Service secrets: Lessons for physicians from McDonald's

Key Points

As the father of four kids, I go to McDonald's more than I would like to admit. And I hate McDonald's. It might as well be prison food. After all, prison food certainly can't taste worse than McDonald's, and death-row inmates probably don't die as quickly as adults who know Ronald on a first-name basis. And the price? Don't tell me it costs more to feed a prisoner than it does to shell out for four Happy Meals.

So if McDonald's is so bad, why is it so popular? The answer, I figured, as I pulled away from the drive-thru with another bagful of bland meat, is service.

In prison, you are a number. In prison, you have no choices. In prison, you have no control. In prison, time is your enemy. You are deprived of the first thing we achieve as a human being and the last thing we want to lose before dying: autonomy.

Now what in the world does this have to do with medicine, the hospital, and-of all places-the dreaded emergency department, where first-year residents are caged for the night sewing up drunks, setting bones, and admitting drug overdoses? I have a few secrets I would like to share that few who are newer to medicine truly seem to know-secrets that can dramatically change the way you and I practice medicine.

SECRET #1

Eighty-five percent of all patients you meet in an emergency situation will get well without you doing anything.

So if most people do not need physicians, even in an "emergency," and we have the potential to harm them to the same degree that we can help, why do patients come to the ED?

SECRET #2

Most patients come to the ED in response to pain and/or fear. If you can offer effective, quick pain management and can communicate in a way that alleviates fear, you will do more to help the majority of the patients you see than you could using any other skill, procedure, or medicine.

SECRET #3

Patients determine how good you are as a doctor in pretty much the same way that other staff-even other doctors-determine how good you are: by the way you treat them as a person.