Patients first

Reminder: Patients are our purpose, not interruptions

In business, you must treat customers fairly and kindly if you expect them to return. The same goes for medicine, writes Arnold Melnick, DO.


“A patient is not an interruption of our work … they are the purpose of it. We are not doing our patients a favor by serving them. They are doing us a favor by giving us the opportunity to do so.”

That quotation (despite a grammatical error) immediately caught my eye—and pierced my heart. First, the quote sounded so familiar, but I couldn’t place it. (A Google search later on revealed that it paraphrases a 1921 quote from Cleveland Clinic co-founder William E. Lower, MD.)

Second, I thought, “What a beautiful practice philosophy. What a great message to communicate to patients.”

And, may I add, what a teaching lesson for medical students, interns and residents.

I found the quotation on a third-class mail flyer promoting a Miami-area clinic. The advertising piece told me something about the clinic’s management and staff: Either they were patient-oriented or they knew how to sell. In any case, the quotation was great and it changed my initial impression of the clinic.

Many physicians, I am sure, practice this way, whether they know the
quotation or not. But some physicians practice the reverse.

Let me give you a personal example. I had come out of anesthesia after a colonoscopy and was getting dressed when my gastroenterologist stuck his head in the room to see if I was all right—he did not examine me. I said, “I have a couple of questions.” As he continued to back out of the room, he shot back, “I really don’t have time.”

What? No time to answer a post-operative patient’s questions (without knowing how urgent or serious they were)? And no “Call me this afternoon after 2 o’clock and I’ll be glad to answer you” or “I’ll call you tonight” or anything else that would have told me he was interested enough and willing—at a later time—to give me the information I needed.

Needless to say, I never went back to him. He had communicated clearly to me that I was an interruption to his schedule. Yes, I did inform him of my dissatisfaction.

Some physicians may have to think about such poor behavior in a context other than medicine to really appreciate the patient-centered philosophy promoted in the clinic flyer.

Suppose your lawyer treated you as an interruption to his or her schedule? How long would you stay with that lawyer? Even more to the point, most of us have experienced inconsiderate behavior in a retail store—a rude clerk, an inattentive salesperson, a merchant who abandons us for someone else. I know how I have felt. I’m sure every physician has been in that situation.

In business, it is understood that you must treat customers fairly and kindly if you expect them to return—even to the extent of believing “the customer is always right.” While many physicians resent analogies to business, the philosophy remains the same.

Wouldn’t it be wonderful if we could inculcate a “patients first” outlook in our trainees and maybe help ensure good care for future patients?

It’s worth reading that quotation again and following it. You will enjoy practice even more—while treating happier patients.


  1. Richard Fuller, D.O.

    Loved your article. I am in favor of and support a Market-Based healthcare delivery system. Physicians can do well if they adopt more of a retail approach to managing their practices and treating patients as customers. First, make them happy and then care for their conditions.It is possible to take care of their conditions and not make them happy.
    Happy patients tell no one for they receive the care they expect. Unhappy patient tell everyone. To spread the “good word”, it is necessary to create enthusiastic patients who receive more than they expect.

  2. Kathryn

    It would serve every practitioner well to remember this. I don’t let it bother me if a waitress, salesperson, or clerk doesn’t make me their number one priority. I do understand that everyone has a bad day. All of us have things going on in our lives that likely follow us into the workplace, whether we overtly advertise it or not. However, in the field of medicine, there is much more at stake. When a physician’s attitude is one that suggests that I am merely an inconvenience that he is forced to deal with, even if I have an obvious condition of a serious nature that needs treated, I am likely to hesitate to seek medical treatment in the future. At the very least I will delay seeking treatment at all costs.

    Realize that it isn’t just about feeling important enough to spend the time with you that a patient is paying for. I do realize that it isn’t as lucrative a field as many believe it to be. How do you like it when your attorney charges you for an hour of his time after a 5 minute meeting? If that same attorney fails to do his job correctly and you end up losing a case, it is even more frustrating. Imagine a patient who is not only made to feel like a burden, but also has had previous professionals completely miss a diagnosis. If the missed diagnosis has caused them difficulty in their normal daily activities, they are most likely even more terrified than most to be in your office.

    Even if you have a great bedside manner, it can still be a terrifying experience for a patient, especially a patient that has had a bad experience or two in the past. Their are many patients who would rather be anywhere but on the exam table. Hopefully they are few and far between. For a patient like this, one encounter with someone who clearly cares can change everything. Not only can will you gain a patient for life, it may well save them from letting a treatable illness go untreated.

    I also would like to correct Richard. Maybe that is your experience. However, when I have a positive enounter in the medical setting I do indeed tell people. With my negative experiences, I have kept them to myself. Family members only know because they were present. I respect everyone’s right to perform their job poorly. I exercise my right to find a new doctor if he happens to be doing just that. I don’t believe that spreading negative things, even if true, does any good for anyone. Maybe I am the exception.

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