Some time ago at a Starbucks branch, I fell in line behind a nurse I knew, still in uniform and in the middle of his shift. He was looking harassed and perplexed. Earlier I had overheard that there was a heated battle among security, the nurses and the hospital-patient liaisons over one simple thing: If a patient wants a drink from Starbucks, who’s responsible for getting it? Evidently the nurse lost the battle. I gave him a thumbs up as he hurriedly dictated the order to the barista.
The nurses I know are, in general, accommodating and hardworking; they often have to be. So for them it’s not a matter of not wanting to give patients what they want; rather, it’s trying to understand what they need, and whether nurses are in any position to provide it. The nurse I saw felt harassed not because of what he thought of as an unnecessary order from a patient, but because he was thinking of patients he had left behind who also had legitimate concerns. After all, time is of the essence in the healthcare industry, and lining up behind a busy Starbucks queue does take time.
For doctors, too, it’s a perpetual balance of trying to give patients what they need while not stamping too much on what they want. We want them to exercise their autonomy, but still give them the best options for treatment available. After all, we have the same goals: for the patient to get better, and if they’re admitted, to go home as soon as they safely can.
I guess this is why it’s called the Art of Medicine: Long gone are the days when doctors enjoyed nearly absolute authority and could force their decisions down patients’ throats; now there are long discussions on patient options and preferences, as there should be. However, I sometimes wonder if we aren’t going too far in the opposite direction. Long ago I heard one of my relatives, afflicted with the common cold, complain that their doctor studied for years to go to med school, only to tell them to take a lot of rest and drink a lot of water. The doctor was actually in the right—the common cold often doesn’t require more, and to give antibiotics or other drugs might even be irresponsible. Still, my relative was unsatisfied even with a good explanation. So does a good product—in this case, the consult—always correlate with patient satisfaction?
As more and more industries step up in giving patients an all-around accommodating, high-quality experience—grocery stores that deliver to your doorstep, online shopping, personal stylists who come to your house and leave you with a new wardrobe, and so on—in healthcare, patients have come to expect something similar. It can be a different thing in public hospitals, but in private ones, it happens that patients expect care to be served with all the smiling humility—dare I say sycophancy—of a five-star hotel concierge, with all the instantaneousness of a precooked McDonald’s burger. It’s not wrong to expect quick service done with a smile—a lesson we all learn the first time doctors get reported for rude or brusque behavior—but maybe there are lines we have yet to draw.
One worries because too often the people who suffer are those at the bottom of the chain, who spend most time with the patients themselves and are on the front line to receive requests or criticism: nurses, nurse assistants, junior doctors, and other staff. They live in fear of incident reports and termination. They don’t have the agency to say no. They aren’t armed to fight back, even in the rare instances when words are unwarranted or requests are not only unnecessary but can actually compromise the time and resources that should be allotted to other patients.
This isn’t to say that there isn’t a role for giving patients what they want. After all, it only makes sense that a patient who is more comfortable is happier and might have better outcomes. Doctors and nurses could also afford to smile more, to be kinder. But at what expense? Healthcare isn’t fast food, and patients aren’t customers, and I hope that they never become that, or else Medicine would be in a sorry state indeed.
kchuarivera@gmail.com