The customer service model simply does not work for healthcare.  It is a model from the business world that we tried to make fit healthcare.  It is a model that works well if you are selling a product or service and the goal is to make money.  But that isn’t the goal of healthcare, is it?  It’s not the reason most of went in to patient care as a career.  When I spend time asking clinicians why they chose medicine I have not heard the answer, ‘for the money’.  There are jobs in business and finance with much better hours and much greater income potential without the demanding emotional and spiritual cost of healthcare.  The answer I hear most frequently is, ‘I wanted to make a difference’.  ‘I wanted to help people’.  The question is, does our healthcare framework support this mission?  Do we set goals and measure outcomes based on the principle medicine is ministry?  Or do we set goals and measure outcomes based on efficiency, volume, and in the end, money?

When we view our patients as customers there is a subtle and subconscious shift that occurs.  They are people who pay us money to provide a service to them.  At first glance, this isn’t so bad.  We should be kind, courteous, respectful, and hard working.  When we expand this philosophy a little more, however, it also makes them customers who should pay us.  Should we have to provide service when the customer doesn’t pay?  Do we have to allow patrons to come into our shop with no shoes, no shirt, no service?  A lot of healthcare groups are moving in this direction.  If you don’t have the right insurance, if you don’t show up for your appointments, if you try to game the system, they don’t have to take care of you.  

We have the opportunity to be better than this. Luckily, we are federally mandated to see everybody!  In my speciality, emergency medicine, we are bound to EMTALA.  The Emergency Medical Treatment and Labor Act is a federal law that requires anyone coming to an emergency department to be stabilized and treated, regardless of their insurance status or ability to pay, but since its enactment in 1986 has remained an unfunded mandate.  Smile.  You get the opportunity to give without receiving anything in return!
The customer service model starts to break down.  This is not an average business. In our environment, especially, the customer doesn’t fulfill their end of the bargain.  So, somehow, we think we don’t have to hold up our end.  We tend to become resentful, bitter, angry with people when they show up dirty and poor and broken.  

Why?  They’re not customers.  They’re human beings in need.  And I think we all know that we wanted to do more in life than provide good customer service.  We wanted to take care of people.  We wanted to heal the sick, care for the poor, show kindness to the dying.  We want to minister to them.

We might be tempted to let ourselves off the hook if we leave behind the model of customer service in healthcare.  It is tempting to feel free of those constraints and just be brutally honest with whomever we see. I am reminded of Jesus when he spoke to his disciples in Matthew 5 about the old law and the new law that he was bringing.  He says, “You have heard…’you shall not commit murder’ but I say to you that everyone who is angry with his brother shall be guilty…” And later in the chapter he says, ‘You have heard…you shall love your neighbor and hate your enemy. But I say to you, love your enemies and pray for those who persecute you. “ NAS version
We are expected to be more than good providers of customer service, aren’t we?  We are actually held to a higher standard.  And we know it.  Excellent customer service doesn’t get you through a grueling twelve hour shift in a busy emergency department.  We have some of the most difficult patients and work in some of the worst conditions.  

If you want to survive here, you’d better have a vision for something greater than customer service.  You need to recognize your work as a higher calling.  Whether or not people pay is irrelevant from our perspective as frontline healthcare providers.  We don’t have the option of declining care because of ability to pay.   That should not even be part of our mindset. In some ways EMTALA is a gift.  We don’t get the option to turn people away.  We get the tough stuff and we get to figure out how to care for tough people!
We look at every person who walks through our doors as a human being in need.  We get to meet that need.  We get to hold their hand, cry with them, relieve their pain, and heal their wounds.  We even get to speak the hard truths to the addicts and drunks and abusers.  Sometimes caring for someone means telling the truth.  That might mean you have an unhappy customer.  But what you are really after is a healthier human.  You are a minister of grace and truth.