It was one of those meetings. I was the only physician or medical person for that matter at the governance meeting of the medical center. Everyone else was either a businessmen, accountant or lawyer from the administration. One by one they presented data on the finances of the medical center. Which DRGs we made money on, which we lost on. Then came in the team for marketing. they showed us the demographics of are area, age, income. They explained that we needed to be focusing on certain patients with our advertising and our services so they would want to come to our medical center. With each presentation, the term patient was lost and customer was substituted.
When the presentations ended there were all kinds of questions about how to market to the "customers" and why certain ones do not come to the downtown hospital. Finally, it was my turn. I asked "Where do our patients come from?" I got the look of looks, and then with exacerbation, the MBA of marketing pulled up the slide of the demographics of the referral area. I just look at him and stared. Finally, I said. "Look, patients have primary care docs. You chased them all out of the hospital. They want nothing to do with you. When Mrs. Smith calls her doctor because she is not feeling well, he is going to tell her where to go. Hospitalists are great, when they work with or for the internists and family docs, not when they work for and only for the hospital. When is the last time you have seen or talked to any of the primary care docs in your pretty demographic slide?"
"If you want to market, work with the primary care docs in the referral area. Show them that you are going to give their patients' the best care. Streamline admissions, testing and follow up care. The referring docs are your customers." "If you want to market you are the best heart center, convince the PCPS and the outside cardiologists." "Ms. Smith is going to go where her doctor tells her she will get the best care."
The rest of the people at the meeting just started at me like I was an alien and then began to discuss their confustion why the biggest Ortho group was moving its cases to the other medical center.
8 comments:
Health Care is weird, isn't it?
There are tons of really, really smart people involved, and most of them do incredibly dumb things. It's an ouroboros of idiocy.
You are spot on with your critique of the "marketing" people, Doc. One of my jobs is at an Urgent Care/Family Medicine place. The payer mix is great - 80% private insurance and 20% self pay or Medicare. We don't accept Medicaid. There are two hospitals within 10 miles. One hospital has a rep who comes by once a month and chats with us in the clinic - not just our docs, but the front desk people and us mouthbreathers in the back who shoot x-rays and do IVs and take vitals. The rep listens. The hospital either explains why inconvenient policies are in place, or works to change them to better serve our patients. The EM docs will chat with our docs about patient management if they have time. That hospital has a records department that actually returns phone calls. The charge nurse in the ED appreciates when I call to give report on a patient we're sending over - treats it like a friendly "heads up!" and not like I deliberately sickened someone to make more work for them.
The other place has five minutes of phone hell before you can get transferred to some obscure voicemail instead of a person who can answer a simple question. The charge nurses and unit secretaries refuse to speak to anyone but a doctor (no shit!). The records are kept on papyrus scrolls in obscure runes. If I burn enough offerings, a wheezing, aged scribe will feebly toss them at any vehicle heading in my general direction, then promptly absolve himself of any responsibility for said patient record.
That Urgent Care/FM place has 20,000 pt visits per year. Where do you think we send the pts who need more involved care than we can offer? It ain't rocket surgery, and you don't have to be an MBA to figure it out.
Great Post!
At the hospital I worked in, we were instructed and then tested on our retained knowledge ..that as employees ..we were to view everyone as customers ..thus give good customer service. And it was pointed out who the hospital's inside customers and outside customers were. The importance of physicians being customers was emphasized. Physicians were considered customers who in turn brought more customers.
Initially, staff didn't like hearing patients referred to as customers.But ..it's true from a business perspective.
A few years ago I gave one of my docs a thank you note ..for him, partners and staff. It was the first one I gave them. I forget what we were discussing as he was leaving, but I remember him saying something about the note meaning something because "You were in the business." The inference was the note meant a little more because having worked in a hospital ..I had an appreciation for how things really are. that's how I took it anyway ..which was true. But I remember being taken aback with the comment because even though we had it drummed into us by then that the hospital had customers and was a business .. I still thought of it as a hospital, medicine and patients/docs that we were to give good customer service to... but it was about the people. (to me) I didn't think corporately, even tho I knew it.
I think business and customers seems cold, impersonal vs the humanity of it all. Yet without the business end ..we wouldn't have the facility and staff to help the customer-patients.
Sorry ..went off track a bit. I also remember our administrator talking about wanting to fix some offices and draw docs in because ours were getting older and we would be needing new ones. My impression was that he was looking to give them the red carpet treatment
"I just look at him and stared." That's funny. I mean the situation isn't ..but the way you describe it. :)
One of my docs passed away. he wasn't really my pcp, although was evolving that way because of some hospital stays. My pcp is affiliated with another hospital system and so this other doc (I also saw for other things) along with my urologists saw me on rounds. I didn't even realize hospitalists existed until reading the medblogs. I have to say ..I much prefer having the physicians that know me checking in vs a stranger. Now I guess ..I will get a hospitalist in future if ever in need of a doctor as an inpatient.
And like you said "Hospitalists are great, when they work with or for the internists and family docs," I still think no one knows the patient like their Dr does. A friend with lung CA was getting a different hospitalist everyday. i guess facts are fact and that is what they work with ...but I still think there is something to havein a relationship - knowing your patient that might alert the pcp whereas a stranger to the pt may miss something. And maybe I am wrong about that. I'm glad I have had my personal physicians tho.
I agree with you on all your points.
I took my comment out because not related to your intent for the post. I'm just over thinking my decisions. Your Ms Smith got me thinking about it.
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