Chandrakanth Are, MBBS, MBA
A few weeks ago, a family member underwent a minor outpatient operative procedure. From a few weeks before the scheduled date of the procedure, multiple text messages and e-mails were forwarded to provide preparatory instructions for the procedure. The day before the procedure, another confirmatory text message was sent to confirm that we will indeed be arriving for the procedure.
On the day of the procedure, we arrived on time as scheduled. At the check-in desk, we were met (not greeted) by a young lady whose face was bereft of any emotion, nor did she exchange any of the customary greetings that traditional human interactions are accustomed to. The young lady was not rude but was nonchalantly indifferent.
In a room with many other patients and no benefit of privacy, we were asked to blurt our name and date of birth. With an equally robotic behavior, she whipped out an iPad and asked us to fill our H and P on it. And, when you reach the end of it, she said, sign in and bring it back. We dutifully did that, handed back the iPad, and were asked to sit down in the room. This was the same room where many other patients like us were checked in with the same robotic efficiency and were left staring into space or the television or their own device of choice.
Following that, we went through the usual motions of getting the procedure done, which was completed with no complications. With discharge instructions in tow, we were asked to follow up in the near future. A day later, we received a call enquiring about our well-being. A few days later came the good news that all results were normal.
The entire episode from the initial consultation to the final touchpoint of receiving our results was carried out with exemplary efficiency. Although any or many errors continue to happen in health care due to the perfect alignment of imperfect forces, this episode was flawless. For the multitude who complain about the grave faults in our American health-care system, this episode could easily put all that negativity to rest. Everyone on the health-care supply chain was prompt and efficient. They were courteous to a fault and answered all our questions. In fact, the majority of health-care delivery episodes in America fall into this category.
Patients Deserve More Than Just Efficiency
Now, here comes the crunch. If efficiency is the only metric on which we rate our health-care system, then this would be an amazing showcase of success. But, in health care, patients should expect and deserve more than just efficiency.
Throughout the entire episode, there was one thing that was glaringly missing: a smile. Everyone was putting all their effort to make the gargantuan machine of American health-care system move on time, so they could promptly repeat the same with the next patient and beyond. In this multitrillion-dollar crucible of health-care industry in America, efficiency and its subsequent revenue implications seem to have taken the prime spot.
Although no one (patients and health-care professionals alike) is opposed to efficiency, health care is based on interactions between two humans: the caregiver and the patient. Every health-care episode transcends the many complex layers of conscious and subconscious human interaction between two individuals. The caregiver is present by choice and in it for the passion of helping others. The patient is present due to a lack of choice and is burdened not only by the disease but by varying levels of anxiety. Health care is based on the human touch between two individuals, and a smile or a similar warm greeting is an essential part of that—and it can disarm even the most stoic person. In the same vein, a smile can ease the anxiety of patients, including the stoic ones who may be reluctant to admit to their own vulnerabilities.
Technology and the Human Element
But we live in an era of rapid innovation, and technology has crept into nearly every aspect of health-care delivery. From the most obvious hype and incursions of artificial intelligence to smart monitoring of health metrics, no corner of health-care delivery is immune to the forces of creative destruction of technology. These technologic innovations are expected to minimize errors, build efficiencies, and improve the quality of health-care delivery.
As technology creeps surreptitiously into every aspect of health care, the human element will increasingly continue to take a back seat. Notice how taking an H and P that involved extensive human interactions between two individuals in the past is now sometimes reduced to a “human-to-digital device” interaction or the complete lack of a smile or warmth in many patients to caregiver interactions. To be sure, we are not trying to promote pantomime or comedy while someone is ill or to appear to downplay someone’s illness or the anxieties associated with it. This is about the most basic human interaction; a greeting and a smile can go a long way in health care. But what we more often witness are patients displaying forlorn looks while gazing blankly into the distance of well-designed private rooms or desolate long corridors of gleaming hospital buildings. If only we could add a bit of cheer to their day with a disarming smile that pretty much costs nothing.
The Business of Health Care
Health care is often compared to the business world, and we are advised or admonished to learn from it. We are asked to learn from its workflow patterns, customer interactions (some may not like referring to patients as customers), and how it builds efficiencies into everything. Reviews of successful companies are written and used as educational material to teach about building efficiencies in the business world. We are asked to cross-pollinate those practices into medicine as well. Leaders of these large companies are often admired for their efficiency in running the business. In fact, over the years, businesses have built super-digitized systems on hyperefficient platforms. And we certainly can learn something from their best practices, if contextualized to our unique settings. But alas, too much of anything is not always good. These super-digitized systems and hyperefficient platforms can lead to the rising trend of impersonal experiences.
Take for example Starbucks, one of the most visible, valuable, and customer-friendly coffee chains in the world. Results of the company released to the public in October 2024 showed that the global sales were down twice as much as feared, and earnings were more than a fifth short of analysts’ consensus. The new CEO noted there is a lot to glean from these dismal results but offered some early clues. One of them was to move away from the hyperefficient and super-digitized-but-impersonal experiences model and take it back to a more welcoming place, where people get together over coffee and smiles. Essentially, that is going back to the very basics of serving good coffee over a few smiles in the most personable approach.
Back to Basic Tenets
So maybe, we in health care can also focus on going back to some of our elemental and basic tenets. While incorporating technology due to its enormous benefits should be encouraged, why not simultaneously get back some of our low-tech initiatives from the history books of health care? As in the past, when technology was not so pervasive, we did indeed spend more face-to-face time with our patients. Maybe we can return to having chats with patients (if time permits) on topics unrelated to their health-care issues. There is always something to learn from everyone. And somewhere along the way, we can hold their hands (beyond when examining them) and sprinkle in a few smiles.
After all, if a $5 latte can get you a smile, patients should expect more from a drop of blood and even more when they part with a portion of their pancreas or liver.
DISCLOSURE: Dr. Are has a patent with the University of Nebraska Medical Center for a laparoscopy instrument.
Dr. Are is the Jerald L. & Carolynn J. Varner Professor of Surgical Oncology & Global Health; Associate Dean for Graduate Medical Education; and Vice Chair of Education Department of Surgery, University of Nebraska Medical Center, Omaha.
Disclaimer: This commentary represents the views of the author and may not necessarily reflect the views of ASCO or The ASCO Post.
