Opinion

Would you rather be treated as a patient or a customer?

Randall Johnson & Ellen Moskowitz & Jacob Thomas & Yuna Lee & Sandra Flood & Roger Goldberg & Michael Swetye & Samuel Forman & Vipan Nikore — April 2008

Randall Johnson '84
Executive Director, SOM MBA for Executives: Leadership in Healthcare

A: I definitely want to be a customer. Any doctor who isn't willing to treat me as a partner doesn't get to see me twice.

Ellen Moskowitz '84

A: I greatly prefer being treated as a customer rather than as a patient. A customer has more rights and choices for treatments, and is not taken for granted. I felt most "like a patient" when a medical school professor was leading his charges around my hospital bed explaining the uniqueness of my case — in the third person. One positive of being a patient, though, was the moment I delegated all responsibility for my care to my neurosurgeon, and deferred asking questions when faced with an urgent need to proceed.

Jacob Thomas
Williams Brothers Professor of Accounting and Finance

A: While I can formulate arguments for both perspectives, on balance I would prefer to be treated as a patient.

In my mind, the key distinction between the customer and patient perspectives is that I would be more powerful as a customer, since healthcare suppliers would be concerned that I would "walk" if my needs are not catered to. By contrast, a patient is more accepting of the expertise of healthcare suppliers.

While that distinction would suggest that I would prefer to be a customer (we all want more power, not less!), I'm concerned about how the healthcare system would respond if the customer view took hold. I believe that an excessive amount of resources would be spent on keeping me happy. I'm also concerned that a customer focus would drive away smart nurses and doctors who are not by nature good at customer relations.

The increased access to medical information has eroded the trust patients have in their health providers. And the tendency for the media to sensationalize medical errors creates the impression that such errors occur more frequently than they actually do. Imposing a customer perspective in this environment could make the situation more complex than it needs to be, and could compromise the quality of healthcare in the process.

Yuna Lee EPH '09 (Public Health Student)

A: Our experience of health is multidimensional and affects us in the myriad everyday settings that we encounter. When I seek and engage in healthcare, I will be experiencing it on a multitude of levels — biological, psychological, social, and spiritual. I will also be judging my experience of healthcare on both technical and service elements, and both will inform my perception of the quality of my healthcare experience. Patients today are savvy, enlightened, and expect care of a standard that may be experienced in other sectors, such as hospitality. I would certainly prefer and expect to be treated as an empowered customer, and healthcare providers today are shifting to fulfill these market demands.

Sandra Flood '87, YSN '87
Chief Operating Officer, Dreiling Medical Management

A: This is a question healthcare providers and academicians have been discussing for the past 25 years or more. Should the person be viewed as a patient or a customer? Another term that has crept into the vernacular is "client." All three words give a different connotation and in my opinion and experience, all three words should apply depending on the circumstances.

The word "patient" is a more passive term. It, in my mind, is also more paternalistic. "You are the patient and I am the doctor. I decide what is best for you."

The word "customer" is much more of a marketing term and is a product more or less of our generation. It implies shopping and, most importantly, customer service.

"Client" has often been proposed in more progressive circles as the word healthcare professionals should use instead of "patient." The concept is that this is a customer as well who has come to you for healthcare advice and/or services. It clearly implies choice and customer service but also something else: a partnership and accountability on the part of both the client and the healthcare provider. It isn't always received that well by some people, particularly the older generation. I remember one incident where I overheard a gentleman say he preferred to be called a "patient" and not a "client" because "I'm not buying stocks, and you are not my stock broker," so one needs to be careful what terminology is used with some people.

Most healthcare providers today, including myself, want a well-informed patient — a true partner in their care. It makes our job a lot easier. However, the client has a responsibility as well, that being to take care of themselves, avoid risky and destructive behaviors, and to follow the advice of the healthcare provider in complying with the treatment regimen upon which they both agreed. By not taking on this responsibility the client reverts back to being a patient, putting all the decision-making and responsibility for his or her welfare back on the healthcare providers.

We are now feeling the effects that the many years of paternalism on the part of the healthcare profession has had on society. If the concepts of customer and client had appeared several decades earlier, perhaps that would have alleviated some of the burden and cost on our healthcare system today.

So, do I want to be treated as a patient, a customer, or a client? The answer is all three. I want to be regarded as a patient, in the ultimate sense of the word, by my caregivers — in other words, the whole focus of their care. I want to be regarded as a customer who has choices and not be taken for granted. I want to have outstanding customer service from my healthcare providers that meets my needs, and finally, I want to be considered a valuable client who is treated as a full partner in that care.

Roger Goldberg MD/MBA '08

A: Although I appreciate how critical business processes are to the efficient and effective delivery of healthcare, when I am actually receiving care, I want to be able to focus on that care completely. To me, this requires being a patient, not a customer.

Michael Swetye MD/MBA '08

A: I'd like to be treated with the professionalism and care that a patient deserves, but I'd also like some of the benefits of being a customer: price transparency, service quality at all customer touch points, and marketing that makes me more aware of my choices.

Sam Forman '95, MD
President, Oak and Ivy Health Systems, Inc.

A: My success has come from innovations in technology and services that are best classified as consumerist or customer-focused. Despite this, I have come to believe that the consumerist focus of American healthcare cannot alone solve fundamental challenges to the sector. At worst, it diverts the efforts of the best and brightest away from solving the real issues.

When contemplating a preference between being treated as a patient or a customer, my mind wanders into personal experience with my mother, Rose. She was a four-foot-eleven firecracker of South Philadelphia womanhood. Fitting a disproportionate interest in humanity and a high decibel level into a small package came in handy as the World War II inside riveter in the nether regions of B-24 Liberator bomber tail sections. By family and friends of a certain age, she was often teased with the moniker of her contemporary, if imaginary, woman war worker, Rosie the Riveter. Like most women of her generation, she gave up hard hats and overalls for aprons and babies, eventually retiring as a homemaker in the very neighborhood in which she was born. She had unbounded pride for her children, including her youngest son, the Yale business student and doctor.

Just as my ventures in healthcare business were succeeding, Rose, then an octogenarian, reluctantly embarked on her last flight. It was not as glorious or as triumphant as those of the airplanes she helped build. Rose was struck with a heart attack. Over the course of a year, she became the consumer of a dizzying array of specialist physicians and nurses, high-tech diagnostics, cardiac surgery, novel pharmaceuticals, therapeutic devices, and specialty-care facilities. As the family member most suited to be her guide through the maze, I was struck by the providers of all stripes poised with hair triggers to unleash the most novel, the most innovative, and coincidentally the most expensive therapies. After initial treatment reversals leading to scant hope of returning to the independent life she treasured, the collective system would not hear the patient Rose's desires for a less aggressive, more personal, and dignified approach.

After her ordeal finally ended, my siblings and I noted that what Medicare had spent on our mother could have paid for prenatal care in broad swaths of inner-city Philadelphia, or an entire preventive health program in some third-world country. All Rose had wanted was to pass on quietly to, as she viewed it, rejoin her husband, Akiba, who had died ten years before. All the while, providers, institutions, and suppliers were doubtless counting their consumer scorecards. I suspect that the fruitless surgical interventions were probably counted as successes, given what I know about the definitions and timeframes of such total quality measures in the increasingly consumer-oriented clinical world.

I am convinced that consumerism may be part of the solution to the challenges faced by the U.S. health sector, but will certainly not be the whole of it. I believe that we can do better for Rosie the Riveter and, indeed, for ourselves and American society.

Vipan Nikore '06
Medical Student, University of Illinois at Chicago

A: People should not have to decide whether they wish to be treated as a patient or customer. Why shouldn't we be treated as both? In the airline industry, individuals are considered passengers and consumers; in sports, spectators are considered fans and consumers; and in education, tuition payers are considered students and consumers. Why should healthcare be any different?

Healthcare has notoriously been poor at conceptualizing patients as customers, but rightfully so, as healthcare is a unique industry where profit maximization and health conflict far too frequently.

In most industries, companies hope customers will return in order to increase future profits; thus, I would never hope to be treated solely as a consumer of health where an injury to myself is valued since it increases profits. On the other hand, being treated as only a patient, without a realization that I am also a customer, completely ignores the fact that healthcare providers are ultimately employed because of their patients. There must be a balance. The roles of both patient and consumer must be respected and must always be in the thoughts of a healthcare provider's mind.