One of the hot phrases in health care these days is "patient-centered," as in "patient-centered hospitals," "patient-centered practices," and "patient-centered medicine." For all of you out there working on creating such "patient-centered" systems, let me provide a bit of advice based on a recent experience my family and I had with Delta Airlines. For if you substitute the word "customer" for "patient," you get what every business, whether in health care or not, should be focused on -- the person receiving, nay, purchasing, their services. The ones you hope will return, again and again.
I'm actually writing this as I sit in the lobby of a hotel in Park City, Utah. It is a gorgeous day outside, crisp and cold, just perfect for the skiing my family had in mind when we booked this trip; it's a short trip-- just 3 days on the slopes before we head home -- so every minute counts. Unfortunately, despite plenty of time sitting in airports yesterday (i.e., no tight connection), only 2 out of our 6 pieces of luggage made it here. Fortunately, one of those was the suitcase filled with skiing togs. Unfortunately, one of the missing pieces was my son's new snowboard, also filled with all of his ski togs. So while my boys are out on the slopes (the snowboard kid wearing my ski clothes), I'm sitting in the lodge awaiting our luggage. It is nearly noon -- half of the day gone, one-sixth, possibly one-third, of our vacation gone--and I have not yet set foot on the slopes. Sure, I could head over and buy all-new ski stuff. . . . but that isn't the point.
The point is how this was handled. I do understand that these things happen. And Delta did send the luggage out on the first flight this morning (hopefully it will arrive before dark). But other than a "comfort pack" with little ketchup-type packages of toothpaste and a t-shirt with the Delta logo emblazoned it, there was nothing else. No sincere apology. When I asked about refunds on the $100 those bags cost us to check, we were told to check the online site. Turns out that if it takes them more than 12 hours to get our bags to us, we get $25 vouchers for future travel -- but not, it seems, for the "oversized" luggage, the snowboard.
When I tweeted customer service at Delta about the same thing, I got the same offer.
Now, if I were running a customer service department, particularly one for an airline that has enraged passengers everywhere with exhorbitant fees for checked luggage (hard to travel without a suitcase, people, and you're in the travel industry) here's what I would have done.
I would have immediately refunded the customer the amount spent to check those bags and provided vouchers for free bag checking on the return flight. That would be in addition to a very sincere apology and some sense of empathy. That's all. It would have cost them $200. And they would have had a very loyal customer for life.
Because you know, shit happens. It happens in airlines, in doctor's offices, in hospitals. No one, no system, is perfect. But, as numerous studies on malpractice have shown, when doctors simply apologize and work to rectify the situation, patients are far less likely to sue. Heck, when doctors have worked to develop good relationships and partnerships with patients they are far less likely to sue.
Airlines-- all other service-oriented businesses, actually--need to learn that lesson.
We don't want to make money off mistakes. We don't want to sue you. We just want what's fair. And we want it delivered by real people who are trained to understand how someone might feel when they've been traveling for 10 hours, it's 3 a.m., according to their body clock, and the luggage for a long-planned and quite-expensive vacation is lost.
So next time you're double booked and a patient complains that they lost 3 hours of work time because you were late, don't come up with excuses. Just apologize! And waive the copayment. Oh, and figure out what's wrong with your scheduling system. Because if the system is supposed to be built around the patient, not the doctor or hospital or administrator, then you need to find out what is important to the patient. And I'll just bet sitting in your waiting room reading bad magazines for 3 hours is not one of them.
Sunday, December 18, 2011
Thursday, December 8, 2011
Plan B: Another Double Standard
For what appears to be the first time in history, the head of the Health and Human Services Department has overturned a decision by the FDA. Was this regarding a drug that was so potentially dangerous it could kill or permanently maim people? A drug for which we have little clinical trial evidence or history? A drug that is produced in appallingly unsafe conditions?
No. It is a drug--actually, a single pill--for which we have years of safety and efficacy data, that is exceedingly safe and easy to use, and, get this -- doesn't even require a prescription from a doctor--if you're 17 and older.
What it does is require is that the patients buying it be at least 17 years of age and head to the back of drugstores to give their names and identification to a pharmacist before receiving it. Oh, and if the pharmacist doesn't want to provide it, he/she doesn't have to. And it does require a prescription for those 16 and younger.
It's Plan B, aka "emergency contraception." All its manufacturer was asking was that we stop requiring that women who need it -- those who had unprotected sex, missed a couple of birth control pills, are taking antibiotics (which can affect the efficacy of estrogen-based contraceptives, were raped, had the condom break or slip off, etc.,-- be 17 years old and have to "beg" a pharmacist for it. Instead, the request was to make it as freely available on store shelves as aspirin.
As FDA Administrator Margaret A. Hamburg said in a public statement: “There is adequate and reasonable, well-supported, and science-based evidence that Plan B One-Step is safe and effective and should be approved for nonprescription use for all females of child-bearing potential.”
Why did the HHS administrator--herself a woman--reverse the FDA's decision? Because since about 10 percent of girls as young as 11 are capable of bearing children, she felt that the drug could not be used safely by these very young girls.
Excuse me? So it's safer for these girls to get pregnant and have to either undergo an abortion or deliver a child? Helloooooo. And it's ok for these girls (or even younger children) to buy admittedly more dangerous over-the-counter drugs, like sleeping pills and even Tylenol? Heck, they can buy lubricants designed to "enhance their sexual pleasure" over the counter with no age restriction or having to request it from a pharmacist, but they can't buy a single pill that could prevent a pregnancy? And really, how many 11-year-olds are even going to know about Plan B?
The rhetoric around this issue has gone from the ludicrous to the insane. In yesterday's paper, one conservative group opposed open access to Plan B because it would "open the door for child abuse and child exploitation" if pedophiles could rape young girls then give them a pill to prevent pregnancy. Really? And allowing men access to condoms to prevent a pregnancy in children they abuse is ok?
Face it. The reason Plan B is not available on store shelves while condoms are is because we still, even in the year 2011, have a double standard when it comes to sexuality and women. It's the same double standard that led the FDA to reject a testosterone product for women to help with low libido (obviously not a problem when it comes to approving such products for men) and created a huge outcry when a vaccine to protect women against cervical cancer was approved for girls (because, of course, if they're now protected against the sexually transmitted virus that causes most cervical cancers, 12-year-old girls will now rush out and have sex) but elicited nary a whimper when it was approved for boys.
We do not want to admit that women--like men--are sexually active beings and provide them with the ability to protect themselves from an unwanted pregnancy.
And yes, I'm sure some of this has to do with our country's psychosis around abortion issues, even though the pill does NOT provide an abortion, only prevents sperm from reaching an egg or a fertilized egg from implanting in the uterus (obviously, some people need to review reproductive science to understand how pregnancy occurs). That's why it should be taken within 72 hours of unprotected intercourse.
I am beyond livid by this decision. But even more, I am saddened, disappointed and, yes, sickened by such a decision in an administration that I thought supported women's reproductive rights.
No. It is a drug--actually, a single pill--for which we have years of safety and efficacy data, that is exceedingly safe and easy to use, and, get this -- doesn't even require a prescription from a doctor--if you're 17 and older.
What it does is require is that the patients buying it be at least 17 years of age and head to the back of drugstores to give their names and identification to a pharmacist before receiving it. Oh, and if the pharmacist doesn't want to provide it, he/she doesn't have to. And it does require a prescription for those 16 and younger.
It's Plan B, aka "emergency contraception." All its manufacturer was asking was that we stop requiring that women who need it -- those who had unprotected sex, missed a couple of birth control pills, are taking antibiotics (which can affect the efficacy of estrogen-based contraceptives, were raped, had the condom break or slip off, etc.,-- be 17 years old and have to "beg" a pharmacist for it. Instead, the request was to make it as freely available on store shelves as aspirin.
As FDA Administrator Margaret A. Hamburg said in a public statement: “There is adequate and reasonable, well-supported, and science-based evidence that Plan B One-Step is safe and effective and should be approved for nonprescription use for all females of child-bearing potential.”
Why did the HHS administrator--herself a woman--reverse the FDA's decision? Because since about 10 percent of girls as young as 11 are capable of bearing children, she felt that the drug could not be used safely by these very young girls.
Excuse me? So it's safer for these girls to get pregnant and have to either undergo an abortion or deliver a child? Helloooooo. And it's ok for these girls (or even younger children) to buy admittedly more dangerous over-the-counter drugs, like sleeping pills and even Tylenol? Heck, they can buy lubricants designed to "enhance their sexual pleasure" over the counter with no age restriction or having to request it from a pharmacist, but they can't buy a single pill that could prevent a pregnancy? And really, how many 11-year-olds are even going to know about Plan B?
The rhetoric around this issue has gone from the ludicrous to the insane. In yesterday's paper, one conservative group opposed open access to Plan B because it would "open the door for child abuse and child exploitation" if pedophiles could rape young girls then give them a pill to prevent pregnancy. Really? And allowing men access to condoms to prevent a pregnancy in children they abuse is ok?
Face it. The reason Plan B is not available on store shelves while condoms are is because we still, even in the year 2011, have a double standard when it comes to sexuality and women. It's the same double standard that led the FDA to reject a testosterone product for women to help with low libido (obviously not a problem when it comes to approving such products for men) and created a huge outcry when a vaccine to protect women against cervical cancer was approved for girls (because, of course, if they're now protected against the sexually transmitted virus that causes most cervical cancers, 12-year-old girls will now rush out and have sex) but elicited nary a whimper when it was approved for boys.
We do not want to admit that women--like men--are sexually active beings and provide them with the ability to protect themselves from an unwanted pregnancy.
And yes, I'm sure some of this has to do with our country's psychosis around abortion issues, even though the pill does NOT provide an abortion, only prevents sperm from reaching an egg or a fertilized egg from implanting in the uterus (obviously, some people need to review reproductive science to understand how pregnancy occurs). That's why it should be taken within 72 hours of unprotected intercourse.
I am beyond livid by this decision. But even more, I am saddened, disappointed and, yes, sickened by such a decision in an administration that I thought supported women's reproductive rights.
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