How to be an Authentic Doctor #22: The Customer Is Not Always Right

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In any other business the golden rule has been that the customer is always right. Nowhere is that more UNTRUE than in medicine. Why? Because giving patients anything they want does not make for good medicine. In fact, it could kill them or lead to addictions, side effects or unnecessary procedures.

The bottom line is that patients are not trained like physicians. They didn’t do four years of medical school and years of residency. They haven’t seen thousands and thousands of cases to compare to. Wikipedia isn’t a reliable substitute for this training. This doesn’t mean patients’ opinions and input are not valid. It just means that our input is just as valid, if not more. A case in point is a patient demanding an antibiotic for an obvious virus. If the customer was always right then in this scenario, which occurs thousands of times a day across this country, that patient would walk out the door with a Zpak or Augmentin and pretty soon our country would have no useful antibiotics left.   This example holds true for patients with tick bites as well. Little secret, not every tick bite needs Lyme prevention.   How about MRIs and CT scans or other expensive diagnostic tests? If they are not warranted then they should not be ordered. Will that piss some patients off? You betcha. But it is the right thing to do. Trying to make them happy could create an extra expense for all of us as well as lead to wild goose chases after finding false positives.  That just creates more problems in the long run.

The doctor/patient relationship is a very unique one.   With a good relationship built on time and trust, many patients will listen to the advice of their physicians and the issue of who is right and who is wrong does not come up. Disagreements can still happen but they are rare and they can be resolved.   When there is no relationship, however, there can be animosity and distrust both ways.   This occurs with new patients or patients going to an ER or urgent care. I have been there and there is no way to make everyone happy. What happens is that the doctor just gives in to move the unhappy patient out.

Here is the real golden rule for doctors. You need to treat each patient to best of your ability regardless if it makes him or her happy or not.   Making every patient happy could turn you into a pain pill doctor.   Making every patient happy could turn you into a disability doctor. No, patients are not always right.   Neither are we but all we can give it our best effort and follow the ethical and moral compass that we have as physicians.

What I am saying here will be picked apart by patient advocates claiming that I am arrogant.   I am just telling the truth and trying to teach the younger docs a lesson. By the way, this also means that physician satisfaction surveys need to be removed or ignored (tell that to your administrator) as they serve no purpose.  Studies show that the higher satisfaction survey scores are correlated with higher cost, higher morbidity and higher mortality.   Basically, it proves my points above.

 

 

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] 

  11 comments for “How to be an Authentic Doctor #22: The Customer Is Not Always Right

  1. Lady A of Gomerland
    July 6, 2014 at 2:52 pm

    I spent the Independence Day holiday listening to my elderly relatives talk all about how aggressively their docs are treating their diabetes. Why does an 88 year old with an A1c of 7 need BID accuchecks? What 10-year complications are we trying to prevent here? And don’t get me started on the “free” diabetic shoes and all the inappropriate screenings (pap tests on octogenerians, anyone?) that this crowd is having. I tried to talk evidence based medicine with them and got the “but what if YOU are that person who is missed” speech. I feel so bad for their physicians, I bet they’re a pain in the butt to care for. But then again, as physicians we still have the power to say no. I deny patient requests for nonsense every day.

  2. Dennis
    July 3, 2014 at 12:28 pm

    Great post, but I never needed to visit your practice to know you’re arrogant! Hahahahahaaha…. Just kidding Doug

  3. Alan Levine
    July 2, 2014 at 2:09 pm

    Great post!!! However…………….in this world of Press-Gainey and other unsubstantiated measures of “quality”and “satisfaction”, there often is a push to “damn the medicine”and have the patient (I will NEVER use healthspeak terms such as client) walk out happy. That is the price being paid because of the dominance of non-medical administrative pinheads.

  4. R Watkins
    July 2, 2014 at 11:10 am

    Actually, any self-respecting professional – accountant, lawyer, priest – knows that the customer is not always right. The pressure being put on doctors to act unprofessionally is part of an intentional, well-organized campaign, led by the whorish medical societies, to reduce us to the level of workers in a service industry. They’re succeeding.

  5. Kathy Wire
    July 2, 2014 at 9:43 am

    Great post. Except that, as one who has managed claims (“No, we can’t pay you $100,000 for that”) and managed patient grievances, I will argue all day long that your folks in those positions should back you in sticking to well-proven treatment approaches. If they don’t, then they need educating. Our job is to make sure that the physicians have the backing they need for doing the right thing.

  6. Lisa Gwin
    July 2, 2014 at 9:10 am

    How do I share this on Facebook??!!

    • Doug Farrago
      July 2, 2014 at 9:20 am

      Under the title is a like for Facebook. Doesn’t that work?

      • Lisa Gwin
        July 3, 2014 at 8:36 am

        No, it doesn’t work. And there is no Facebook option at the bottom of the post, just LinkedIn and Twitter.

      • Lisa Gwin
        July 3, 2014 at 1:05 pm

        Thank you for your help and individual attention! It is shared on my Facebook page. Have a great weekend.

  7. Stella fitzgibbons MD
    July 2, 2014 at 8:10 am

    Nurses, thanks to their early indoctrination, are especially vulnerable to the thinking that keeping the patient satisfied is paramount. I’ve seen several cases of aspiration pneumonia in patients who were fed all the morphine they asked for and some that they didn’t (“You look uncomfortable, Mr. Patient, how’s about some nice narcs/”). And in my own case recently (a week getting inpatient IV antibiotics), NOBODY encouraged me to get out of bed, presumably because I might not feel like it. And I assure you that deconditioning is not quickly reversed.

  8. July 2, 2014 at 7:43 am

    But arrogance is one of the few sins in a culture where anything’s permissible – except for what’s not. When one learns how to understand things, and becomes very good at them, and forms opinions without regarding the opinions of others – why that’s arrogance, and must be slapped down.
    Now, with medical homes, we shall arrive at medical decisions that pass the test of being tolerated by the most petulant toddler at play circle – a social consensus among fractious and jealous ‘provider-teams’ with members not speaking to each other because of who’s filching out of the coffee fund.
    Hell is an eternal High School of the soul. Let’s bring medicine to where it belongs.

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