Customer Satisfaction in medicine

A recent survey- about ONE THIRD of responders are willing to buy into “customer satisfaction” as an open ideal such that maintaining corpses in an acute care ICU is should be a family right and privilege and the corpse should stay right there till the family gives permission to remove it. Given the current “customer is always right” climate in medicine, I sort of expected this but I am still amazed by it. I think those electing to appease this mother are sincere in their idealism, but sincerely wrong, and this has the potential to do much more damage than good.

Medicine is different than fast food. It isn’t like Burger King trying to do ANYTHING they can to outfox McDonalds. They’re fighting over the same burger in a different wrapper. It doesn’t matter what one is willing to do to garner more customer satisfaction because it’s a zero sum game. But in medicine, allowing customers to rule has the potential for disaster. Medicine is one of the few, perhaps the only “business” where the customer is not always right. And the customer should not always have what they want. There are points in the delivery where the customer might very well use faulty, and especially media fueled logic to desire things that are paradoxically detrimental. At some point, those who know better must step in and divert that detriment, whether the prospective patient likes it or not.

So, in medicine we try to create customer satisfaction in the realm of public relations. We see that they get treated fairly, equitably, with kindness and compassion and that they get accurate information they can make decisions by. We do not, however, allow open ended customer satisfaction in the realm of clinical decision making. It is here that the notion that the customer is always right has over-extended.

When a corpse reposes in an ICU on a ventilator, a family has a right to accurate information, compassion and sympathy for their situation. They have a right of reasonable visitation with the decedent to say their goodbyes and acclimatize. After that, they do not have the right to maintain a corpse on “live” support interminably as a manipulation to express their anger at the socio-political ethos that brought them there.

This mother knew her son was going to be dead 48 hours before the fact. He was shot in the head and was completely unresponsive and was told in no uncertain terms that the chances of survival were nil, even before brain death. There was time to acclimatize. Once brain death occurred, and the death certificate was filled out, she then intentionally manipulated the situation, not for anyone’s benefit but only to assuage her anger. She was angry at having to live in a war zone. Angry that her son got mixed up with violent illegal activities. Angry that the cops and the community could or would not do anything about it. And that anger spilled over to the caregivers because we were all part of the same evil system as far as she was concerned.

So in her anger at the situation, she struck out to show them (us) all that she did too matter, and she did too have power, and she did too have the ability to make them all hop on demand, at least for a brief while. She struck out by insuring that her wishes were finally respected, if even for a brief period of time. She did so by making demands that showed them all. Not power to make things happen but power to keep things from happening. Same kind of power as far as she’s concerned. She did that by finding out what we all wanted, and making sure she got crosswise with it.

She had 48 hours from the time he was shot, then nine hours from the time the death certificate was filled out to be with the body of her son and do goodbyes. She spent 30 minutes of it at the bedside and all further negotiations took place by phone fro her phone. She made no attempt to come back in. She knew we wanted to move the body so she refused. It was her way of showing us who was in charge. Then she disappeared and refused to discuss it, saying only that she’s get around to it and she’s let up know when she got around to it. then stopped taking calls. She didn’t care that other sick patients were awaiting care in this acute care unit and that the corpse was literally blocking traffic. She cared only about getting quits with the powers that put her in the position she was in.

Is this the kind of customer satisfaction we should buy into because of the inalterable maxim “The customer is always right”?

The answer is no. This is no longer a matter of customer satisfaction, it is a matter now of simply doing the right thing come what may. This customer was never going to be satisfied no matter what was done. Her satisfaction derived specifically from getting as crosswise as possible with the “system” and getting away with it as a means of getting parity. The only means she had.

So she was gently told that she was not going to be allowed to maintain a dead body in an acute care area. it was not a decision she was authorized to make. Period. No further discussion. She then threatened to sue (an empty threat but a common one from people working the system), and then got in her car and drove here not to see her son, but to the Patient Relations office to complain that her demands were not being met and she was an unsatisfied customer. Mercifully, the Patient Relations office told her the same thing I did and also told her that they would be happy to have her lawyer (when she found one) contact the hospital lawyer.

Then then drove home and has not been heard from since. Presumably she feels she got quits with the system now and it’s back to business as usual.

D. Crippen, MD

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