I’ve been dealing lately with the inevitable health issues that go along with aging, chiefly with my elderly parents and in a far less urgent way with my own. I’ve spent a good deal of time at hospitals, clinics, doctor’s offices and even therapeutic teaching facilities and noticed that universally there is a tremendous amount of frustration on the part of those needing care toward those who provide it. The entire health care system in the U.S. is by any standard a mind-blowing problem that will not be addressed or solved by me. Skyrocketing costs, limited access and overworked staffs are surely the broken pillars of a system in dire need of emergency renovation. What I’ve run across more often than not, however, are customers (referred to as patients in this domain) suffering from run-of-the-mill bad service.
Obviously the outcome for healthcare issues is never guaranteed. There are always mitigating factors and unknowable complexities that can complicate and shift a person’s health in various directions. Health professionals are usually very skilled and diligent about qualifying their patient’s expectations. Unlike other businesses where one is purchasing a service or product that can be held to a standard, in healthcare the contract is never for more than a range of statistical probability. That said, what I’m talking about when I talk about bad service isn’t that this or that provider didn’t deliver on restored health. My complaint is that healthcare providers have such power over their customers (patients in this case) too often they subject them to inconsiderate treatment simply because they can easily get away with it.
If a doctor keeps you waiting forty-five minutes past your appointment because he’s out to a late lunch, how likely will you be to complain about it if you want him to take a sincere interest in your well being? Right or wrong, all the way back to alchemists and witch doctors, physicians are revered and feared because they are believed to possess the magic knowledge that can take away our pain and restore our normal lives. Unfortunately, human nature often dictates that without a motivating fear of reprimand, loss of business, or loss of employment, service providers tend not to look at the service they are providing from the point of view of the person receiving it. Except for the fear of litigation, which is guarded against with countless waivers, doctors exist at the top of a pecking order with no one really to answer to.
In a hospital setting, therapists, nurses, and nurse’s aides all have well-defined responsibilities with limited boundaries of liability. They carry out their doctor’s orders but must always be careful not to overstep their position. Too often the players below the level of doctor are so concerned with the fiefdom of their particular tasks that even though they may feel empathetic they are not empowered with the responsibility to care for the patient as a whole person. Any communications up the chain, from janitors to orderlies to nurses to therapists to case-workers and finally to doctors and specialists creates a distraction and probably more work for those receiving the message. It isn’t hard to understand why communication breaks down if nobody wants to be in a position of always bringing more problems for their boss to deal with. It isn’t that different than a restaurant setting wherein servers are afraid to bring food back to the kitchen for fear of reprisal from the Chef.
Because bucks get passed and shit rolls down hill, it isn’t surprising that the medical world isn’t very different from any other business. Most medical facilities have strict policies for providing superior service. But just like other businesses those who are held most responsible for providing the required service are often the ones least empowered to do so. Since nurses and aides spend more time with patients and their immediate family they are likely more inclined to empathetic behavior. Yet their ability to respond is held in check by the doctor’s scientific objectivity and very often brief exposure to the patient. When a whole group of specialists are required, which is often the case for elderly patients, the end result is like the blind men and the elephant. Each one touches a different part, the trunk, the leg, the tail, the belly. They have a totally different opinion of what it is they are touching because they are incapable of seeing or feeling the entire animal. Such is how it is with specialists. They contribute their expertise on the patient’s lungs, heart, intestines or mental condition but no one sees the person living inside all the parts.
I do think it is reasonable to expect, at the very least, basic good manners from healthcare providers. As with service in any field, the breakdown most often occurs along lines of communication. It is no more excusable to be sitting in a doctor’s office for an hour waiting for your appointment, or waiting by the phone for days too long for important test results, or to have the call button from your hospital bed ignored than it is to be stranded in a jetliner on a runway for hours with no information from the cockpit as to why the delay. Delays and screw-ups are inevitable in every walk of life. In restaurants, hotels or retail outlets, communication of problems to the customer may not be delivered due to a fear of reprisal. Servers in restaurants, for instance, tend to take their chances that their guests aren’t noticing how long the kitchen is taking rather than address the issue and create dissatisfaction when there might not be any. Likewise a hotel won’t tell you the upgraded room they’d planned for you was inadvertently sold so they’ve put you in a room by the noisy elevator shaft. It’s probably always a mistake to withhold information but it seems much worse when it’s done with an attitude of callous awareness that the victim is helpless to do anything about it. It’s not very easy to switch doctors or dentists or choose an emergency room or paramedic. We all have to hope that the people involved in healthcare will still find a shred of the caring and empathetic nature that is inevitably squeezed out of them every day, but that also very likely called them into their chosen profession.
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