Is The Patient Always Right?


Customer service was not a priority in the old days for physicians.   Like a pendulum, trends like this swing both ways and unfortunately to the extremes.   In the old days, doctors were revered and you didn’t question them.  I have had some bad interactions with physicians like this growing up (and even in my early days as a family doc myself) and it made me fear and despise a lot of them.   They gave you an attitude and could be real asses.   That has changed, thankfully.   That same pendulum, unfortunately, has swung the other way.  Now the customer/patient may have too much power.    Heresy, you say!  I know this is politically incorrect but it’s true.  They can complain to your employer, which is more and more becoming a hospital who uses this information against you.  They can complain too easily to the Board of Medicine who loves to meet quotas in how many doctors they discipline.  They can screw you on the unproven satisfaction surveys.   Yes, I know there are legitimate concerns out there by patients.  I get that.  But there are many patients who love this newfound power.   I had been thinking about a way to explain this when I found this blog entry by Matt Walsh.  I have to put the whole thing in here because it is too good:

I could have taken a picture of you and posted it here to publicly shame you, but I didn’t. That’s because I am not trying to be vindictive, ma’am. I’d merely like to answer that question you posed. This can be what the politicians call a “teachable moment” for you and everyone like you.

See, I was in line at that particular fast food establishment yesterday. You probably didn’t notice me — I assume you didn’t notice any of us from the way you blatantly barged to the front. I was about to tap you on the shoulder and politely explain how lines are supposed to work in a civilized society, but I could tell you were in the throes of an ungodly rage. I figured this must be an emergency. My God, you were practically foaming at the mouth. I thought maybe someone at the counter had killed your dog, or framed you for a murder you didn’t commit, or urinated in your oatmeal this morning. Obviously something serious was going on.

Then you suddenly screamed, “NO ketchup! I said NO ketchup!”

Okay, so maybe this wasn’t a dire situation. It was a condiment situation. Not exactly life or death, but close enough, I guess. The girl at the cash register looked confused. I don’t blame her, some irate middle aged woman just barreled in the door yelling about ketchup. She asked you for some clarification, which was reasonable, but apparently you didn’t think so.

“What’s wrong with you people?! I just sat in the drive thru for ten minutes and now I have to come in here because you guys can’t understand f*cking English! I ordered this burger with NO ketchup but of course I get it with gobs of ketchup. Unbelievable. This happens every f*cking time!”

Wait, it’s unbelievable yet it happens every time? Hmmm. And your ketchup specifications are this important to you yet you continually come to the one place in town that apparently has a ketchup obsession? There are literally six other fast food joints within a two mile radius, but here you are at the one place that screws up your order “every f*cking time.” Interesting. Logical thinking isn’t exactly your forte, is it?

The poor girl at the counter, who likely had no hand in this ketchup fiasco, offered to give you a new burger, plain and dry, just as you prefer. But that wasn’t good enough, was it? Their failure to obey your demands must be punished.

“No, I don’t want a new burger. Give me your name and the number to corporate. I’m sick of this sh*t. Give me my money back and the number to your corporate office! Why can’t I ever f*cking get good customer service?!”

And the exchange went on from there. You of course handled yourself like a woman of culture and dignity, while the fast food employee and her manager tried everything to find a remedy for the Tragic Ketchup Calamity. It ended with you promising to get them all fired as you stormed out. Then I finally had my turn at the counter. I ordered a burger. With extra ketchup.

Now, I replay this back to you because I realize you probably scream profanities at minimum wage customer service representatives every time you run an errand or grab a bite to eat, so you might not recall the specifics of this one incident. And that brings us to the possible answer to that query you posed in the midst of your ketchup rant. You asked: “Why can’t I ever f*cking get good customer service?” Well, ma’am, that might have something to do with you being a vulgar, miserable, malicious person. Maybe you get bad customer service because you’re a bad customer. Did you ever consider that possibility?

I get it. “You’re the customer so you’re always right.” They work here so they have to bend over backwards for you “because that’s their job.” Well, you’re partially correct about that. Yes, you are a customer and, yes, they do work here. But it’s actually not their job to deal with psychopaths. They aren’t hostage negotiators, they’re fast food workers. And even if the powers that be at these corporate chains push this “customer is always right” crap because they’ve decided it’s good business to placate horrible jerks, in the real world, outside the land of plastic chairs and soda fountains, adults who throw temper tantrums in public are never right about anything.

I’m sure some people might take your side. They might come to your defense by telling their own horror stories about all the times when customer service has failed to live up to their standards. Those folks are under the same delusion as you. They think their hallowed “customer” status somehow gives them the right to treat everyone with a uniform and a name tag like garbage. They think their past encounters with sub-par service makes it acceptable for them to fly off the handle about ketchup every once in a while. They think the rules of basic decency and respect come second when they are The Customer. And they’re wrong.

Do you ever wonder why we have so many atrocious politicians in Washington? Well, you shouldn’t wonder. Just look in the mirror. Bad politicians are generally bad because they can’t handle power. It goes right to their head and they become narcissistic, petty, controlling sociopaths. But at least it’s a lot of power so the temptation to be corrupted by it is almost understandable. You, on the other hand, become a maniacal tyrant when society hands you temporary and meaningless power over 17-year-old fast food cashiers. I shudder to think what you’d do if you had an army at your disposal.

We all get a little unwanted ketchup every now and again, and we are all expected to handle it like mature and decent adults. Some of us manage to make it through our whole lives without ever feeling the need to berate restaurant or retail employees over some small and fixable mistake. Other folks, such as yourself, seem to get into a customer service Battle Royale every time they step outside their house. Maybe it’s because the universe is against you guys. Or maybe — just maybe — it’s because you behave like selfish obnoxious bullies.

Just something to think about.

Oh, and I’m betting you actually forgot to say “no ketchup” when you placed your original order. Wouldn’t that be a totally expected twist to this captivating saga?

Has anyone else seen this person come through your medical office?

Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  9 comments for “Is The Patient Always Right?

  1. Patti
    August 29, 2013 at 3:48 pm

    As a former ER nurse, I saw MANY of these people. Several of them would come up to me and demand “when are we going to be “waited on”? I would tell them clearly – If you want to be “waited on” you should go to a restaurant. This is an ER – we will TAKE CARE of you in the order of your TRIAGE designation. Since most of them didn’t know what that meant – it usually stopped them cold… least for a little while. 🙂
    They also wanted enough tape, bandaids, bandages, etc to be given to them so they could change their bandages for the required length of time without having to go buy any supplies. I once told a woman her kid had better shoes on than I could afford to buy my kids – I’m sure she can afford to buy a box of bandaids at the dollar store. My mom swore one day someone was going to be waiting outside the ER to shoot me for saying those things.

  2. Anonymous for a reason
    August 28, 2013 at 12:48 pm

    I am genuinely afraid for my job as staff physician in small community ER managed by a big company. I had this woman handed off to me at shift change with a chief complaint of right-sided abdominal pain. No red flag symptoms, unimpressive exam and she mainly came in “because it was making her migraines worse.” My colleague had ordered a contrasted CT study to (A) punt her to the next doctor and avoid having to dispo her, (B) make sure he didn’t miss the needle in the haystack and have to endure a lawsuit and (C) because CT scans are free, as she clearly had no intention of ever going to the clinic. Sounded more like biliary colic, but a negative CT and 2 mg of Dilaudid ought to appease her and lyse the colic. And I can order an outpatient GBUS and tell her how important it is that she get this taken care of to avoid an emergency surgery and pancreatitis. No problem, right? Well, after her 5-hour visit and a negative workup, she says, “So, you’re sending me home? To go through all of this again? You’re just sending me home to suffer?!” I told her, “Not to be crude, but yes, I’m sending you home. Although you have pain, you do not have an emergency. You were seen here for the same thing three weeks ago and have not bothered to follow up with your primary care doctor. (Because she can’t afford it. You don’t actually expect me to pay for it, do you? How am I going to pay for my cigarettes and to keep my hair bleached then colored purple, you jerk?) You have to be responsible for taking care of yourself I made the mistake of telling her. You probably have a gallbladder problem. There’s no evidence of infection or obstruction. I will go ahead and set you up to have an ultrasound study, but you will have to follow up with your doctor.” I leave the room to set up the GBUS, which I am told “the earliest appointment they can do is in 8 days,” and “the patient would like to speak with you again.” (In other words, “The Queen orders you to appear before the royal court.”) I go back in the room to be reminded what an evil person I am for not fixing this problem for free, right here, right now. “Well, you’re in luck, because I don’t think 8 days is acceptable, so I’m ordering an ultrasound right now. But if the test is negative, you are going home. And you can follow up with your PCP.” Of course, radiology drags their feet now, as I have pissed them off, and four hours later tells me her exam is negative. No gallstones, normal female organs. To demonstrate my compassion, I think I ended up giving her 4-5 mg Dilaudid, 2 mg Ativan, and I set her up for an outpatient nuc med GB study, which she will never get. Later I see the hospital administrator in the ER, analyzing the board that’s all lit up in the warning colors of “too many patients here too long,” wringing his hands. Either way I’m screwed. How dare I tell her she doesn’t have an emergency and she has to take some responsibility! That might even deserve a trip to appear before the state medical board, if she gets their address. On the other hand, a 9-10 hour visit to the ER just crashed some “metric” that determines my worth as an human being, and that’s all that matters to Massa.

    Can anyone help me out here? I’m beginning to think of just telling the hospitalist that anyone who needs a PO-contrasted abdominal CT study and more than 2 mg of Dilaudid is admission criteria.

  3. S. fitzgibbons MD
    August 28, 2013 at 10:16 am

    This happens at the hospital too now that “patient satisfaction” is beginning to affect reimbursement for medical care. And it includes drug-addicted sociopaths whose reaction to “I’m sorry but any more Dilaudid will be dangerous” is to pick up the phone and call Patient Relations. A doctor who gets too many of these individuals’ complaints is called in to the chief of service’s office.

  4. Sandy
    August 28, 2013 at 10:05 am

    Physicians shouldn’t have just one employer. All our patients should be our employers. We should work for ourselves, like we used to in the good old days. Then we wouldn’t have to worry about patients threatening our job security.

  5. Pat
    August 26, 2013 at 10:28 am

    How long before physicians are prohibited by their employer from firing a patient, before a “review” or some such is done to (further) protect the customer nodes this already happen?

  6. kevin
    August 26, 2013 at 12:21 am

    I see these people every day. I HAVE had them contact the board of medicine and file bogus complaints about my “demeanor” because they have nothing objective to complain about except that they don’t want to pay their deductible. The rabid BME then conducts a formal investigation costing me $6000-$10000 in legal fees that I can’t recoup even thought I am vindicated every time.

  7. EMarsh
    August 25, 2013 at 10:35 pm

    Any psychopath really should receive appropriate psychiatric consultation. However, for the occasional bitter chronically-dissatisfied-with-life patient that we all encounter I have a directive for my staff: have no patience for that patient.
    The happiness and productivity of my staff is more important than a person who would brazenly disrespect others. I demand respect of my receptionists, medical assistants, nurses, and patients by not allowing such behavior in my office (by anyone). Besides, if we bend over backward to accommodate rudeness then it gives abrasive people an unfair advantage. This works in a self-defeating way to generate even worse “customer service” through encouraging that behavior.
    For a great story about customer service look up former Southwest Airlines CEO Herb Kelleher’s letter to one of his constantly disappointed airline customers. Spoiler Alert: “Dear Mrs. Crabapple, We will miss you.”

  8. Dave Mittman, pa, DFAAPA
    August 25, 2013 at 2:46 pm

    I have a great disposition with patients. Of someone was like this lady and was cursing AT me, a letter of dismissal would follow.
    Life is too short.

  9. Ken
    August 25, 2013 at 11:56 am

    These are the only people who come to my office

Comments are closed.