Patients and Assist Providers. Research in Action, Issue 5. AHRQ Publication No. 02-0024. May 2002. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/qual/ptcareria.htm
    2. Disrupting The Hospital Business Model. Clayton M. Christensen, Jason Hwang, M.D., and Jerome H. Grossman, M.D., 03.31.09. http://www.forbes.com/2009/03/30/hospitals-healthcare-disruption-leadership-clayton-christensen-strategy-innovation.html

  11. The environement in which health care practitioners such as doctors operate in has set rules and regulations that make it difficult for them to exclusively operate either under a patient oreinted strategy or a customer oriented strategy exclusively. Traditional medical school enculturates student physicians that their role is to serve the patient. The patient is not described as being paying or non paying. The patient is simply presented as a human being whose medical needs must be caringly taken care of. This idealism unfortunately is severly challenged when in the quest to self position as a professional the physician is faced with a “changed patient.” Whereas, the patient was the main reason for coming into medicine, the physician discovers that the real “patient: is actually more complex. In fact the patient is also a customer. How is this possible? Many physicians can attest to giving medical care to patients that they knew they would never be paid for. In that instance, the customer relationship does not exist because there is no exchange of money for services rendered. At other times, the physician is truly confronted by a self paying patient who truly wants value for the out of pocket money that they are paying for. The physician has to contend with satisfying the “patient” aspect of the interaction and the “customer” aspect that questions every decision he makes, demands a “certain drug” and generally wants to make sure that thier money was well worth it. Therefore, a patient oriented strategy does not take anything but the well being of the patient into consideration. A customer oriented strategy would have to still find a way to amalgamate the physician patient relationship because the patient is essentially the physician’s customer. The customer oriented strategy though, involves the exchange of money for Goods and therefore the patient has more control over the outcome. It is therefore possible to have both patient and customer strategies running parallel to each other. Whilst one may argue that the insurance companies are the customers. Ultimately it is the patient that makes the initial “buying” decision to pick up the phone and make an appointment. The insurance companies are simply part of the package that comes with the customer.

  12. Nowadays, customers demand fast and effective service in all of their dealings. This is no less true of patients that need access to healthcare. I think that patients nowadays are highly result oriented and believe that they should be well treated by their care providers. The primary focus of any business should be the satisfaction of their customers. This same principle applies to healthcare. The only difference here is that we have the added factor of dealing with the wellbeing of a human and are thereby bound to follow the rules of medical ethics. In this sense, I will say that healthcare providers have to incorporate a patient- as well as consumer-oriented strategy into their organization. Doing this would involve staying abreast of current needs of our patients. A publication from Wake Forest University showed that longer waiting times have a negative impact on patient satisfaction 1. To help alleviate the longer wait times, physicians need to first do a thorough cost analysis of their scheduling service while looking for the root cause of the long wait. Also, an ergonomically designed waiting room goes a long way towards alleviating patients’ discontent while waiting on physician.
    Cited Sources:
    1- Anderson, Roger T & Al. “Willing to wait?: The influence of patient wait time on satisfaction with primary care” PubMed Central. PMC1810532. July 2007.

  13. The Customer-oriented approach would try to achieve the goal that all customers are treated equally and satisfaction would be the main priority, as long as it came under budget. While the patient-oriented approach would pursue a practice that makes sure patients are treated as top priority, ranked depending on the severity of their disease, and managed with whatever measures necessary regardless of price. Ultimately, to have both a patient and customer oriented strategy that is effective; the individual medical needs of the patient must not only be satisfied but done within or under budget. Our responsibilities to patients sometimes conflicts with our responsibility to society (saving money), yet these conflicts can be minimized by refusing to order expensive ineffective procedures while pursuing ways to increase cost effectiveness. 1 This will take the effort of all parties involved; the physician must be knowledgeable in the cost saving measures and alternative methods that achieve the desired outcome (saving money and maintaining efficiency) along with the patient’s efforts to not demand things that aren’t really necessary for their care. Some health economists recognize that an evidence based approach will help minimize this conflict and are collaborating with health workers to establish the complementary discipline of evidence based purchasing and management.1 This optimum level of care is absolutely achievable; however, it will be difficult to obtain without the collaborative efforts of all involved. If you think the Healthcare bill was monumental, achieving a customer and patient oriented management strategy would set the bar even higher because the participation of a larger group of the population would be vital for its success.
    Citations
    1. Author’s reply to: Cost effectiveness and equity are ignored, BMJ volume 313 20juLY 1996,
    •Evidence-Based Medicine Working Group. Evidence-based medicine. JAMA 1992;268:2420-5.
    •Sackett DL, Richardson WS, Rosenberg WMC, Haynes RB. Evidence-based medicine: how to practice and teach EBM. London: Churchill-Livingstone (in press).
    •Sackett DL. The doctor’s (ethical and economic) dilemma. London: Office of Health Economics, 1996.
    •Walter SD, Hurley JE, Labelle RJ, Sackett DL. Clinical rounds for non-clinicians: some impressions. J Clin Epidemiol 1990;43:613-8.

  14. I have many difficulties in seeing how it is possible to have both a customer oriented and a patient oriented strategy simultaneously with the same person in one setting. Several organizations exist where the strategy is entirely patient oriented such as charitable healthcare organizations and military medicine, but the vast majority of healthcare facilities are customer oriented even if they make the claim to be patient oriented. Most hospitals and clinics are businesses that require money to operate. The procurement of that money is a vital portion of the business which requires customers to be primary source of revenue generation. Only through acquiring operating costs from a source other than the patient can a provider truly become patient oriented. According to the article “Determinants of Customer Oriented Behavior in A Healthcare Context” by Panisa Lanjanada (Journal of Service Management, 2009, 20:1, p 5-32), customer service qualities delivered by the healthcare team play a large role in combining patient and customer oriented service. Considering the findings of the study in this article, individualized patient service is the most feasible way currently available to integrate both a customer and patient oriented strategy.

  15. As most professionals, physicians are also faced with difficult decisions on a daily basis. However, the real difficulty is not based on deciding between right or wrong, but the degree of rightness or wrongness that is often at stake. The issue of endorsing a customer oriented vs patient oriented care is an interesting ambivalence. Although it may sound like semantics, the two approaches are quite different and their distinction is well presented in the Management Health Rx blog “Hospitals have two distinct population groups…those who NEED care and those who WANT care. Those who NEED care are patients; those who WANT care are customers.” Although their implications are very different, physicians are constantly pressured from multiple angles to reconcile these seemingly competing approaches. On one hand, insurance companies and medical administrators budget physician’s time and resources in an effort to increase efficiency without much regard for quality of care. The presumptive rationale behind this “rushed care” is in the best interest of the business and not on the patient. There is no wonder why beneficiary’s satisfaction with this type of care is often unsatisfactory. This is the danger of patient-oriented medical care.
    Customer-oriented organizations, on the contrary, seek to convince the customer(patient) that they are granted empowerment to make medical decisions about their care. In reality, this empowerment is premeditated and is also intended to compensate the clever business strategies of administrators. This approach clearly overlooks the fact that “customers” more often than not lack medical sound knowledge to make conscious medical and financial decisions that will benefit the majority rather than the individual. Moreover, customers that are better off financially would also have more to say about their medical care than those with less financial luck. This could eventually result in beneficiary selectivity and discriminating stratification.
    Still, not all is bad. There is still the possibility of selecting what is best from both approaches and merging them in search for a greater good. We could consider preserving the customer approach idea of greater patient satisfaction while at the same time remaining conscious of the costs of poorly manager care. Moreover, patients must be properly educated about the economical and health care implications of their medical care decisions. Ultimately, there is a need for the collective effort of administrators, providers and patients to create an efficient, effective and high quality care.

    Health Management Rx. “Customers” vs. Patients – Economics and Enabling 28 Jun, 2010

  16. Like a couple of my classmates, I have a hard time envisioning a health care system that is both patient-oriented and customer-oriented in its approach. Perhaps this is because I do not consider the patient a customer. More than just a purchase is riding on a patient seeking health care; many times their life depends on it. Dr. Scott Haig wrote, “But is it fine to persuade patients, so you can squeeze more money from them? Is it fine to scare patients into tests and iffy treatments, to persuade people who aren’t sick — who are not patients — that they need treatment anyway?”

    In healthcare today, it is more likely that insurance companies are the “customer.” It’s true that they often limit what physicians are able to do for their patients, but I don’t feel that emphasizing a customer-oriented strategy is the answer. To me medicine should only be limited by the scope of knowledge that exists. Dr. Haig sums it up perfectly: “The great physician will often prescribe what’s unsatisfying, looking farther down the road past “customer satisfaction” to patient well-being.” Thus, a patient-centered approach shapes great physicians, and I want to be a great physician!

    Reference
    1. Haig, Scott. “My patients are not customers.” Time, online edition. 2007: Jul 27. Accessed Jul 10, 2010. http://www.time.com/time/health/article/0,8599,1646831,00.html

  17. Dr. Haig concludes: “The great physician will often prescribe what’s unsatisfying, looking farther down the road past “customer satisfaction” to patient well-being. I think that a patient-centered approach is ideal; however, if the correct medical intervention is simply to recommend losing weight or quit drinking (unsatisfying option), the patient is not going to say, “wow, doc, I had no idea – I’ll quit immediately.” The patients choose to engage in such activities knowing they are unhealthy. The doctor has to shift towards a more “customer satisfaction” view, because they still have to treat the patient in a way that allows the patient to continue drinking and not exercising – thus the customer is satisfied. Take smoking for example, the business side of a physician would say: let them smoke, they will need lots of treatment, and be repeat customers. The patient based approach would be to treat the patient while at the same time recommending they quit smoking. However, for the greater good, a physician would not treat a patient that would not quit smoking. Allowing patients to continue smoking, hurts future generations: “grandma smoked all of her 90 years, she just had to get those breathing treatments sometimes.”
    Haig, Scott. “My patients are not customers.” Time, online edition. 2007: Jul 27. Accessed Jul 10, 2010. http://www.time.com/time/health/article/0,8599,1646831,00.html

  18. Focusing a strategy around the customer forces the physician to meet the expectations of the patient, which puts added stress on the physician with less of a health benefit to the patient due to perceived good health. On the other hand, focusing on a patient-oriented strategy forces the physician to spend more time with the patient in order to meet his own goals of treating the patient to the full extent. This adds stress to the patient with no added benefit to the doctor. Both strategies are needed to run a medical practice correctly, and as seen both have their benefits and downfalls. As stated by Dr. John Spencer, “direct contact with patients can be seen to play a crucial role in the development of clinical reasoning, communication skills, professional attitudes and empathy. It also motivates through promoting relevance and providing context.”(1) I believe that this shows that the more contact a physician has with patients, the more efficient he should become at providing not only customer needs, but the needs of the patient also. Although much easier said than done, this will allow the physician to satisfy all patients while providing the highest quality care.
    1.) “Wiley InterScience :: Session Cookies.” Web. 13 July 2010. .

  19. A patient oriented approach to health involved providing the best possible medical care for each and every patient: the health of the patients trumps all and is paramount. This echoes the Hippocratic Oath all physicians must adhere to. However, because a physician’s office is a business, the doctor must also consider a customer oriented approach. This approach revolves as treating the patient as a customer that must be catered to just as a customer would be in any other industry. Ideals such a price, location, office experience, and weight times must be taken into account to ensure attainment of market share. Even though both of these approaches must be used in order to successfully run a practice, the two often clash and one may prevent the fulfillment of the other. For instance a doctor with a critically ill patient may need to devote a significant amount of time to that patient, subjecting other patients to long wait times. A 2010 study cites long wait times as the major factor in patient’s decision making. In order to blend these two approaches, a physician’s office today would need to focus on lowering wait times as much as possible.

    Reference:
    Ahmed, Arif. (2010). Physician Office vs Retail Clinic: Patient Preferences in Care Seeking for Minor Illnesses. Annals of Family Medicine 8:117-123.

  20. When a healthcare professional implements a patient-oriented strategy, the professional tends to treat them as such-a patient, with a symptom, wanting a prescription. This results in a low quality doctor-patient relationship which is seen when patients are waiting long lengths of time for healthcare. On the other hand, when the healthcare profession views the patient as a customer, as in the customer-oriented strategy, the doctor-patient relationship is strong, and is seen as more than a person with a symptom. As a result wait times are decreased, as the doctor is more flexible in providing healthcare, is more willing to work around “customer’s” individual schedule and is focuses on providing a quality healthcare experience, and malpractice lawsuits are decreased. Since these are almost polar opposites, I do not believe patient-oriented strategy and customer-oriented strategy can co-exist. Would anyone want them to? It seems like most would prefer to have a strong doctor-patient relationship, and actually be seen as a person, with a choice of doctors they could have gone to, but chose you and needs your services.

    Literature Cited
    Loh KY, Sivalingam N. “Enhancing The Doctor Patient Relationship: The Humanistic Approach”. http://www.ncbi.nlm.nih.gov/pubmed/18935748

    Bell T. “Importance of a good Doctor-Patient Relationship”. http://www.articlesbase.com/videos/5min/227682614

  21. The terms patient oriented and consumer oriented has subtle differences but are indeed one in the same. Insurance companies are typically considered the consumer and the patient is the “patient” however, as patients with insurance, premiums are paid and thus, technically, this makes the patient once again the true consumer although under the stipulations of their insurance rules. Stanford’s study on improving health benefit design speculates how the patient could be made to feel like they matter again. Ultimately, this is the responsibility of the provider. Physicians have a responsibility to these patient consumers to not only provide good health care but to also treat the patient with genuine concern; mind, body, and spirit. This would include such things as valuing the patients time maintaining an appointment schedule where you don’t run behind and most importantly, taking the time to listen to the patients concerns; not only about their present illness but also about how they qualify the care they are receiving. As physicians, we cannot forget this basic premise: without patients we can’t treat and there is no guarantee that just because you build it they will come.

    References:
    Stanford University. “Consumer Oriented Strategies for Improving Health Benefit Design.” Agency for Healthcare Research and Quality (AHRQ) Home. Web. 17 July 2010. .

  22. A recent study done by Peter Wing, M.D. noted that over 84% of the people visiting his practice preferred to be called “patients” rather than “clients”. Most cited “patients” as a much more personal term for their relationship with their doctor. Over the past few years, the rise in technology has created a distance between the doctor and the patient. Intimate discussions about one’s health have now been replaced by lab test and CT scans. This combined with the rising cost of healthcare is one of the major reasons the patient-oriented strategy has switched to the customer-oriented strategy. Physicians must realize that no matter how good their technology is or how upscale their clinic is, the two most important thing a patient looks for in a doctor is a professionalism and personality. Because of the heavy reliance of the doctor-patient on these qualities, the relationship must not shift towards a doctor-consumer relationship.

    Wing, Peter C. “Patient or Client? If in Doubt, Ask.” Canadian Medical Association 157.3 (1997): 287-89
    http://www.cmaj.ca/cgi/reprint/157/3/287.pdf

  23. It baffles me to think that patient-oriented and customer-oriented services are not the same thing. Despite subtle differences, there seems to be the same criteria. Yes, we desire to give the patient what they need and make them the priority of any services rendered. Despite this any “service-rendering” business must look at profits. As long as the customer and patient have what they want and is done ethically and legally, there should be little room for complaint. As with any on-the-spot services you have to wait in line realizing that the person in front of you in line may need more time than you. This is the same with any “on-the-spot” services. Take oil change, haircuts, or ATM withdrawals. Any one of these can cause you to “waste time” for the person in front of you. Doctors should listen attentively and make accurate diagnoses. When they rush, they make mistakes. Soon enough someone sues and more time, energy and money is wasted. Doing things right the first time may take time, but is worth all opportunity costs of those in the waiting room sitting on a plush couch watching ESPN’s 30th rerun.

    Source:
    “Why Do I Wait In the Waiting Room for Such a Long Time at a Doctors Appointment?” http://patients.about.com/od/followthemoney/f/FAQappointments.htm

  24. Patient vs. Customer

    A lot of people could argue that healthcare is moving towards consumerism. However, patient centered care and customer centered care have many important differences. If a physician is not well liked they constantly have the risk of being sued. The physician also has to constantly deal with not being paid on time or at all. We as consumers constantly deal with people who make us wait. As a consumer we get angry with these people but the truth is we have limited options of who else we can get service from exactly like a patient going to the doctor. The doctor also has to deal with telling the patient what they don’t want to hear even when it is necessary for their health. In the coming years doctors will have to decide whether to see patients with Medicare and Medicaid when they will be getting 25% more from people with private insurance companies. In other service industries most people would simply not provide their service for less than full payment.
    Bibliography
    O’Connor, S. J. (1999). Comprehensive Patient Service Quality Expectations For Healthcare. Academy of Managment Proceedings and Member , A1-A7.

  25. The patient should be treated as a customer and the point of treating a customer is to satisfy their needs. The patient is an individual that comes to you as someone needing medical advice and care. The customer is an individual who comes to you for quality business. The health professional should deliver the best quality of care to the customer. By definition, you should provide the best service to the customer so they come back. The same applies to a patient. One possible difference, a health professional’s strategy is to provide the best medical care to treat the disease no matter the cost to the patient. In the case of a health professional treating a customer, same strategy is true however it should be done in the most effective process so that the business can profit. If you were to have an HMO, then they are the ones who dictate which physician a patient will go to for their medical needs and thus the HMO’s become the customers since they make the decisions. But in other kinds of insurance such as Blue Cross, the patient decides which physician to go to and thus the patient becomes the customer.

    Jaeun Shin, Sangho Moon, “Do HMO Plans Reduce Expenditure in the Private Sector?”, Economic Inquiry, Jan 2007
    http://trusted.md/blog/hippocrates/2006/01/04/patient_vs_consumer_what_is_the_difference#axzz0uGdf5fAm

  26. Yes. I believe healthcare facilities could strive to have both strategies implemented effectively. Customer oriented strategy desires to give the “customer” a feeling of satisfaction whereas patient oriented strategy desires to improve how the patient feels-from sick to health. For example, one concern of patinet-oreinted strategies in the article titled Patient-oriented strategies for the prevention of drug interaction by Alderman CP is the prevention of adverse effects caused by drug interactions.

    It is understood that money drives many. However, providers could implement a strategy that could pay the bill and rid the painful conditions patients experience at that same time. As my peers mentioned above, it has become tough for providers to treat their patients effectively because they have to meet the regulation that has been imposed upon them by the regulators. When physicians are forced to treat many patients in a day, they become less effective and temporally forget why they become physicians on the first place; this concern of course become an issue for those whose initial goal was not all to increase personal capital.

    Alderman CP. “Patient-oriented strategies for the prevention of drug interaction” MEDLine February 2002

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