Some years ago my husband and I built a custom home. One day he was in the local hardware store and ran into one of the contractors working on our house. The contractor was quite happy, as he had been awarded a store credit for buying the building materials for our house at this store. My husband sought out the manager and asked him about this.
“Yeah, we do that for all the contractors,” the manager said.
“How does it work?”
“Well, the more they spend, the bigger the credit.”
“So do I get a store credit?” my husband asked.
“Because the building materials were for my house and I paid for them.”
“Yeah, but you’re not the client,” the manager explained.
“How can I not be the client, it’s my house.”
“Because you will get your house built and that’s the end of you. If we treat the contractor’s right, they will come back here and buy their supplies for the next house and the next one.”
“So you are giving the contractors a reward for spending more of my money?”
“Well, when you put it that way….yeah, I guess so.”
We didn’t have a great experience with that house and in time came to understand the objective was to bill us as much as possible, using statements and language that was confusing and vague, while erecting barriers that kept us feeling powerless and protected the lifers working in the system. We were the amateurs; they were pros, and they were out in front of us at every turn. Sound familiar?
Many America patients experience health care in a similar way. We often come at it weak, frightened and poorly informed. We might assume that as patients, we are the clients, but we’re not often treated that way. Basic customer service would not include leaving a sick person sitting in a waiting room for hours without any explanation as to the delay. We’re rarely asked to complete satisfaction surveys, ubiquitous among retailers who clearly do value their clients. The niceties and amenities that would keep us coming back to other business are lacking. If we want service, like being informed of our test results, we often have to ask for it, it isn’t offered. When hospitalized, we can experience a dismissive attitude, as if once the procedure or surgery is done, our continuing presence is a distraction and a chore.
I can point to a few reasons for this. We are captive audiences—we don’t get to choose when, or if, to be sick. My choice among providers is often limited by insurance and geography, so the competition in the marketplace doesn’t hinge on my satisfaction. American medicine is designed to excel at acute care and interventions, so patients who access these more expensive services may be more highly valued. We’ve been taught to be passive; to treat the doctor as boss, and this is slow to change. And those who are weak and sick may be more challenged at banding together, raising a collective voice and demanding service. Like the home owner, each patient may be a cog in the wheel that makes things go round, but the actual clients are the ones who continue to work in the field and depend on each other for their future success—the hospital groups, insurers, pharmaceutical manufacturers, companies developing diagnostic equipment and supplies, labs, physicians and support staff in all these areas.
The Affordable Care Act may bring some positive changes. Citizens will have more choices around insurance and more individuals will be buying their own insurance. There will be incentives to encourage better outcomes and reduce readmissions. The numbers and the cost of chronic illness has become a real concern and there seems to be motivation to address this. And after all, the new healthcare buzzword is ‘patient-centered care’. I guess we’ll see, won’t we?