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


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.



55320cookie-checkHow to be an Authentic Doctor #22: The Customer Is Not Always Right