The difference between care and service is significant

The difference between care and service is significant

the current state of medicine, where it feels like doctors spend

  • 75 percent of their time battling with the electronic medical record,
  • 15 percent of their time battling with insurance companies for authorizations,
  • 10 percent of their time apologizing to patients for running late,
  • 10 percent documenting patient-care hours and
  • another 10 percent of their time actually providing the kind of care they went to medical school to provide.

(Wait, does that add up to more than 100 percent? You get my drift.) 

the point is to figure out how to provide the kind of care old-school doctors could provide in the current environment.

But when a patient went into cardiac arrest, the bag-valve-mask was hidden behind fancy wood paneling, and no one could find it for a few precious minutes. I’m sure the patient satisfaction scores on that unit were very high, but one could argue that the most important question on such a survey should be, “Did you live, or did you die?”

So I wish that the medical-industrial complex comprised of patients, insurance companies, and administrators would allow physicians to prioritize care over service.

One lesson I learned as a patient: it’s OK to wait your turn.

I’ve called the pediatrician’s answering service late at night about a fevering toddler. I’ve felt the irrational parental fear, the frustration with the endless automated phone tree and interminable wait for the pediatrician to call back.

But just because I want to call the physician’s cell phone and get an immediate response, doesn’t mean that, medically, I need that immediate response

When I keep a patient waiting, I apologize but also let them know that the delay wasn’t because I was drinking coffee or watching television, but providing care.

Another lesson I learned as a patient: It is important to trust the experts…

When it comes to dealing with pain or opioids, the “experts” are often flat-out wrong according to current data and research.

They seem to rely mostly on the media (including medical publications), which follow public sentiment instead of science (dollars instead of sense), and other self-appointed “experts” arising from the same distorted public perceptions.

They have been completely fooled by the anti-opioid and unscientific views of a few extremely vocal anti-opioid activists, mainly from the PROP group.

PROP is a group of mostly “interventional” pain specialists who stand to reap huge profits from pain patients no longer able to access opioids, who become desperate enough to allow invasive procedures that often leave them in even more pain than before.

I chose my obstetrician because he was experienced. When I was admitted to the hospital in labor and asked about my birth plan, I said, “My birth plan is Dr. B.” (And an epidural, let’s be honest.)

Because the music and the lights and the decision to ingest the placenta were window dressing; all I needed was a healthy baby, and Dr. B was my best shot to make that happen

I wish patients knew that Dr. Google is not a substitute for years of training and practice.

When a patient asks for antibiotics for a viral upper respiratory infection or a stress test to evaluate noncardiac chest pain, I believe it is acceptable to say that you know more than they do and explain the flaws in their medical reasoning.

Of course, wishing that patients would wait their turn and accept that the doctor is the expert does start with patient trusting that their physician’s sole motivation is optimizing health and well-being.

The best way to share this: tell and show. Tell by explicitly stating this obvious fact to patients and show by recognizing that there are instances where better service does mean better care.

  • Care is the effort we expend to optimize our patients’ health and well-being.
  • Service is the details that lead to burnout.

I wish patients knew that when the service appears suboptimal with long wait times or doctors not ordering the tests they believe they deserve, the real question is whether their care was compromised.

As physicians, we cannot easily stem the outside pressures on the system, but we can try to strengthen the patient-doctor relationship, one encounter at a time.

Author: Michelle M. Kittleson is a cardiologist.

3 thoughts on “The difference between care and service is significant

  1. canarensis

    It’s sorta funny to me that people so often complain about having to wait for their appointment (& I do myself, occasionally). I was a very sickly kid, constantly going to doctors. I received allergy shots from about age 4 til 15 or so, and the allergist we went to ALWAYS had a wait of at least an hour, frequently 2 or 3. Mom and I would each bring a stack of books. God knows why that office did that in the mid 60s-70s, and I can no longer ask Mom except by Ouija board, but I got programmed early to accept the fact that “doctors make you wait.” It’s a lot more aggravating as an adult with responsibilities, of course, but most of the time I just read & ignore the time.

    What I do have huge problems with is that fact that it’s impossible to believe any more that doctors actually give a flying rip about their patients’ well-being. Beyond trying to make sure they don’t get hit with a lawsuit, I feel like doctors view patients as so many pieces of sausage to be ground through the works & passed out the door with as little fuss, attention, and interaction as possible. I know my former pcp cared, but she retired. The chance of finding a new doc who sees me as a person with health problems instead of merely a problem to shuffle out of his office as fast as possible appear to be between slim & non-existent. And forget even thinking about pain treatment –not that Oregon is going to allow that after October, anyway.

    I’d wait all day if I thought there was the slightest chance that I’d eventually see someone who wanted to try to help me, rather than someone who viewed me as an aggravation at best, a lying druggie at worst. But I think I’ll be waiting forever before I see someone like that, in this new Age of Corporate, Sadistic Medicine. And I will not be extorted into dangerous procedure which are likely to render me in even worse shape than I am now (ESI, for example). I would, literally, rather die.

    How did we get to this place in Hell?

    Liked by 1 person

    1. Zyp Czyk Post author

      Both doctors and patients are being squeezed for every last drop because healthcare has become a big corporate business and the focus has changed to purely profits.

      Back when I was still seeking a diagnosis and saw many different doctors, I noticed the best ones usually had the longest wait. It was because they spent more time with their patients, just like they eventually spent more time with me when I finally got to see them.

      But now, everything runs like clockwork because time/money has become paramount and there’s no time allotted to actually having a conversation with a patient (unprofitable). I don’t know how I would have fared in today’s system back when I was so desperate to find my diagnosis and had the privilege of telling several doctors enough of my story so they could help me.

      Liked by 1 person

      1. canarensis

        It’s a horrifying thought, isn’t it? wondering how many people are going to flail along without a Dx b/c docs are too busy to spend any time or attention. I know when I read that story that said doctors let a patient talk, on average, 11 seconds before interrupting, my immediate reaction was, “That long?!”

        Why in God’s name anyone can actually believe that a profit-based system would provide decent care is beyond me; it’s not based on care, it’s based on PROFIT.



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