Monday, October 15, 2012

I Am Not A Cocktail Waitress

As doctors continue to lose control of their livelihood, the politicians are ratcheting up new ways to make life miserable for us. One scheme is to make sure our patients are happy and satisfied with their medical care. This year, Medicare will take away 1% of hospital reimbursements and redistribute the money to the facilities that make their patients happier based on a questionnaire developed by politicians. Starting in 2016 that goes up to 2%.

The public may not understand it, but hospital pretty much run on profit margins that would make most other businesses run away from this industry. Between all the free care hospitals by law are supposed to give and the decreasing reimbursements from the government and insurance companies, most hospitals have profit margins of about 1% or less. At Grady Hospital in Atlanta, they made $1 million on revenue of $650 million this year. That's a profit margin of 0.15%. After Medicare reduces reimbursements due to low survey results, the hospital will lose $230,000 from the government. By comparison that iPhone 5 you hold covetingly in your hands probably gives Apple a 50% profit margin.

Questions on this patient survey include subjective inquires like, "How often did doctors treat you with courtesy and respect?" And, "Did you receive help as soon as you wanted it?" To indulge the patients, doctors are being cajoled into pulling up a chair and sitting down next to the patient when talking to them.

Excuse me? I am not some cocktail waitress who sits next to you when taking an order in hopes of getting a fatter tip. My life does not revolve around making you feel you had a delightful experience at the hospital. I am here to treat your illness, not feed your id.

As anyone who has ever worked in the service industry knows, it is impossible to please everyone all of the time. Some people just can't be appeased no matter how hard you try. Especially in a hospital setting, the nature of human illness makes people even less likely to see the sunny side of their stay. As one nurse related at Grady Hospital, a patient they had rescued from a massive stroke and managed to walk out of the hospital gave the facility low evaluations because the food was not to his liking. This is the kind of mentality we are supposed to kiss up to?

One hospital here in Los Angeles tried to make patient happiness the center of its mission. When Century City Hospital opened in 2007, there was much fanfare about how it would steal patients from the nearby powerhouse hospitals Cedars-Sinai and UCLA Medical Center. They were going to do it with state of the art surgical facilities, fancy flatscreen TV's in every room, and gourmet meals conceived by none other than Wolfgang Puck himself. Well the idea was nice. But they forgot one thing: people like nice things but they don't want to pay for it. Century City went bankrupt in 2008, taking millions from the physician investors who bought into the concept. Perhaps their doctors didn't pull up a chair when they were talking to their patients. Maybe their nurses should have performed lap dances to raise their patient satisfaction scores. At least patients might willingly pay for that.

How can we reverse this situation?  We need to vote these rascal politicians out of office. But wait, these incumbents are usually entrenched in their positions, using the millions of dollars they have at their disposal from political donations provided by special interest groups. We doctors on the other hand aren't even allowed to receive lousy pens and notepads from drug reps anymore because somehow that will influence how we treat our patients. Looks like doctors better get familiar with service with a smile. And learning a few lap dance techniques can't hurt.


  1. Quote attributed to a hospital CEO:

    "Quality of care is negotiable. Perception of quality of care is not"

  2. I was under the impression the surveys and Medicaid redistributions would be based on objective outcomes not subjective opinions. That doesn't seem appropriate for this field of work. Allowing checks and balances through a patient's access to file a complaint is appropriate. However, a hospital wide satisfaction survey for allocation of reimbursement? *cringe*


  3. So do you advocate horrible bedside manners or is your issue specifically with a too service oriented approach by the hospital management?

    From the patients side I can tell you that a smile can do wonders, even if you only see your doc for a few minutes. It's reassuring to be treated friendly, and I have experienced both that and more businesslike. My orthopedic surgeon is the head of the childrens orthopedic department, and he likes to draw smilies to indicate the correct limb, even on adults. Even though it's just a small gesture, it's surely lightened my mood and amused the staff in the OR preproom where the anesthesiologists put you under.