Another time, a contractor agreed to fix a plumbing leak in our upstairs bathroom that had caused water damage to our first-floor ceiling. While tearing out the floor to reach the leak, he mistakenly ran a circular saw through a pipe, causing a considerably larger gusher that quickly destroyed said ceiling.
I understand these things happen. However, imagine my surprise when the eventual project cost was more than twice the estimated cost. He explained that repairing the new water damage was quite expensive and accounted for the variance with the estimate. We “discussed” this development, during which time I explained to him in no uncertain terms what the temperature in hell would be when I paid for his mistake.
So, it stung a bit to be called a “contractor.” But I could live with it. In fact, on the surface my patient’s analogy was quite good. Hospitalists do swoop in and fix patients’ problems only to then leave their lives, most often for good. It was only after a few days that her statement started to sour in my amygdala.
Habitual tardiness, sketchy response times, vague payment structures, lack of transparency in pricing, pricing errors into the cost of the job—I don’t think the analogy was intended to be so perceptive. I and the healthcare system within which I work really had adopted some of the less-desirable attributes of the contracting world.
I usually tell patients I’ll be back in an hour to give them their test results, knowing that I’m on “doctor time” and this could mean several hours or more. My tardiness usually results from being delayed while caring for another patient—but it’s all the same to the patient left waiting. Trying to build in cushion time for these unforeseen delays leaves a patient with a disagreeable contractor-like window of time to wait. For those who want to have their family at our daily rounds, an “I’ll come see you in the morning” is not just unhelpful—it disrespects the importance of their time.
Then there’s our payment system. It’s a mystery even to me: $12 aspirins, $100,000 cancer drugs, intentionally inflated professional fees and hospital bills that aren’t expected to be paid in full (unless the patient lacks an insurer to negotiate a lower price when they ironically are expected to foot the entire bill). All of which is made worse by the lack of transparency in our pricing. Patients (and most often I) simply are not privy to the costs of various tests and interventions. And, costs for the same procedure often differ among hospitals.
Few of us would contract for work without playing a role in choosing the supplies and knowing the rough cost of the materials. Yet that’s the situation our patients find themselves in daily.
Finally, expecting patients or their insurers to pay for my mistakes is not fair. I recognize there are adverse events that are unavoidable and should be reimbursed. However, many errors are as avoidable as being careful not to cut through a working pipe. Payment for these outcomes should be shouldered by the health system—not the patient.
I limped through the next few days re-examining my patient interactions. I licked my wounds, vowing to eschew those traits that so offend me as a consumer. I might not be able to repair a broken healthcare system, but I can refurbish the way I interact with my patients by being timely and responsive and not underestimating the effect of poor customer service. TH
Dr. Glasheen is associate professor of medicine at the University of Colorado, Denver, where he serves as director of the Hospital Medicine Program and the Hospitalist Training Program, and as associate program director of the Internal Medicine Residency Program.