I'm Not Comfortable With Customers: Repeat Three Times


After spending some time on the in-patient service during that always-difficult month of July, when new interns, residents, and fellows arrive, it struck me that there are more rules, traditions, and other quirks that permeate the hospital culture than ever before.

Why do "codes" have to be announced a minimum of three times overhead (are there data to suggest that response times and patient outcomes are adversely impacted when the announcement only blares twice)?

Photo pgiam/

Why do we constantly use the construct "I’m not comfortable with..."? As I tell the house staff, if I were concerned about their comfort, we would sit on couches during rounds.

Why are there never enough elevators? I have a theory but can’t prove it. Specifically, I suspect that the first detail architecture students learn in the course entitled "Introduction to Hospital Construction" is: Estimate the number of elevators needed and divide by two.

Why do hospital administrators refer to patients as "customers"? Are we running a store or a place for healing? Perhaps we do learn something by remembering that service matters, but there is something not quite right about referring to a patient who just had a myocardial infarction as a customer. This point was made by Donna, the world’s greatest ward clerk, who observes everything and can find a bed better than anyone.

On the subject of beds, why are there "no beds in the CCU"? It seems to me that there are always beds in the CCU. Monitors, too.

I could go on but then I would sound like Jerry Seinfeld. I’m actually comfortable with that but fear that the news would be repeated three times, and our customers would simply not tolerate it.

Dr. Paul J. Hauptman is Professor of Internal Medicine and Associate Dean of Clinical-Translational Research at Saint Louis University and Director of Heart Failure at Saint Louis University Hospital. He currently serves as an Associate Editor for Circulation: Heart Failure and blogs while staring out his office window at the Arch.

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