Expectations vs. Entitlement: Part I
Beginning to Define Core Values in Healthcare
Charlie goes to the same local restaurant every Wednesday at 1:00 for about 10 years. He is a good patron. He shows up on time, is courteous to all the staff and is a generous tipper. He enjoys sitting at his favorite table by the window.
One day a new waitress places him at a table in the back near the busing station because some local big shot business men and women were to have a power lunch and she thought that they would like that window area.
Is Charlie entitled to his seat at the window or should Charlie just expect to get the seat by the window?
By all accounts he seems to have earned a sense of entitlement. He probably has given the restaurant thousands of consistent dollars over the last ten years and had limited demands. Shouldn't that entitle someone to the best seat in the house? Maybe he should expect it and then realize that not everyone can realize his expectations all the time. What do you think? Do you expect me to care what you thought? Are you entitled to tell me what you thought? Whatever.
What should a patient expect in healthcare today? Are patients entitled to any specific rights or actions of others? If there is some entitlement, where is its source? Who gets to decide? Are expectations reasonable? In what circumstances should one expect a certain behavior on the part of nurses or doctors? Do you expect to get a call back from your doctor within 2 hours from when you left a message? What about 4 hours? What if it was 4 days? What if he never called you back but had his nurse practitioner call you instead? Aren't you entitled to a call from your own doctor, or is it just a reasonable expectation?
Your lawyer charges by the hour and calls you back. Your doctor does not get paid for that callback - is the expectation tied into financial relationships or does a higher order supercede in this situation? Does any higher order exist? Did this order evolve or was it intelligently designed (er...I mean created).
I had this discussion with my patient Henry recently, who is 90 years old and sees me for his chronic shoulder arthritis. Every once in a while I inject both of Henry's shoulders and that keeps him going for quite a while.
One day I kept Henry waiting for about an hour (a short wait some days in a busy office). While I apologized for my delay, Henry cut me off and said "Doc, I really don't have many places to go and I know that you squeezed me in today and I appreciate it."
What did Henry expect? What was he entitled to?
I used this moment to discuss this very issue with my wise old friend. We came to the following conclusion: A patient is entitled to get the full attention and energy of the doctor during the visit and during the entire treatment plan and have the doctor make meaningful decisions always in the best interests of the patients. We both decided that a patient was entitled to that just by entering the doctor-patient relationship.
A patient could expect to be seen on time but is not entitled to this. An expectation not an entitlement. We actually could not think of any more entitlements than the one we came up with. Most of what we discussed seemed to be expectations.
Patients with a displaced sense of entitlement are actually quite annoying. Almost as annoying as doctors who have disdain for patients and don't respect their complaints enough to fully listen to their problems. Almost.
Close to 5000 office visits move across me on the river of medicine I call my practice. Not a day goes by where I either fail to meet someone's expectations or come across an unreasonable SOB with a sense of entitlement that their issue should dominate the entire attention of my office because, for example, they are the CEO or the Whaterthehellitis Corporation. It upsets me to not meet a patient's expectations and it enrages me when the entitled cross the threshold.
Not that the Declaration of Independence represents an authoritative piece of work but there is some good quotable stuff in there. Life, Liberty, and the Pursuit of Happiness.
Pulled out my copy of the DOI and looked intensely for the section of free medications. Not there.
I looked for the section on "no waiting more than 10 minutes in a doctors office". Not there.
I looked for "having the doctor call every family member on their private jet with constant updates about Grandma because we are too busy to get our rich fat butts into the hospital to see her ourselves." I originally thought that was there and then realized I was wrong. Not there.
Life, Liberty and the PURSUIT of happiness. Pursuit. The opportunity to have the freedom to pursue a dream or a goal. Not the entitled attainment of that goal.
What do you think?
Related Topics: Choosing A Doctor, Being A Good Patient
Technorati Tags: healthcare, doctor, patientadvocacy,
Charlie goes to the same local restaurant every Wednesday at 1:00 for about 10 years. He is a good patron. He shows up on time, is courteous to all the staff and is a generous tipper. He enjoys sitting at his favorite table by the window.
One day a new waitress places him at a table in the back near the busing station because some local big shot business men and women were to have a power lunch and she thought that they would like that window area.
Is Charlie entitled to his seat at the window or should Charlie just expect to get the seat by the window?
By all accounts he seems to have earned a sense of entitlement. He probably has given the restaurant thousands of consistent dollars over the last ten years and had limited demands. Shouldn't that entitle someone to the best seat in the house? Maybe he should expect it and then realize that not everyone can realize his expectations all the time. What do you think? Do you expect me to care what you thought? Are you entitled to tell me what you thought? Whatever.
What should a patient expect in healthcare today? Are patients entitled to any specific rights or actions of others? If there is some entitlement, where is its source? Who gets to decide? Are expectations reasonable? In what circumstances should one expect a certain behavior on the part of nurses or doctors? Do you expect to get a call back from your doctor within 2 hours from when you left a message? What about 4 hours? What if it was 4 days? What if he never called you back but had his nurse practitioner call you instead? Aren't you entitled to a call from your own doctor, or is it just a reasonable expectation?
Your lawyer charges by the hour and calls you back. Your doctor does not get paid for that callback - is the expectation tied into financial relationships or does a higher order supercede in this situation? Does any higher order exist? Did this order evolve or was it intelligently designed (er...I mean created).
I had this discussion with my patient Henry recently, who is 90 years old and sees me for his chronic shoulder arthritis. Every once in a while I inject both of Henry's shoulders and that keeps him going for quite a while.
One day I kept Henry waiting for about an hour (a short wait some days in a busy office). While I apologized for my delay, Henry cut me off and said "Doc, I really don't have many places to go and I know that you squeezed me in today and I appreciate it."
What did Henry expect? What was he entitled to?
I used this moment to discuss this very issue with my wise old friend. We came to the following conclusion: A patient is entitled to get the full attention and energy of the doctor during the visit and during the entire treatment plan and have the doctor make meaningful decisions always in the best interests of the patients. We both decided that a patient was entitled to that just by entering the doctor-patient relationship.
A patient could expect to be seen on time but is not entitled to this. An expectation not an entitlement. We actually could not think of any more entitlements than the one we came up with. Most of what we discussed seemed to be expectations.
Patients with a displaced sense of entitlement are actually quite annoying. Almost as annoying as doctors who have disdain for patients and don't respect their complaints enough to fully listen to their problems. Almost.
Close to 5000 office visits move across me on the river of medicine I call my practice. Not a day goes by where I either fail to meet someone's expectations or come across an unreasonable SOB with a sense of entitlement that their issue should dominate the entire attention of my office because, for example, they are the CEO or the Whaterthehellitis Corporation. It upsets me to not meet a patient's expectations and it enrages me when the entitled cross the threshold.
Not that the Declaration of Independence represents an authoritative piece of work but there is some good quotable stuff in there. Life, Liberty, and the Pursuit of Happiness.
Pulled out my copy of the DOI and looked intensely for the section of free medications. Not there.
I looked for the section on "no waiting more than 10 minutes in a doctors office". Not there.
I looked for "having the doctor call every family member on their private jet with constant updates about Grandma because we are too busy to get our rich fat butts into the hospital to see her ourselves." I originally thought that was there and then realized I was wrong. Not there.
Life, Liberty and the PURSUIT of happiness. Pursuit. The opportunity to have the freedom to pursue a dream or a goal. Not the entitled attainment of that goal.
What do you think?
Related Topics: Choosing A Doctor, Being A Good Patient
Technorati Tags: healthcare, doctor, patientadvocacy,
