Tuesday, July 18, 2006


Is the customer always right? I don't think so, and neither does The Chief Happiness Officer.

I worked in a hospital where the corporate policy was to do Medical Screening Evaluations (MSE's) and to require pre-registration and pre-payment for those who we determined did not have an Emergency Medical Condition. When I started there, the ER director, a nurse administrator, explained that the corporations intent was to "train the community" in the proper utilization of the ER and to discourage inappropriate use.

A number of hospitals don't do this, both because of a fear of liability and a fear of alienating "customers." I always thought you wanted to alienate over-utilizers and those for whom you wouldn't receive payment because the insurance company would deny payment for a non-emergent condition. Additionally, if you do a good job in your MSE, there should be minimal liability.

Anyway, I told the nurse director that I would do this if it was policy but he should understand that there would be a significant number of complaints. He stated that the administration understood this.

Well, what do you guess happened? I did the screens and got complaints. Some people were grateful when the registration person told them they would have to pay if their insurance company denied the charges, but the majority were unhappy about being told their conditions weren't emergencies. After all, isn't the customer always right? I can remember being taught that a condition was an emergency if the patient determined it was.

But, geez, what about the person who shows up at 7pm on a Tuesday night requesting a refill on her Prozac? She had taken her last pill that morning and there was no reason she couldn't call her PMD in the AM for a refill, except that she owed him so much money that he refused to provide care until she started paying. Should we be required to see her and give her a prescription, with no expectation of payment?

One of my colleagues tells this story: He asked a patient one night why he had not seen his PMD for his presenting complaint, a chronic problem, and the patient replied, "I don't have any money to pay a doctor." My colleague, exasperated, replied, "I don't work for free, you know."

Anyway, the end result of my efforts to pursue MSE's was that the administration of the hospital almost fired me over the number of complaints I was getting. Now I don't disagree that a hospital should want to keep down the number of unhappy customers, but why tell me to do MSE's, knowing you will get complaints, and then criticize me for the complaints when I did appropriate MSE's. I would always have a nurse in the room when I explained it to the patient and the consensus was that I did a good job and was not rude or insensitive in my presentation to the patient.