Patient Care vs. Customer Satisfaction
> 1/4/2006 3:24:34 PM

In an essay in yesterday's New York Times Health section, Dr. Richard Friedman examines the often tenuous relationship that doctors have with patients as both those in need of care and those who are "buying" a service.  He mentions that more and more, patients must be viewed as customers who are in need of services.  When these services are rendered in a comfortable and timely fashion, the customers are happy.  But health care is almost never clean and easy, and often it can be very painful or uncomfortable.

He relates a particular anecdote where a patient complained about the psychotherapy that she was undergoing, saying that the resident that she was seeing had a "challenging manner" and was often late.  As Dr. Friedman relates, this woman was dealing with borderline personality disorder, a mental health affliction that is often categorized by extremely temperamental behavior.  Dr. Friedman describes her: "[she had] a very fragile sense of self and drastic shifts in her mood in response to even the mildest interpersonal friction."

The trouble is that her complaints about her relationship with her therapist were directly related to her problems.  Beyond that, Dr. Friedman knew that because she was being challenged, the therapy was working.  The point of this, as he makes clear, is that treatment, especially in mental health care, is not clean and easy.  Patients get upset.  Doctors can be challenging.  Therapists are not meant to hold a patients hand and tell them that everything will be okay.  If it were that easy, we wouldn't need to see therapists, our mothers have that function on lock down.

Dr. Friedman's conclusion is a great one:
But in good psychotherapy, it is not possible, let alone desirable, to keep patients happy and satisfied all the time. Frustration, anxiety and discomfort are unavoidable in life, and in therapy - particularly for patients with certain personality disorders.

This isn't to say that doctors and hospitals shouldn't submit to intense scrutiny of how they do things. But they can't be blind to the fact that good treatment doesn't always feel good. Conversely, sometimes patients feel good about years of bad psychotherapy that is doing little to help them.

For medical consumers, there is a message here: good medicine sometimes means that the customer - I mean patient - isn't always right.

Or even happy.

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