Customer Service

The latest thing in healthcare (well, over the past few years, anyway) is "customer service". The basic idea is that you have a choice on where you receive health care services, and we want your business. This is great, generally speaking, but it brings with it some problems.

When you are sick, you go to a hospital because we know what we are doing. We can figure out what is wrong with you and know how to fix it. If we cannot fix it, we know ways to at least make you more comfortable. A hospital, however, is not a hamburger joint or a shopping mall. We want you to be involved in your care, to be able to make informed decisions, and more. You have the right to accept or decline any treatment offered. But here is the clencher: You cannot always have it your way. We are not Burger King.

So let's look at our customers. Generally speaking, the "customer" is the patient. The problem is the patient is ill, may be in pain, depressed, irritable, you get the picture. We get drug seekers who want nothing more than their Dilaudid or morphine and get quite disgruntled when their doctor orders them up some Tylenol. We get hypochondriacs who think every twinge indicates the need for horribly invasive procedures. And we get people like my patient the other night.

It was 4 AM, and I was the charge therapist. I was not assigned to this particular unit of the hospital, but I was carrying the ER pager when a very distraught nurse called. Turns out she had an asthmatic patient who said he was having an asthma attack and she was not getting an answer from their therapist. I looked up the man's meds and said I would be up right away. By the time I looked him up, retrieved his ordered medications and made it to his room across the hospital, a measley 4 minutes had passed. To put this time in perspective, we have 20 minutes to respond to a STAT order before anyone asks questions. To make my time even more impressive, we had just had a rapid response call and a code blue.
As soon as I walk into the patient's room (a patient who appeared to be in no respiratory distress, by the way) I was getting screamed at for taking 4 minutes. He accused me of trying to kill him. Seriously? I grabbed his spacer and the inhaler out of my pocket and started to give it to him. A word about the spacer: we use them not only to increase efficacy of medications, but also because they have a one-way valve that means we can use the same inhaler on multiple patients getting that particular drug. This saves money for the hospital and patient because a 200-dose inhaler doesn't go to waste on a 3-day hospitalization. But this guy didn't want to use the spacer and started to argue while I was trying to explain its necessity. He ripped the spacer/ inhaler combo from my hands, took off the spacer and threw it at my face, and continued to take 5 puffs of the inhaler in the most ineffective way imaginable. Since this was a new inhaler, I could not leave it with him. Thinking he was done, I reached out my hand to get the inhaler and this is when he scratched up both of my arms and took a swing. By this time, all of the commotion had aroused a family member of a patient across the hall, and she had emerged from her room to witness the entire ordeal. I ended up having to call security to get the med back--I can't leave it with the guy, even though it is now garbage by that point. I am responsible for its administration. So security gets there, and asks why he is hitting staff members. This is when the patient says I hit him, that I was doing nothing to help him, that he never took any dose off of the inhaler, blah, blah, blah. When security asked him why they should believe him, his response? With and evil smirk, he said "Because I am the patient." Then he proceeded to threaten to call hospital authorities on me.

Of course his plan was foiled. He actually left red welts up my arms and a mark the distinct shape of his closed fist on my upper arm. And there were witnesses. My supervisor and department director saw all of these the following morning before I left for my shift. But this man is still in the hospital and has had security called to his room for one conflict after another nightly for 2 weeks.

This is what we deal with. This is what happens when some people get too much power. I knew I was in the right, so he didn't get what he wanted from me. But what of the other people he has been terrorizing? People who are afraid to lose their jobs or are afraid of frivolous lawsuits give in to this sort of behavior. (Yeah, he threatened that too, by the way, when in truth, because he was mentally competent, I could've been the one pressing charges on him for assault.) All in the name of customer service. Of keeping the patient happy. Even knowing I did the right thing, I was still a teensy bit worried. Customer service is such a big issue that when the customer complains (i.e. the patient) it is a Big Fricken Deal.

With all of this being said, I usually do what it takes to keep my patients happy. I fetch ice water or snacks when it is not against medical orders. I tuck them in with warm blankies. I leave the door open or shut to their specifications, and much more. None of these fall under the specifications of my job. It's just something I do. Again, customer service.

But....If the mantra of customer service is "the customer's always right", then my experiences have shown me that this has no place in healthcare.