Health Care With Customer Care? Customers Have To Force the Issue


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Last month, I underwent planned but significant surgery. In the process, I “enjoyed” a bird’s eye view of the U.S. health care system, which in itself looks like a bird. A vulture. Makes me wonder, in fact, whether there’s room for healthcare and customer-care to co-exist, considering the aggregate narcissism and greed of many players in our healthcare system.

Here’s just a sampling of the recent goings-on.

  • I was referred to a “reputable” orthopedic surgeon in a multi-site practice because of pain in both shoulders. Following a five-minute “history” and a subsequent MRI, Doc McChopShop told me both shoulders urgently needed rotator cuff surgery, with the left one having priority. After five minutes explaining the supposed MRI outcomes (without me seeing them) he instructed me to go to his scheduling nurse’s office to “get on the calendar.” The only place I went was for a second opinion.
  • Next I saw Dr. McShoulder, who happens to minister to the delicate arms of a major league baseball team. Looking at the same MRIs, but walking me through them, he showed me that my right shoulder was a mess. However, considering my age, he didn’t see much value in surgery to correct a long-ago high school pitching injury to my left shoulder, since it doesn’t seem to be getting any worse over time and can be dealt with through physical therapy and occasional meds. But he wanted to do the right shoulder “yesterday.” Unfortunately, his next open surgery slot at the only hospital where he has privileges and I have insurance coverage was In three months. So “yesterday” turned into three months.
  • Prior to surgery, McShoulder’s PA (physician’s assistant) referred me to a PT (physical therapist) who also specializes in shoulders so I could loosen things up and manage pain before getting cut. When I arrived for my first session, Mr. PT-shoulder told me, “you’ll be working with APT (assistant physical therapist) so-and-so, after which I barely saw the PT except when the APT had to ask him what to do. Yah sure. Helluva recommendation.
  • When Dr. McShoulder finally operated, he discovered that things were in much worse shape than shown on Dr. McChopShop’s MRI (health insurance wouldn’t pay for a second MRI), very likely because my right shoulder had continued deteriorating over the three-month interval. Consequently, he had to perform a different and much more extensive surgery than anticipated. He informed my wife immediately after, and she caught some of what he was saying, but he didn’t talk to me until my post-op appointment 10 days later. That might have been okay, except in his haste he forgot to change my post-op care instructions. So I did potentially injurious stuff until I saw him. Fortunately, I survived (or rather my shoulder did).
  • And then there was the nursing. I did have several knowledgeable and helpful nurses during my stay. During the day shift. But overnight, nothing but NAs (nursing assistants) who were left on their own to dispense and adjust serious pain medication, despite an obvious lack of training or nursing temprament. And then there was the recovery room nurse who kept me in the post-op room for about an hour while chatting up everyone in sight. Too bad they don’t serve post-op pain killers there. And when I asked her when I was going to my luxurious suite, she responded, “When I have time.”

I’ll leave things there, without regaling you with stories like my previous physician declining to authorize a sleep apnea test because: “You just need to lose weight.” And C-Pap machines (the common remedy for sleep apnea) rarely work, anyway.” When he finally did authorize the test because I couldn’t get through the workday, the hospital started recording “normal” sleep patterns, only to stop in less than an hour because my blood oxygen level was “in the red zone,” putting me at risk of a stroke or heart attack. And when I got to the pulmonary clinic to get set up with a C-Pap machine, the pulmonary PA just exploded hearing the story, saying (literally): All the jerk had to do was point a flashlight into your mouth to see that this has nothing to do with weight.” All this after I’d had to put my consulting on the back burner for a considerable time while I tried to get healthy (I recovered completely in a week using the C-Pap machine – and fortunately they don’t count against carry-on baggage limits).

Okay, I’m regaling. But I’ll stop after saying that in our cost-cutting times when doctors and clinics are rewarded for keeping patients away from expensive tests, two different doctors told me my right shoulder problem stemmed from “arthritis.”

Okay, so why did I belch out all this sordid stuff? Because I’d like you to wear your patient hat while you try to answer two questions. First, “How would CRM software functionality (imbedded in medical practice systems, of course) fix any of this?”

You betcha. We actually have CRM yahoos out there pushing use of CRM software functionality to improve relationships with patients But why should healthcare be any different. Isn’t it always about software?
Second, what, in your opinion, will it take to put the patient in the center of the health care circle (well-applied 2X4s aside)? Personally, I don’t believe our health care system is capable of behaving better of its own volition.

I believe reform will only result from customer push-back – as in constantly reminding practitioners that we’re customers, not patients. And very vocally taking our business elsewhere when they can’t grasp that. Moreover, when some surgeon tries to pay for his daughter’s wedding or whatever by cutting open both my shoulders, starting with the wrong one (do you know that statistical research proves that Ob-Gyns are far more likely to deliver via c-section when they have a daughter getting married?), we’d better start filing complaints – with clinics, hospitals, insurance companies, HMOs and even state medical boards. Which is exactly what I’m doing.

Or do you think I’m being too cynical?


  1. Dick

    I am just glad to hear that you survived.

    Healthcare does seem to be in a costly mess, no matter in which country you look. It certainly is in Germany where I live; which is why going to see a Docter is the last resort for me.

    The best providers seem to be those that work with a mixture of looking at the end-to-end customer experience so that things work for the customer, lean operations so that the customer pulls what they need out of the system on demand with no queues and a systemic approach to management so that activity in one part of the system doesn’t upset another part.

    It’s a scary thought, but perhaps we will only see real progress when the customer experience people start running healthcare. How do you fancy The Disney Hospital?

    Graham Hill
    Independent CRM Consultant
    Interim CRM Manager

  2. Graham – just after I posted I saw an absolutely discouraging account from a doctor about how constrained he is by insurance mandates, including not being able to refer someone like me for an exploratory MRI without screwing up his mandated ratios. Time past due for a radical restructuring.


  3. Dick,
    Glad you made it through our chaotic health care non-system. Your final point that isn’t it all about software is an excellent one. I urge you to read this recent article in the New Yorker ( )about Peter Pronovost, a maverick MD at John Hopkins. His solution to many hospital foul-ups–did you know that line infections, which can be fatal, are considered a routine part of the ICU stay?— is a checklist. Yup. While medical procedures have grown in complexity, the article shows that there hasn’t been a corresponding focus on systematizing these tasks. In the same way that a pilot uses a checklist before takeoff, you’d think a doctor ordering a drip would have a list of *written* tasks to be completed. They don’t. Incredible, but there’s no software in place to indicate what’s been done on patient X and reminders sent out to technician Y that procedure Z has to be completed in one hour. An on-line retailer has more knowledge of who you are and what you ordered than a “high-tech” hospital. The medical industry will have to be pushed into a customer-centric view of the world.

    Andy Green

  4. Andy – thanks for your comment and the link to the New Yorker article. I don’t know if you remember the incident, but several years ago Duke Medical Center botched a highly publicized heart transplant for a young Central American girl, following which she died. Incredibly, not only wasn’t there a checklist to assure organ compatibility, but the process used could not have been more poorly designed.

    Dick Lee


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