The Patient Dilemma

Written by Jason T. Smith

September 28, 2020

In clinical practice, we generally find that sincere customer service cooperates with clinical effectiveness. That is, they act like a positive force couple. One promotes the other. 

The better you serve the healthcare “customer”  (your patient), the more they listen to your instructions, trust your judgment, and comply with your treatment. This, in turn, improves their clinical outcomes and health benefits. When patients get better, they feel positive about what you have done for them, which causes them to reflect more kindly on the service you have provided. Patient engagement and trust goes up. They recover faster. And around the Mulberry bush, we go. Everybody wins – and both customer service and clinical effectiveness come off looking good.

Some might even say, you can’t have one attribute without the other. Customer service and clinical results are inter-dependent, and therefore inseparable. 

I’m not sure I agree. Nor did a cohort of experienced clinicians who recently joined me online for a recent Practice #impact workshop.

Where’s the problem, then?

Well, sometimes what the patients “wants” and what the patient “needs” are not always aligned. 

I’m a physiotherapist, so in my profession sometimes a client requests a relaxation massage, when I know they really need stretching and exercise. Or they demand me to “click their back”, when the best advice I could give them would be around modifying their nutrition and coaching them to lose 15kg. Hands-on treatment may be their expectation, but a range of psycho-social “yellow flags” might lead me to believe greater education and referral for other services is in their best interest. 

Sometimes we are required to hold patients to account, give them hard news, impose some discipline, call them out, and even cause temporary pain to help them overcome their injuries in the long term?

Where does our duty of care lie when customer service might compromise our empirical clinical judgment?

For many, this is the great patient dilemma!

The solution starts with a progressive understanding of the partnership expected between patient and clinician in the modern health care context. Patient-centred care is about treating a person receiving healthcare with dignity and respect and involving them in all decisions about their health. It includes showing compassion, tailoring care to suit their unique needs, being empathetic, demonstrating active listening, and involving all stakeholders as relevant for an optimal outcome. It’s about putting the patient at the “centre” of their healthcare story.

Certainly setting clear and reasonable expectations with your patients helps to avoid conflict in the delivery of care. As does identifying who the real “customer” is, if at times it’s not the patient – as there are lots of stakeholders in the health-chain including other family, insurers, employers, compensable bodies, and the like. We have also found that identifying patient beliefs driving their service perceptions and expectations will go a long way to understating how to journey together.

At Back In Motion we have done some interesting client market research that gives insights into this real-world challenge, to help us walk the fine line we sometimes find ourselves in.

Below is a chart showing the top 11 characteristics patients value most in their practitioners in relation to a range of communications, expertise, and outcome-related measures. A brief review of these will quickly reveal some insights into how we can bridge any gaps that might exist between customer service and clinical effectiveness.

If I were to summarise my top 5 strategies to keep my patient at the center of their care, it would be the 5 Cs:

  1. Clock – be punctual and always value their time;
  2. Courteous – treat every patient like a loved family member, with dignity and respect;
  3. Clean – ensure my facilities and equipment are hygienic and comfortable – as it inspires confidence in my attention to detail;
  4. Client Language – use “their words” to describe symptoms, goals, treatment, and strategies as it keeps everything relatable; and
  5. Complaints – consider them a gift. Anytime I hear about dissatisfaction of any sort, it’s a prompt to do better and change my approach.

For all the patients and clinicians reading this article, be encouraged we all want the same thing for you. Optimal lifelong health. Sometimes we get caught between a rock and a hard place, but if we work together we can overcome the complexities and deliver both sustainable clinical results with personable customer service. 

My commitment, on behalf of those I lead at Back In Motion Health Group, is that we will never stop trying to deliver exceptional experience and excellent health outcomes- every patient, every time. 

[If you would like to listen to the recording of the online Practice #impact workshop recording on this topic, you can link to it here: ]

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