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February 16, 2014


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l recognize everything you're writing. Here in Holland it is the same. When l call a doctor or a hospital, then there is the waiting, the long waiting. And when you speak with someone they are not always friendly, they do not understand you and the do not even try. Being sick is difficult, but they make it even more difficult.


David Meerman Scott

Hi Diana, Yes, being sick is also very confusing - new terminology and so on. There has to be a better way.

John Murphy

I think the Cleveland Clinic has done a good job giving patients full access to their health records and much more. It's completely transparent. Plus, on every visit, they print out all the doctor notes and give them to you if you want. Mine are just posted to the mychart portal. Lets hope the ACA doesn't louse this up!

David Meerman Scott

John - I've heard good things about the Cleveland Clinic too! I seem to recall a few years ago they were one of the first to put a surgery onto YouTube.

Mark Copemam

Ditto in the UK, David.

"You want to make an appointment, today?! Afraid we are booked till mid next week..."

"Errr, my daughter is unwell today,"


It's not the GP's fault necessarily, it's the system, however no other business type would survive using this type of approach. Particularly around the customer service elements.


Health care in the US (and I suspect most other countries) is an oligopoly. Your choices are limited, so why should they expend the effort to attract customers (patients). You will have to settle for one of the limited options available.

I believe that this is primarily caused by the health insurance companies, and their focus on driving down costs. To survive, practitioners have to see more patients every day, reducing the time the spend with each patient. This trend is aided and abetted by the rise of large medical groups, etc., managed not by MDs, but by MBAs. Or MD/MBAs. The problem is not the practitioners. They too are trapped in the system.

The best solution at an individual level is to be an informed consumer, and not end your appointment until all your questions are answered. Unfortunately you must know the questions to ask. Woe to the patient who does not know what to ask.


Speaking as someone who used to work in the healthcare industry (IT vendor), there are many interesting opportunities that exist. There is a general movement towards disease prevention, and implementing technologies that enable many of the improvements in service that you describe. The unfortunate reality is that many specialties are understaffed, and healthcare is constantly playing catch-up.

The good news is that there are regions in the US where it is possible to provide coverage for a great number of patients with technologies that you're used to in the banking industry. The idea of the typical family doctor will go away (I'll call them family guessers), and replaced with healthcare facilitators who will be responsible for directing traffic to specialists and triaging (which is really all they do now) patient issues. You'll hear a lot about electronic patient records - and organizations like Kaiser Permanente use them well. There's no reason why a patient can't use computer-aided systems triage themselves, and arrange appointments with the most appropriate hospital or clinic in their area - right down to selecting their own appointment time. This happens today already, but is facilitated by family doctors. Health cards will allow patients to check themselves into hospitals with their full relevant health history attached and avoid long line ups while waiting to re-explain all the things to the administrative staff.

There's no doubt in my mind that there's an application of technology that will remove the mundane tasks from healthcare, improve information sharing, and allow practitioners to focus on delivering exceptional service that you describe. It's just unfortunate that healthcare is FAR behind other industries (insurance, finance) in using technology in the most beneficial ways.

Oh...and it's HIPAA. :)

David Meerman Scott

Mark - I agree that it isn't the physician's fault. But I think physicians have a role to play in making things better.

Bob - I'm resisting jumping into the political aspects of the poor customer service in the healthcare field because this is not a political blog. However, I certainly hear you!! I agree on being an informed consumer, but there's a problem in the huge amount of information available on the public web. While some is vetted such as WebMD and other sites, there is a lot of bogus and confusing stuff out there when you consider alternative medicine and strange theories like vaccinations are a government plot. So the practitioner should be guiding patients to the best information in their particular case.

Don - thanks so much for offering your observations. That's the first I'm hearing about self-directed triage. Fascinating. In my experience presenting at many healthcare conferences, the people in the industry today are fearful of change so it will be interesting to see how quickly these ideas will be implemented.

David Laurence

Serves as a reminder that culture is as important as technology in affecting how markets perform.

This post makes some interesting points about the telehealth opportunity : http://www.nickhunn.com/nhs-claims-200-of-global-telehealth-users/ - uses the phrase the "sceptical GP".

Just saw a headline saying cultural change will be the biggest impediment to building information modelling - a process for transforming the way buildings are designed, built and operated.Good luck.

Perhaps we should modify a well known comment to read "It's the culture stupid " !

Linas Simonis

Hi, David. In Lithuania you can do it online, it's normal practice. In most cases you can see availability and book appropriate appointment time online.


Hi David -

On the patient education side, as your experience in physical therapy shows, medical professionals were not overly concerned about educating you as a patient. In general, they were the experts and they would take care of you. Fortunately, that view is changing as doctors/healthcare providers realize that an informed, engaged patient does better.

I think this area of "patient engagement", is a big opportunity. Think of sending a kid to school and not sending them home with the right information or not having them take notes during class. You would say to your child "What did you learn today?" and they would say "I don't really remember". Teacher talked a lot with words and concepts that I really did not understand.

So patients now want to "revisit the visit". They want to capture all that information that you are sharing with them verbally so they can do the right things after the visit. Like the business buyers you write about - they want the right content, at the right time, in a form that is easy to consume.

At the same time, medical professionals are crazy busy people and each solution also needs to reflect their workflow. Too much work and they will not adopt.

David Meerman Scott

David - cultural change is always the most difficult. I *still* work with companies that block employees from using Twitter and Facebook at work!

Cliff - thanks for your thoughts here. I think the potential of what you are doing with Postwire is an amazing opportunity in healthcare!

Jack Derby

David, I hear your pain...

But, at MGH, I am online with their Patient Gateway. All my files, tests, media and doc notes. I schedule appointments from the platform. My GP directly receives results from other docs in an out of the system. Ended up in emergency room at Portsmouth Regional Friday AM. All I needed to do to get admitted was to have my license scanned at the terminal, and all of my MGH records were immediately available.

I've grown up in the healthcare system running various med device companies, and think that the change is superb today. Not there yet, but huge technology strides over the last five years and five years from now, connected health products, data analytics and best practice assessments will be everywhere.

David Meerman Scott

Jack, wow! I'm encouraged by what you have experienced. Hopefully market competition will mean that innovations like those at MGH will be rolled out at other health providers (like mine). Thanks for letting us know.

Jim Edholm

David --

Fascinating post and some dynamite commentary.

There IS room for individual practitioners to be more open and available. My MD for example, gives all his patients his email address, encourages them to write with questions, and then he give each a personal answer.

He's also very good about steering me to the right person in his practice, e.g. the nurse practitioner deals with me on most of my mundane health care needs, and he's excellent at spending the time you need and addressing the questions you have. Unfortunately, that generally means that if your not the FIRST appointment of the day, you will have to wait, sometimes an excruciatingly long time.

One of the earlier commentators mentioned the problem created by "insurance companies" and their focus on quantity over quality, and there is an element of truth in that, particularly with HMOs and their deeply discounted rates that minimize the time a doc can spend with a patient.

However, i think the real problem (or at least one of the major problems) is the lack of transparency in the medical system. For example, I live in Boston, and if I need a colonoscopy from a network facility, I have a choice of about 30 adequate providers (i.e. they meet quality standards), but the costs range from $1,100 to $3,700! And that information's not easy to find (I work in the business of helping employers design and adopt medical plans).

As a result of this murky picture, patients pick facilities based on their "reputation," generally when it doesn't matter. And that leads to higher costs. For example, there's a high quality community hospital in Cambridge where a normal deliver pregnancy costs $5,900 and has a quality score of "X" (I don't know the exact numbers).

Across the river in Boston is a world-reknown institution specializing the children's matters, and the SAME pregnancy costs $20,000! And the quality rating from THAT famous facility is "X-", i.e., it's very good but a shade lower than the community hospital across the river.

Yes, health care is an oligopoly, and the big hospitals are trying to turn it into even more of one, but transparency can STILL introduce a "marketplace mentality" where the kind of treatment you describe becomes less common.



I've been dealing with this a lot lately. What I hate the most is when doctors or their assistants or office staff use Obamacare as an excuse. I'm sure it's difficult and changed their work lives significantly, but, if they hadn't complained with the same excuse before Obamacare, then it wouldn't sound like the same old sad story I always hear. And, as a patient, I don't want to hear about the woes of your backend operation. Buck up, and get your work done. The economy ups and downs has affected every industry. If I were to whine to my boss, and even worse my customers, I hope my boss would fire me. Deal with it. Move on and be the exception - take the opportunity to stand out. As the head of our company says, if you see a void, take the initiative to fill out. Don't just talk about it. Same could apply to the health care industry. I could write for hours on this topic, but won't. Very glad that a well-known marketer like yourself is bringing to light the customer service gap in this industry.


I agree that the service has gotten worse. It is also very frustrating when you are waiting in the waiting room for more than an hour just to see your doctor for a 20 minute appointment. It can be even more frustrating if the receptionist is being rude to you. Hopefully in the future something can be done to make the doctor's service more available and helpful to the patient if he or she has a question.

Thank you for the information!

Andrew C.

David, our service here in Nevada has also gone from bad to worse. I would like to believe that positive change is on the horizon, but I'm not holding out much hope for such change in the foreseeable future.

David Meerman Scott

Jim - thanks for adding some color commentary. We've certainly got a convoluted system. But that doesn't mean we can't get good service!

J - Well said. People go into healthcare based on their own choice as we all do for our respective careers). If you don't like it, do something else. But don't take out your frustrations with patients.

Andrew - I'm always hopeful. Heck the airlines have been improving!


The service is horrible and so is customer service. For the amount of money we pay, we should be offered at least water or juice while we wait. The health care industry is preposterous. They are ready to take our money, but when we have a question, we are left hanging. We need to change this industry's customer service. Thanks David for addressing this issue.


One of my most read posts was addressing how locally here in Puerto RIco with a lot of U.S. influence many doctors have become less worried about patient care. On the Island the fact that at one point there was a lack of Doctors makes some of these individuals think they are part of what I call the "White Coat Caste".

One of the main reasons I eat as healthy as possible and take good care of myself is the extra incentive that in the Island you get an appointment on a certain date not even a set of hours. Some doctors are known to take care of their patients like cattle and even if you have an appointment it is first come first serve basis. Patients even some delicate ones can easily spend 8 to 10 hours in an office waiting for care.

On the other side I have a physician who was a client. He has tons of restrictions on his patients but when it comes to service he puts a ton of restrictions on me some that might have taken me into bankruptcy. To many these behaviours are based out of pure greed since to become physicians the cost of education is so ridiculous then they become sort of robots trying to pay that off and acquire wealth.

I think you are on to something here.

David Meerman Scott

Raul - an 8 to 10 hour wait? Wow! That makes my rant extremely minor in comparison!

My daughter is currently in university taking a pre-med course. Hopefully medicine will change by the time she is a doctor in about 8 years.

Kiana Clark

Mr. Scott I thought I was the only one with this issue. In order for me to feel fulfilled after my appointments, I bring a list of possible concerns and questions because I know if I call after I wouldn't get them completely answered. What's the point of paying healthcare and paying doctors if we're going to use http://www.webmd.com for free? Great customer service is mandatory!!


Going through my blog feed and saw this picture. I used to work at the company that made they drawings and instructions. We sold a software package that had high quality printouts, but the PT was probably using our old photocopy system. The goal was to increase patient education. Small world. :)

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