We Can’t Say No To Patients? I Thought We Were Professionals.

Yes, the customer is almost always right — except if they’re paying cash for healthcare. In this case, yes, the “customer” has the right to take their business elsewhere. But do they have the right to complain when I won’t prescribe a drug I know they don’t need?

No way. And just like I don’t WANT to pay taxes, my accountant provides me with options to address what I need to do and what I should not do.

Of course, I don’t have to listen to my accountant. I can forego paying my taxes.

However, I shouldn’t be surprised when the IRS calls me to demand payment, garnishes my wages, and ultimately closes my practice.

Reports say patients are increasingly asking doctors for drugs by name, and docs are complying. If they don’t write the script, they risk a low rating on one of many doc-ranking sites.

We know the truism, “The customer is always right.” And businesses need happy customers. Happy customers keep coming back and they tell their friends. Keeping the customer happy is a businessperson’s number one priority. And as we said, Direct Care is a business.

However, things get blurry when the business is a medical practice, and the customer is a patient.

On the one hand, people need to keep coming through the door in order to keep it open in the first place, and making sure people have a good experience when they come to you for care is important.

On the other hand, sometimes patients want things that are medically unnecessary or even plainly inappropriate.

Finessing situations that fall into that latter category while trying to maintain a pleasant physician-patient relationship can be very difficult, and the pressure is increasing.

Just as with restaurants and movies, there is a seemingly expanding list of websites out there that let you rate your doctors.

Parody articles in The Onion about physicians doling out controlled substances to help their Yelp ratings make me laugh a dry little chuckle as they find a mark uncomfortably close to home. As reported in a recent Daily Beast article, a new study shows that physicians aren’t that great at telling patients “no,” even when it comes to narcotics.

After all, how hard is it really for a disgruntled patient to log into Vitals or Healthgrades and give you a one-star review? How motivated are the generally-satisfied majority of your patients to log on just for the sake of saying something nice about you?

Really, though, I don’t feel any of that pressure to prescribe controlled substances.

I’d rather keep my professional dignity and have a patient mad at me or even leave the practice than have their measly $50 per month.

I’ll wait to fill that spot with someone who actually trusts me.

Which brings me to an interesting facet of our Direct Care world: fear and love.

If I treat patients out of fear of a bad Yelp rating, I only stand to statistically increase the likelihood of a negative outcome. It’s right there in the math — if I resist my sound medical opinion based on the whim of an uneducated consumer, we are going to be in trouble.

Ours is a tricky business. Ex: All tires are not created equal. If you prefer one company’s tire over another, by all means, go for it.

But if our market started wrecking the ratings of automotive garages because a mechanic wouldn’t put unsafe tires on a vehicle, we’d be arguably insane.

And yet doctors feel this same pressure.

Like I said, I am definitely of the opinion that the free market stands to incentivize doctors to practice better medicine — to not rush, to not resent the extra work required to get paid.

But we are a select business, selling a service that requires copious training and adamant trust.

Did you hear about Miley Cyrus being hospitalized for an allergic reaction to antibiotics?

Same issue. She wound up getting sick for 3 weeks. However, initial reports omitted that she received antibiotics for a sinus infection, otherwise known as a viral common cold! Basically, a doctor is put in a high pressure situation. If Miley lambasts this doctor, that doctor might lose a substantial number of patients. As a result of Miley’s insistence to take antibiotics, she winds up in the hospital.

It’s a lose-lose for the doctor.

And it’s a primo example of the hurdles Direct Care practitioners will need to overcome.

The difficulty isn’t limited to medications. I spend a surprising amount of time talking people out of pointless tests and needless referrals. For some, there is security that comes with just a little more investigating, or with having a specialist weigh in. But just like more treatment doesn’t always mean better care, additional scans and blood draws and consultations don’t always benefit the patient.

Stop there — MAJOR BENEFIT OF DIRECT CARE — I don’t get paid to administer countless tests and prescribe expensive medications. Remember, I charge at cost for tests, panels and drugs. My money comes from the $50/month you pay me for access to 80% of what you need, and the actual cost of almost everything else.

Yet every time I have to tell a patient “no” to a medication, test, or referral I don’t think is necessary, I have a little twinge of anxiety.

What if he or she bails on my practice for a doctor who will follow the patient’s recommendation?

Who’s in charge here?

Delivering cost-effective patient care is challenging enough. My colleagues and I have cultivated a space where we know we’re practicing the best medicine that we can humanly achieve.

But don’t think this was some walk in the park. We’ve invested hard years in order to get our practice going, and many hours of it trying to make it possible for docs nationwide to join our primary care revolution, #IWantDirectCare.

At the end of the day, the truism will remain “the customer’s always right”. And if my recommendation isn’t “right” for someone, then they should be free to take their business elsewhere — without the risk that I’ll go out of business.

One thought on “We Can’t Say No To Patients? I Thought We Were Professionals.

  1. Pingback: http://t.co/zJKYbfrBlZ We Can’t Say No To Patients… « Hippocrates Shrugged

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