Opinion | Has Patient Service Gone to the Dogs?

Over the weekend, my wife and I realized that our dog Winchester needed an appointment.

If you’re a regular reader of this column, you’ve probably met Winchester before, likely in one of my columns about our annual forays up to the lake in New Hampshire.

He is an elderly yet distinguished gentleman, nearly 14 years old, and we realized on Sunday that we are going away for a few days somewhere he could not accompany us, so we needed to get him into boarding for the upcoming weekend.

As we were preparing lunch yesterday, my wife called the boarding facility where he occasionally stays, and left a message on their voicemail with the dates and times we wanted to drop him off and pick him up.

Literally walking from the kitchen over to the table to eat our lunch, my watch buzzed with an email from the boarding facility, confirming his appointment.

That was fast, that was easy, that worked out just fine, just the way we hoped it would.

It reminded me of a promotional training video around customer satisfaction that was making the rounds in healthcare about 10 to 15 years ago. It was called “It’s a Dog’s World,” where a man and his dog are out playing in the park and they both get injured, the man hurting his shoulder and the dog hurting its leg.

The rest of the video follows their paths as they each venture down and into their respective healthcare systems, the human healthcare system for the man, and the veterinary one for the dog.

Of course, the dog is treated like a king, given an urgent appointment and seen immediately, attended to right away, and placed in a cast, all with loads and loads of tender loving care.

The man is treated somewhat less optimally, ignored and receiving subpar care, even before he gets in to see the doctor.

This video was supposed to inspire us to provide outstanding customer service to our patients, and this type of thinking has led to enormous resources being poured into trying to improve the patient experience in healthcare.

Unfortunately, it feels like we haven’t really advanced that far, that these same sorts of things still happen over and over, every day.

The man can’t reach anybody on the phone, they have no appointments available, when he arrives they think he’s somebody else, they tell him he’s “the flu shot,” he is misdirected throughout the practice, ignored by the doctor who is busy answering his pager, sent off wandering through the hospital in search of Radiology, and eventually ends the day feeling worse than when he started with his injured shoulder.

This feels a lot like where the healthcare system still is today, along with even more issues heaped on top of it, from stressed providers being told to do more with less, understaffed roles at each practice, endless boxes to click in the EMR, employees who are underpaid and underappreciated, all topped off with pandemic burnout and mental health crises looming throughout the system. So, how should this be addressed?

No one can deny that physicians and other healthcare providers certainly do have a role to play in customer service.

During our interactions with our patients and in follow-up, we have a responsibility to listen to them and communicate and help guide them along the way through the complex healthcare system they need to navigate. And when we’re running late, it certainly helps to do a little service recovery, to apologize, and to try and make things better.

But we are not a service industry, we are the doctoring industry. We are here to take care of our patients, to minister to their health. We are here to evaluate them and manage them and nurture them and support them, and to be advocates for their health.

The rest of the healthcare system, this huge complicated machine built up around us, is the thing that needs improved customer service.

Patients need to be able to reach someone when they call the phone number of our practice, or any practice, and have someone get them what they need without a whole lot of rigmarole.

The processes that have been designed for listening for “trigger words” to decide acuity and parse appointments, following scripts for various maladies, messaging one person after another, sending emails to a pool or chats through the EMR, all create more complications than our patients need, and usually lead to more patient dissatisfaction than actual clinical care.

The processes of getting a referral or a refill should be smooth and seamless, with minimal involvement of the time and energy and mental processes of a physician or any other healthcare provider.

Patients need to be able to self-schedule through an online portal that works, that gets them the right appointment at the right time, every time.

And when they have questions about something, the systems need to be smart enough to help guide them to what they need, without always defaulting to sending a message to the doctor.

I’m hopeful that our partners in IT and healthcare administration will help us accomplish many of these goals moving forward, creating a kinder and gentler system that does what it’s supposed to do, that best serves the health and sanity of everyone involved.

I envision the future healthcare experiences of our patients being intimately linked to electronic systems, helping to remind patients of things they need to do, be it taking their medications, monitoring themselves at home, working on diet and exercise, or scheduling follow-up appointments with their primary care provider, subspecialists, and any healthcare maintenance items for which they are due.

I’m not suggesting that we let the electronic systems become Big Brother, watching over and nudging everybody all the time, but we can certainly do better.

Right now, I get about half a dozen messages each day through the portal saying, “I want to schedule an appointment.”

There has to be a way that this doesn’t have to come to us: this isn’t doctoring, this isn’t what we were trained to do all day.

We are all bombarded with countless tasks that get in the way of us actually taking care of patients, and this is what needs to be fixed in a thoughtful way.

We are unlikely, no matter how many resources we get, to ever find a system that truly lets us only do things that our license tells us we are trained to do.

But one can only hope we can do better, because otherwise it’s a dog’s world.