One of pushbacks I have received from those who work in a hospital, especially the clinical people, is “We gave them quality care, what else do they want?” or as it is more colorfully expressed at times, “We are here to save their ass, not kiss their ass!”
If I am feeling a bit feisty, I might ask, “Whose ass did you save today?” While healthcare is often about life and death, it is also often not about life and death, but about resolving an issue in the best-practice way. Even if the situation is dire, it is often as much about comfort. So, that phrase really carries with it an urgency that is often not present. Not everyone in a hospital is having their ass saved. We are all going to die and some of us will die from things that we are actively receiving care for. But the implication we so busy saving asses that we cannot be concerned about the niceties of human interaction is inaccurate as well as insulting.
But setting that extreme position aside, the notion that patients enter a hospital expecting nothing more than a specific solution to a problem misses the real point of the human experience. Patients enter hospitals for the same reason they enter a bank or a grocery store; they need a wound stitched, they need a car loan, they need a loaf of bread. But they also have an underlying expectation that they will be treated in an understanding, even compassionate, way. If you had an altercation with the check-out person at a grocery store and they said, “Hey, I sold you a gallon of milk, what else do you want?” that interaction would leave you angered. Call it civility, politeness, or understanding, but the expectation is that this transaction requires some baseline of humanness. Without it, tensions are created. Patient advocates would say that this is how a lot of their work starts.
Some are going to have their feathers ruffled, as I just compared a “check-out girl” with a highly trained health care professional. And this gets at the REAL issue here. Some in healthcare think that what they do is simply more important than what other industries do. Apparently, if you are smart enough, or have a specific skillset, you don’t need to be nice. What I am about to say may piss off some people (feel free to vent in the comments), but you are not more important. Yes, if I am in full cardiac arrest, you are more important. But if I need my taxes done, you are not more important than an accountant. You are not more important than a real estate agent, if I want a house in a good school district. In fact, those people may have more long-term importance on my overall comfort and happiness than you will. Indeed, I have purchased thousands of gallons of milk and never had a heart attack. So, on a day-to-day basis which person is more important? If your response is “Well, next time you have chest pains, perhaps you should go to the dairy counter at your local market” you are willfully missing my point. I am saying that in a specific situation, you are CRITICALLY IMPORTANT, but within the larger context of life, less so. Further, wearing that sliver of value on your sleeve and not letting anyone forget how important you are actually does you more harm than good.
This sentiment is often defined as ‘terminal uniqueness’ or the sense that one cannot compare one thing to anything else because it is just at its core different. You cannot compare healthcare to a bank or a grocery store because it is just different. It has different rules and different guiding principles and is subject to different oversight.1 Not only does this make it difficult to have a conversation about how to improve the experience, but it also creates a divide that is detrimental to all communication. Saying, “you wouldn’t understand, it’s a healthcare thing” both shuts down conversation in the moment and creates a tension, neither of which are helpful to problem-solving. You have put up a velvet rope and a bouncer and told the other person that they are not on the list, they are not worthy, and they are not welcome. You may have shut down conversation today, but you have also created an enemy for the future. You just told me that I am too stupid to understand, but what you fail to realize is that you need me to understand. You need me to understand:
- That I should follow your clinical advice once I leave your facility
- That I should choose your hospital/clinic/outpatient surgery center over your competitors
- That I should take any public health precautions like wearing a mask, social distancing, or getting a vaccine seriously
- That my community should give you a tax break or a waiver for hospital expansion
- That my community should work with you to access land for new development
- That the FTC should allow you to buy your competitor or expand your footprint
By building the wall, you have cut off communication that is important for both sides. This is the same problem that has faced academia in some settings, where some universities have said, “we are smart, you are dumb, don’t question us, leave us alone” and it has led to the sentiment that they are in an ivory tower and are effectively shut out of contemporary conversations. When they want or need to be in the conversation, they are the ones outside the velvet rope.
Setting aside the macro-concerns, this temperament means patient pushback on more immediate health concerns. When you say, “We gave them quality care, what else do they want?” the implication is that you expect them to understand you gave them quality care. But how do they know that? What have you done to assure them that this is what they got? You told them that you are right and they are wrong.
Healthcare providers will often complain that they must co-practice right next to WebMD or “Dr. Google” but never ask the question WHY they are in this position. You would not let patients into your nightclub, so they found a place across the street that doesn’t have a velvet rope and a bouncer. Perhaps that nightclub is not as good as yours, but at least they can get a table there. (Yes, I am aware that this metaphor is getting quite a beating.) Patients are clearly looking for something and if you won’t provide it, they will look someplace else for it. Instead of complaining about the changing face of healthcare, you could take a minute and understand the motivations for this behavior.
Patients want to understand their care and take an active role in their care. For years healthcare has bemoaned the fact that some patients don’t take an active role in their own health management. They don’t manage their high blood pressure; they don’t track their diets; they don’t do the things that they need to do to be healthier. Now that patients are doing research trying to understand their care better, we ridicule them for not doing it the right way. We argue that they are not looking at the right research or are trusting voices other than ours. It is certainly true that there is bad information on the internet. There are idiots and there are people trying to deceive. But our response cannot be to simply make fun of people trying in their way to understand their care.
About a decade ago, a friend was diagnosed with multiple sclerosis (MS), and I was helping her navigate that universe. This was long before there were a dozen medications advertised on TV to help manage MS. This was at a time when if you were not lucky enough to get into a trial, you just would hope that the next relapse would also remit, but knowing that every bout would leave you a little worse than you were before. Given this environment, my friend would do research and find treatments that might help with the death sentence she was given. She tried gluten-free diets. She ate quinoa and took all sorts of supplements. She wanted to fly to Paraguay to try a surgery on the veins in her neck that would help with brain fogginess. Her doctor could have derided her for these stupid things, but he knew that it would drive a wedge between them. Instead, he read what she gave him and discussed in thoughtful terms the value of a gluten-free diet or taking a fistful of supplements. He gently discussed the insanity of flying halfway around the world to have someone risk serious nerve and spinal damage to perform work that would have no impact on the disease. He didn’t dismiss. He was talking reason to nonsense, knowing that he had very little to offer her. All he could do what help her not waste a lot of money on something that could make her much worse.
Second, patients use these sources when they cannot get in to see you. I helped another family member who got diagnosed with cancer and was told it would be six weeks until they could get in to see the oncologist. I certainly understand the reality of our current healthcare system and that we cannot simply create availability out of nothing. But what was the expectation for this patient? That they would sit passively by, watching TV and just wait for their number to be called? Why are you surprised that a patient is doing web-searches to understand what is happening, when the best you can offer them is a number at a deli counter?
Let me be clear, I am not blaming clinicians for the reality of a healthcare system that cannot efficiently treat all patients immediately. I am not blaming modern medicine for not having solutions to all ailments. What I am saying is that what patients hear when you say that you only care about ass-saving is that you don’t really care about them as people. That you seem unaware that there is a human attached to that ass you are attempting to save. They will remember that when they need something in the future and they will certainly remember that if you need something from them in the future.
1If you believe this, I think the FDIC or the FDA may want to have a word with you on this front.
PX Matters with Joseph Snipp 
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