Customer Service: Mailbag

Last week's show on putting customer service into health care generated a large number of really thoughtful and reflective emails from you. Click on the link below to read some of the best of them.
We received many emails from patients and their families eager to share their experience on the other side of the divide between customer and health professional.  

Julie Kristof, Montreal
"Thank you for your show yesterday. I have a daughter who is now five years old and has been diagnosed with a chronic neurological disease. We spent a lot of time in the neonatal intensive care unit at the beginning of her life and were in and out of the hospital over the first few years. Now, thankfully, we have been able to manage well at home. I have to say that my interaction with the medical staff...was stellar  With few exceptions, we as parents always felt part of the conversation, were asked how we felt, if we needed anything, had any questions, etcetera. Dr. Shaw was musing on the show that when she asks her patients if she can do anything more for them, many are not sure how to react. One thing that I found helpful was having a notebook and a pen with me during rounds and meeting with the staff. Before the rounds each day, I would prepare my questions, suggestions, thoughts. So when it came to the "can I do anything else for you today", I was prepared to ask about the items that were not crossed off. It never took more than a few minutes to answer my questions. Perhaps providing a pad and pen for patients would help? Let them know that it's ok to take notes, even tape record a conversation so one can listen to it again later on in order to absorb all the information.  Thanks again for your show."

Jacquie Adain,Scarborough, Ontario
"I was reminded of a time when I had occasion to be in the emerg... a couple of years ago with a very painful ankle. Several things happened that did not sit well. First, I had ask for a wheelchair. No one seemed to notice that I could barely put weight on my foot. The nurse who took me to the desk to register told me to walk into the examining room. They also wanted me to walk into the x-ray department. The intake nurse/receptionist wheeled me in because she could see that I was in pain. I was there for quite a while and noticed someone else being offered a sandwich. I asked if I could have one and advised them that I was lactose intolerant and didn't eat pork. A young nurse brought me a ham and cheese. When I told her I couldn't eat it because I couldn't eat cheese or pork she yelled at me that that's all there was and I should be grateful. She may have been having a bad day --  I don't know and I wasn't trying to be difficult but I don't think I deserved to be yelled at. I went hungry. Not a happy experience."

Barb Kibler, Southampton, Ontario
"A few years ago I had elective surgery on both my feet. Things went as planned and I stayed the night. My husband went home, traveling 30 kilometres. The next day when he ventured out there was a tremendous snow storm; zero visibility, all roads closed.  My luggage, purse, ID sitting in the car. When I was able  to hobble to the bathroom the doctor discharged me.  The nurse came in a few hours later to tell me I had been discharged and I must leave. I explained I had no clothes, just hospital pjs, it was -20 C outside, I had no money and no identification and my husband was 30 kilometres away.  And I knew no one in town.  She went and got her supervisor, and I explained things again. He proceeded to tell me I must leave and I had to figure it out. I started to laugh;  I thought they were kidding and the painkiller I was given was wearing off fast. I explained again that I had no where to go,  the highways were closed and I had no clothes or money. I can just see the look on the face if I showed up at a hotel with and no money and casts on both feet.  He told me he was going to get security. Clearly the situation was a one-off and an exception had to be made. I finally said to them think about this, you give me a solution and I'll leave, but until then I was not going anywhere. They finally left, and I stayed the night and left the next day. Still to this day I cannot understand how the nurses could not read the situation and automatically come to their own conclusions. I imagine a lot of paper work was involved."

Name withheld, Calgary
"In a matter of 24 hours,  my mother- in-law was diagnosed with lung cancer then bone cancer. While we rallied around her and her health quickly worsened we found it challenging communicating with her medical staff. She kept saying they' re not listening to me. Although we tried to comfort her, she was right that they were not. Listening to your program today and hearing your guest say 'is there anything else I can do for you?" -- it was as if a light bulb going on. Not only would that have been a great opportunity for us to ask questions it also would  have given her the opportunity to speak up, for herself. There is an obvious superiority complex in the medical field but that should not absolve the doctors from the act of civility. Not once did my mom receive care from someone that showed an ounce of compassion. She was terrified and unsure of her future and through everything she had to fight to be treated like a person. For the sake of our loved ones, I hope at least one medical professional heard your show today."

Name withheld, Ottawa

"The point made in the show about the power wielded by receptionists really hit home.  In my early 50s (just a few years ago) I had double by-pass heart surgery. There is no question that this saved my life and that the surgery was necessary. However, my recovery has been awful with a great deal of pain and discomfort at the incision; the surgery also seems to have exacerbated long-standing back problems causing more pain and discomfort there. So, I hope it can be understood that every time I go to the cardiologist for a checkup, once every six months, I am not in the greatest frame of mind to start off with. My last visit started with the news that I would have to pay for four hours of parking in the lot in front of the cardiologist's office.  Four hours! I usually spend all of five minutes getting an ECG and another five with the doctor. Things headed downhill from there I was greeted by a surly, condescending receptionist who, rather than having the sensitivity to help me ease my way into the appointment, just set me off. She treated me like an ignorant moron and I just couldn't let it pass by as I should have. I yelled back at her not really knowing what I was saying at that point. After waiting some time in the examining room, the doctor comes in to tell me that "the clinic has a zero tolerance policy."  "A what?" I thought to myself.  At first I didn't know what he was talking about. Long story short, he said that he would complete that day's examination (which amounted to him looking at the ECG and my BP) but that I would not be allowed back. He said he would transfer my records to whichever cardiologist I went to next. At first I thought he was kidding.  But he was not.  He wrote to my GP saying, essentially, that I had been expelled and that my GP should find another cardiologist for me. So the question is, having a record of good behaviour essentially forever until that day, do I deserve to be turfed out on the basis of a policy of "zero tolerance"? Sure I understand that doctors feel that they have to back up their staff, but is it a one way street?  Did the cardiologist ever discuss how the receptionist could have handled things better, how she could improve her "bedside manner"? I'm pretty sure he did not as he laid 100 percent of the blame on me. If a receptionist knows that she or he is unconditionally protected, regardless of their demeanor, what incentive is there for them to improve their interaction with patients? Can they get away with ANYTHING?  Question for Dr. The way this whole thing was handled has made me feel like a criminal and certainly will not help how I feel when it is time to go to my new cardiologist."

Janet Bavelas, Department of Psychology, University of Victoria
"Dr. Shaw seemed to say that, in response to her question, no patients actually reported any unmet concerns. This result could have been predicted from the attached study on exactly how the question is phrased. I hope that her blog and your item will not encourage physicians to ask the wrong question, if they really want an answer. The interview also raised the broader issue of whether "patient-centered care" is simply physicians unilaterally acting with empathy toward their patients. A better definition would be bi-lateral, that is, it would also include accepting information from the patient, in this case, unmet concerns that the physician has not thought to include."

Chase McMurren, Toronto
"I had the unique opportunity to listen to the program today while taking a road-trip with a carload of family medicine residents en route to a retreat. I felt compelled to write about some of our discussion. I think it's important to share the good news that, at least from a primary care perspective, family medicine residents are now being trained to practice in a patient-centered way. It should be a comfort to patients (or, customers, in Dr. Shaw's words) that my car of family physicians-to-be was a bit shocked that asking patients how we can help them is something novel. The approach to patient care has changed; I think it's fair to say that our specialty training as primary care physicians emphasizes the ability to connect with patients in a meaningful way. Suffice it to say that new physicians take for granted the training we're being given, and hopefully patients will benefit because of it - our (expected) autopilot is patient-centered (or better yet, person-centered), and aims to keep patients in the driver's seat when it comes to their health. I commend Dr. Shaw's effort to check-in with patients; I wonder, though, if asking patients and their loved ones what we could help them with at the beginning of an inpatient ICU visit rather than the end would provide the opportunity to elucidate their agenda/goals/questions/fears and offer the opportunity to more meaningfully meet them where they're at (before the blur of potential med-speak threatens to cloud the encounter). From an interesting semantics perspective, research has shown that the yield is greater when physicians substitute "something" instead of "anything" when they see how else they can offer help. I suspect that "something" seems in genuine search of the specific; whereas,  "anything" can come off as hollow and hurried like a cursory "how's it going" when crossing paths on a hospital stairway. Thanks again for exploring this important topic!  Other issues that emerged like single issue-visits, patients as customers and medical education are all ripe for further discussion (and debate)!"

Dave Brown, Vineland, Ontario
"The radio show this week inspired me to drop a quick note on customer service from the experience of an observer of the West Park Healthcare Centre in Toronto. It seems this organization has the right idea as far as paying attention to customers (ie. patients and visitors) with creative and innovative ideas for raising funds to help finance the critical patient care delivery service model. Customer service can involve responding to the demands of a dynamic marketplace. At West Park this sensitivity may apply with its cuisine offering (often neglected or disregarded entirely by many hospitals).  In this case, the hospital is leading the way, as its Food Services Production Supervisor, Tina Braun was awarded first prize in the Kraft Philadelphia Cheese Cheesecake of the Year recipe challenge for her Pumpkin Spice Latte Cheesecake with Pumpkin Seed Brittle and Cinnamon Nutmeg Cream. The Centre has suggested that the menu selection may not initially be on the regular food services menu, but the retail cafeteria Presse Cafe could provide a welcome culinary treat for patients, staff, volunteers and visitors."

Tony Lort, Vancouver
"Today was the first time I listened to your show but it won't be the last.The one thing that scares me more than anything else is when medical professionals consider me as a customer. I want to be considered as your patient, a person who you will do your utmost to help keep healthy. I do not want to be considered as though I'm some guy in the line-up at Tim Horton's waiting for his double-double and doughnut. Yes, health care professionals need to be paid for the excellent care they provide but please I'm not your customer. I really liked the direction that the ICU Dr. is taking although I think that maybe the question might be better phrased as "Are there any questions or concerns that haven't been answered?"  The phrase she is using makes me feel like I'm back at that Tim Horton's again."

Maureen McCartney, Winnipeg
"I was happy to hear Dr. Susan Shaw ask her patient's the question "Is there anything else I can do for you today'. I think this question puts a human element  into the doctor-patient relationship and adds a wee touch of "I care about you." I hope that docs are not coming out of med school thinking that they always have to supply all the answers, they DON"T and a touch of humanity goes a long way and so does "I don't know ,but I will find out and get back to you!" I think that approach is a more palatable than the the super-human approach which some docs fall into. I was shocked to hear you, Brian ask the patient you interviewed (Heather Thiessen). 'Why do doctors and nurses not ask Dr. Shaw's  question?"  In my long  and varied nursing career I would never have left a patient's bedside 'without' asking that question, it was part of good nursing care; just like observing a patient's face and body language for non-verbal communication! Much is gleaned from eye contact, facial expressions and a quick head to toe observation! I hope Dr. Shaw's approach catches on through all medical disciplines. Thanks Brian I love your show."

Janet Garnhum
 I have just listened to your program on customer service in medicine, and I thank you for it. I have never encountered one of these "one problem only" people, but I have known of them for many years. I find this practice disgusting, and I think such physicians are a disgrace to their profession. I am the widow of a general practitioner to whom I was married for 50 years. In my husband's life, the patient was the centre of his universe. In fact, the other time I wrote to you was about the time he went to work immediately after a fall in which he had cracked a couple of ribs. My husband's philosophy was that the person in the room with him was the most important person in the world. There could be 10 people in the waiting room, but they didn't count. He gave his entire attention to the person across from him. He was fully, fully aware that the condition people present when they come to the doctor is not always the one on their minds. Patients come in with a hangnail when what they really want to tell you is that they read an article about a disease and fear they may have it, or that their son is in jail or their mother has cancer. Dan was very good at ferreting these things out, which may be why his patients loved him so. Meanwhile, I must confess, that I have never been to a doctor who did not treat me like a person, or who did not give me all the attention I needed. I also confess that I have at times not brought up a problem because I have felt that I have taken up enough of the physician's time and he/she has more patients to see. One of your greatest fans."

We are certainly fans of your wonderful comments, questions and messages.  Thank you so much.
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