The Customer is NEVER Right - A Nurse Practitioner's Perspective
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Stellar customer satisfaction may be hazardous to patients

I thought a colleague was pulling my leg when he mentioned to me, “There’s a not so recent article that [found] patients with [customer satisfaction] scores of 5 have the highest mortality.” To say the least, his claims caught my attention. How or why was that possible? I thought. Baffled by his claim I did a hasty Internet search and there it was, an article by UC Davis researchers titled, Patient satisfaction linked to higher health-care expenses and mortality, just like my colleague had said.  
After reading the article I could not decipher the correlation between poor outcome and high satisfaction scores. However, the following statement caught my attention, “Fenton [co-author] pointed out that because many physicians receive incentive compensation based on patient satisfaction, they may be reluctant to bring up the downsides of requested tests or treatments. Providers who are too concerned with patient satisfaction may also be unwilling to bring up uncomfortable issues such as smoking, substance abuse or mental health, which may then go unaddressed.”
Now, that does not sound like a customer service issue, instead, it sounds more like negligence. While on a humanitarian mission I had a discussion about the book with a healthcare administrator who used a bad haircut as an example for poor customer service. His argument was, “If you get a bad haircut would you not want to complain about it and maybe get your money back?” My answer was, “Not really. The hair will grow back. And believe me I have had my fair share of bad haircuts. However, a bad haircut is not poor customer service. A bad haircut is a bad PRODUCT. The HAIRCUT being the product. Having said that, it is likely it was the good customer service that kept me from complaining about the bad product because it was still a bad haircut regardless the good customer service.”
Essentially that is the gist, the confusion about customer service. Be it in healthcare or any other industry, customer service is not the product; the product should stand on its own. Because of that, not catering to exaggerated unrealistic emotional expectations, entitlements, or so-called VIP is not a poor product. And in healthcare, our product is to help others and sometimes that requires bringing up uncomfortable issues or having to tell patients, “No,” to inappropriately requested tests or treatments.
More rewarding, while looking for the UC Davis article, I came a across a much more fascinating article written by Kai Falkenberg (who is not a healthcare worker) for Forbes titled, Why rating your doctor is bad for your health. 
It was obvious the article had caught the attention of many, as when I first visited the article it had been up for four days and had some 31,000+ views, today, two days later, it has 52,030.
Unlike me, Ms. Falkenberg interviewed subject matter experts and researched her facts, to include the UC Davis article, yet she and I came up with pretty much the same finding, that customer service rating is not good for healthcare. Following her article there are a number of comments from those who read her article, most left behind by healthcare workers, and I too uploaded the write up below hoping Ms. Falkenberg would champion the plight of healthcare workers as our attempts have fallen on deaf ears.
Ms. Falkenberg,
I am one of those healthcare providers who have been asked to resign, not fired, a number of times because of patient complaints. Because of that I wrote and published a book titled The Customer is NEVER Right: A Nurse Practitioner’s Perspective in 2012, to tell my story knowing it is the story of many healthcare workers. Recently, I asked a colleague to look at my blog ( and he replied, “A not so recent article [found] patients with [customer satisfaction] scores of 5 have the highest mortality.” Baffled by his claim, I set out to find the article he mentioned to include in my blog and serendipitously found the article you published.
This is the book’s synopsis: An earnest yet unsettling account of frontline emergency healthcare in the USA today from the point of view of one man, a nurse practitioner, who struggles to maintain his integrity and his job, and, ultimately, failing, at least in terms of the job. Honesty and agony jump off the page as the author points out the serious problems between healthcare administrations and the transformation of healthcare from a helping profession to just one more profit-driven business.

Healthcare is a time honored profession and the practice of medicine must remain evidence based and not about catering to arbitrary satisfaction scores.  Medicine is not Facebook and we should not be concerned about being “liked” or “friended”.
Ms. Falkenberg, you have written a superb article that draws attention to a number of pressing healthcare issues, as does my book, however, we both seem to be preaching to the choir. These issues have been mentioned a number of times before, by a number of authors, in a number of mediums, and continue to fail in grabbing the attention of administrators and policy makers as if they are not paying attention or are not remotely interested, a poignant point I outline in my book.
The purpose of me joining this discussion is to highlight the fact that, even though you are not affiliated with healthcare as your primary profession, you came up with the same objective findings that I, and the many that have replied to your article, have come up with. As noted by your followers’ replies, healthcare workers likely have ten stories for every story you and I could share.  Having said that, health care workers are not sniveling as the PG CEO suggested when he exclaimed, “Suck it up.”
Now, we in healthcare can only hope administrators and policy makers will consider your story as neutral, as you do not have a reason to grumble, because our attempts to bring the same pivotal findings to anyone’s attention have fallen on deaf ears.
The train may have left the station, as the PG CEO tells physician groups, but it has gone down the wrong track. Medical care should never come second to customer satisfaction. Not to mention the trail of collateral damage left behind from catering to patients with exaggerated unrealistic emotional expectations. With that said, history bears witness that bad ideas are successful when do-gooders stand by and let the train run down the wrong tracks.
Thank you for writing such a timely, critical and informative article and hopefully with your investigative journalism and our desire to keep healthcare an honorable profession, we can expose the insidious practice that customer satisfaction rating is in healthcare.

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