One of my, like, 6 doctors and I often talk politics at the end of our visits. This is one of those times.
Me: Doctor, can I ask you a personal question?
Doctor: Sure
Me: Every time I come here, I get an email the next day asking me to fill out a survey. So far, I’ve never done it. I feel like asking for, or even demanding, customer satisfaction in healthcare is counterproductive to getting people into being their most healthy selves.
Doctor: Tell me why you think that.
Me: Let’s say I come here for an appointment. You tell me I have an inoperable tumor. When I get home and on my computer, do you think I’m going to be in a good mood or headspace to give a fair, qualified review of you?
Doctor, smiling*: You know, you’re the first patient I’ve ever had who brought this up. It’s true, I have had patients where, I would perform a colonoscopy, find something, and then say to them that we need to repeat it- maybe for a biopsy, to determine the extent of the condition, or to remove something endoscopically. Then the patient gets mad, complaining that they have to fast again or whatever inconvenience they have to go thorough, and I’ll get an email from HR about it shortly after. The patient will call me an idiot, which is really not that far from the truth, and then every three months I have to have a meeting about my patient interactions and customer satisfaction, which often times is unfair because repeated procedures and inconvenient diagnoses are often relevant and medically necessary. Some of these procedures have a 20-26% chance of accurately diagnosing specific conditions and that’s a horrible rate, but those are the tools we have. When I practiced in the South, I had a patient who tried to sue me for malpractice when I didn’t diagnose a case of achalasia- where the esophageal sphincter can’t relax- after I did an endoscopy on them. I had to go before the State and justify myself… It was horrible. And then it turned out they didn’t even have achalasia. Fortunately we resolved the issue before the lawyers got involved, but that’s a real risk in being a healthcare professional in a culture where patients expect perfect results.
Me: So… what’s there to do about it?
Doctor: I don’t know. Patients need to have protections against doctors who don’t properly care for them, so we can’t take those away, but those same patients aren’t trained to identify what is and is not an issue caused by the provider. If you wanted to do me a favor, you could give me a glowing review.
Me: I don’t really feel like that resolves the underlying issue of it being an inherently abusive system.
Doctor, shrugging: It’s the system I work in, and I don’t have a better one.
*This is SUPER paraphrased, even by my standards. Doctor got really excited about this question and started talking a mile a minute. I couldn’t even register one idea before they moved on to the next. This big paragraph represents maybe a third of all that they said and not a wholly accurate representation of their opinions. I did my best!