Saturday, March 08, 2008

Doctors, Patients, Students

Suddencheese wrote the following comment after reading Just Ask Pogo About Customer Service Interesting view on students as customers. It never occured to me that simply because someone pays for something they were automatically categorized that way. Could it be said that patients at a hospital are customers?

Actually, yes. Patients are indeed customers in a hospital. It is not simply that they may be paying for a service as such but because of the relationship that is formed just as in the case of a student and a college. That relationship is one of someone providing a service and another receiving and using it. It is not the passage of money that creates a customer or patient-provider relationship; it is the nature of the interchange and affiliation that is created. In fact, money can be taken out of the connection entirely and we still have a customer-provider relationship in many situations. This can be seen easily in the situations in which the payments are not even provided by the patients but by insurers; or in a college by Pell, grants or even scholarships given by the school itself.

True, the word customer is not the word that is always common in medical service provider situations such as hospitals, nursing homes, recuperative care. The term most commonly applied is patient with the second most common consumer. The patients are seen as consumers of services. They use the services and care provided. Yet, they are customers nonetheless because they are the direct recipients of the services the care provided.

Think of a customer as a consumer (not in the negative sense of a Pac Man-like creature gobbling up resources) but as a person who receives and uses the services provided. Granted there is money being exchanged somehow in all this but it is not as direct as in a retail business from which most people try to define the customer service issue.

It is also interesting that the etymology of the word customer seems to derive from the idea of a custom as a habit of a people. A custom is something that is customarily done in the and by the group. That custom takes on more and more strength as it becomes embodied in the behavior of the same people. As it does so, it forms a tradition, folkway, manners of behavior and finally a code which has a more powerful sway over the people. In England, the word custom took on a stronger sense of the way to do things around 1200 and after 1215 with the signing of the Magna Charta, the word custom begins to move from a habit or folkway to more of a sense of code then law. This is where the sense of money exchange appears starts to come into the word as a tax, a custom due, the one who enforces the laws. Finally, by the 14th century, a customer is one who collects the custom due shifting to a sense of customer as buyer sometime in the early 1400’s. I would speculate that there was a sense of “hey, I’m a taxpayer and I want…..” Often the lord would provide some services to maintain the loyalty of the people (nobles) rather than taking a chance of one or two of the nobles deciding they wanted a new leader for the taxes, tribute custom that they paid. So the word moves from a habit, an action that is part of the social and cultural interaction to later having some exchange of money in the meaning centuries later. But all the etymology of the word customer still remains in various aspects of the word’s use.

In hospital (and college) culture, the patients go to receive services that are expected within the hospital. There are indeed habits of behavior and relationships between the consumers and the providers often referred to as bedside manners. Doctors are in the superior position as long as the doctor provides services in a manner that fulfills the cultural expectations of what good bedside manner is. When this happens patients are comforted and place trust and faith in that doctor. They become willing consumers of the services and the care. If however, the doctor does not perform in a socially, culturally, i.e. customary manner, the patients (customer) lose faith that medical customs are being broken. They will then either ask to be transferred to another doctor, ward, hospital or just plan on suing.

In fact, the work of Alice B. Burkin, a nationally recognized expert and medical malpractice specialist at the Boston law firm of Duane Morris, LLP, studies and then applies research into what makes a medical customer want to sue a doctor. And what makes a doctor being sued for malpractice more likely to lose a suit. Not much of a surprise in what she found. Successful physicians, who are less likely to be sued for malpractice, even when they might have committed it, adhere to positive cultural customs of doctor-patient relationships. They have a good bedside manner treating their patients (customers) with respect and value. They do, or at least pretend to care in other words.

The culturally expected relationship between doctor and patient is that of care giver and the consumer of that care. This customarily leads to a doctor’s performance that includes some traditional elements of social interaction common to any aspect of the culture by the way but then moves into the specialized medical service provider-consumer roles. These are initially elements basic to what we think of as customer service by the way.

The doctor says hello and introduces him or herself the patient by name. The doctor tries to understand what the patient has come into the hospital for, what service the patient needs. She listens to the patients, to the patient’s presentation of symptoms and concerns, to the patient’s questions and answers all of the questions. The doctor then determines the accuracy of the patient’s situation and next explains the condition or course of treatment in layman terms so patients can understand. The doctor is human and personable. She attempts to educate the patient as she goes along and thus tries to enlist the patient in the process and care. She indicates to the patient that she actually cares about him as an individual and not as a co-pay keeping her from yet another co-pay. And that caring means assessing the real needs and telling the patient the truth but in a humane manner. Even when the truth is painful.

The services provided also include telling the patient what he or she must do to get better, healthier and stronger. It is then up to the patient to determine if he or she wishes to comply. If the doctor has performed her role well for the customer/patient, the patient will trust the doctor, have faith in her services and the probability of compliance is much higher by the way. Substitute professor for doctor, or PhD for doctor and it works for higher education.

To summarize, being a customer is not necessarily related to money. More to the relationship and interaction of service provider and consumer or client of that service. In a college our students are our customers then as are we of one another. A faculty member could not provide his or her service if others did not provide theirs. There would be no class roster for example if the registrar’s office people didn’t do their usually good work and provide it to the departments. The registrar could get its work done if the bursar didn’t collect tuition so students could register. And so on. If each area performs the service that we expect of it, then the entire academic culture can move forward. We are all customers, i.e. consumers of services of one another area yet no money passes from one to the other.

AcademicMAPS has been providing customer service, retention and research training and solutions to colleges, universities, career colleges in the US, Canada, and Europe as well as to businesses that seek to work with them since 1999. Clients range from small rural schools to major urban universities and corporations. Its services range from campus customer service audits; workshops, training, presentations, institutional studies and surveys to research on customer service and retention. AcademicMAPS prides itself on its record of success for its clients and students who are aided through the firm’s services. 413.219.6939