“Words used carelessly, as if they did not matter in any serious way, often allowed otherwise well-guarded truths to seep through.”
― Douglas Adams, The Long Dark Tea-Time of the Soul
Vocabulary is never just a bunch of words. Consciously or unconsciously, word choices reflect underlying ethical, moral, and philosophical values. Which brings me to why I have a problem with the growing trend to embrace the Customer Service Model of Patient Care.
Genetic counselors wake up every morning and go to work because we are driven by a desire to help people. We strive to use our skills to alleviate the psychological and physical turmoil dealt by the cruel and impersonal hand of Genetic Fate. We encourage patients to pour out their sadness, anger, fear, and insecurity in the safe havens of our offices where we offer comfort, unquestioning support, and some hope in their darkest hours. We want their lives to be better for having met with us. I witness this same deeply ingrained desire to help patients in many of my health care colleagues – physicians, nurses, imaging technicians, office staff.
So what’s not to like about the Customer Service Model of Patient Care? It encourages health care providers to be supportive and respectful, and to put patients at the center of clinical encounters. Customer service skills in the clinic are important to our relationships with referring physicians, and for genetic counselors who work in lab positions where they interact primarily with health care providers.
My uneasiness with the Customer Service Model stems from the implications of referring to patients as customers. Think about it. Labeling people as customers subtly focuses the health care interaction on profit. Patients are stripped of their emotional and physical vulnerabilities and reduced to revenue sources. It is downright disrespectful. Why should I feel compassion for patients if I am trying to convince them to fork over their hard-earned money?
The message communicated by the vocabulary is not “Let us try to alleviate your suffering and to care for you as human beings.” Rather the message is “I am being nice to you so you will keep coming back to my store.” And, inevitably, models of customer service developed by highly successful corporations like Amazon, Nordstrom’s, and Starbucks are held up as paradigms for healthcare providers to emulate. Scripted patient interactions and Greeters at hospital entrances cannot be far behind. But corporately-mandated niceness can be as transparent to patients as a pair of Lululemon yoga pants.
Typically, the Customer Service Model is presented as a clever acronym, such as MAGIC, ACES, FISH!, or HEAT. Does anyone sincerely believe that the complex interaction between health care provider and patient can be simplified to a conveniently bulleted PowerPoint slide?
I am not a financial naif. I am acutely aware of the dire economic status of the American health care system, the razor-thin profit margins of hospitals, and the critical importance of a fiscally sound organization. But there is no reason to believe that the Customer Service Model generates any more income or additional business than empathic providers and highly competent medical care. Indeed, keeping the focus on the patient – rather than the customer – has the potential to increase hospital revenue because it implies that health care providers are emotionally invested in the care of their patients.
The possibility that patients might think that the medical encounter is financially driven is re-enforced when they walk into physicians’ offices where nutritional supplements, skin care products, eyeglasses, and other medical “accessories” are offered for sale. If patients are led to believe that we view them as customers, then it could reduce their trust in us and the care we provide. Why should patients trust our medical advice if they think we are trying to profit from their suffering? This makes it all the more critical to stay sensitive to the appearance of conflicts of interest and to our blind spots.
We cannot honestly say to ourselves “Well, I know I am calling them customers, but I don’t really think of them as customers.” As George Orwell pointed out, language can corrupt thought as readily as thought can corrupt language. We must choose our words carefully.
The DNA Exchange 
In the distance, I hear the echo of the patient/client discussion…
Part of the problem is that our society has allowed medical care to be *marketed* to patients just as a television set, automobile, or pair of yoga pants would be. If that is the case, then why wouldn’t the same attitudes creep in from marketing/advertising into direct patient care? And patients are becoming greater drivers of their healthcare, in part because of DTC marketing (Sally Field for Boniva! Pretty flying butterflies for my insomnia! Woo-hoo!) and in part because patients are bearing a greater burden of healthcare costs. Like it or not, in our current system in the Untied States, patients *are* customers. They are spending their hard-earned money on $20 co-pays, $100 prescriptions, and $3000 genetic tests. Why shouldn’t they have they same expectations of Kaiser, Blue Cross, Myriad, Cedars-Sinai, Georgetown U, etc. as they do for Honda, The Gap, or Coca-Cola? I would argue that the “Customer Service Model” is a reflection of the reality of patients as customers — it’s not the beginning of this change, it’s the culmination of it.
In fact, I would argue that there is a much greater societal issue at hand. I believe in the free market, innovation, and similar capitalist principles; however, I also believe that allowing them to creep into healthcare to the point that they have results in a corruption of what medicine is supposed to be. In my view, the expanded allowances of pharma DTC marketing was a big part of this change. If we want to change the damaging perception/reality of patients as customers, then we not only have to be conscious of this in our daily practice, but we, as a society, also have to figure out how to better handle the role of for-profit companies in pharma, med tech, insurance, genetic testing, etc. If we want our patients to be viewed as patients and not consumers, then the Pfizers of the world need to stop treating them that way.
Here’s another thought: why do also we let these companies treat us, as medical professionals, like customers? How about we stop taking free pens? Don’t display post-it notes or calendars with blatant logos on your desk for patients or colleagues to see. Stop taking free meals at NSGC. Go to the sponsored sessions to learn about cutting-edge technology, not to get free pastries.
(After writing this, I want to be clear I mean no disrespect to GCs or other clinicians who work in industry. Most, if not all, of these companies have excellent tests, drugs, technologies, and other products that save lives, reduce morbidity, and improve QOL. The problem stems from making profit a greater priority than health outcomes, from putting advertising before evidence.)
Just a quick note that some of the companies I mention in the 1st paragraph are non-profit or academic institutions. The point of including them was not to lump them in with the for-profit entities and their challenges (although non-profits/academics have other notable challenges), but to draw attention to the fact that they, too, have to deal with the “Customer Service Model.”
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