I observed the following clinical scenario several times over the last few months and wonder if it is just episodic events or something more.
There is a type of patients who openly abuse acute care system. Such patients have a multitude of chronic conditions which can be managed successfully on outpatient basis, but willfully ignore all recommendations, teachings and the rest of it. Instead, they come to ER within 24 -72 hours after discharge stating symptoms which, as they know perfectly well, would warrant readmission, such as chest pain. Once admitted, they terrorize providers and the rest of staff, refuse interventions which are recommended, demand increase of opioids, benzos and other "good stuff" and, in general, refuse to go home till receiving as much of "customer experience" as possible. The cycle is repeated X times. Then, one beautiful day, karma struck. The patient somehow bent the stick too much and totally and profoundly upset provider and nurses. Therefore, he couldn't get more of his beloved dilaudid 1 mg IVP Q2h, no more phenegran IV, appropriate 2 grams sodium/ADA1500 diet instead of regular, no private room which "they always put me in because that's what I want", and his call lights are somehow always got answered the last. Nurses even stop obligingly wipe his butt upon demand, even though "they always did it for me before". After a couple of temper tantrums, the patient leaves AMA or upon the first opportunity to do so, with a loud promise to (never shop there again) never come back to this bad, bad hospital where "nobody cares for me".
That all is a common and well known and I wouldn't bother with it. But I saw several times recently that the patients in question truly disappeared from the ER for several weeks and, when they finally came back, they were there for legitimate reasons. Moreover, their behavior changed quite a bit. They stopped doing things which caused acute decompensations, such as skipping insulins and breathing treatments. They started to take most of their meds regularly, not only "ma' pain pills". They became more flexible with home and office care. They get flu shots and avoid large gatherings of people during flu season. In other words, they finally started doing what we wanted them to do for years before.
I was so mystified that I asked two of them, indirectly, what happened. The answers were: since I cannot get what I want here, then I do not want to go here anymore unless there is no choice; so, I am just trying to stay out of this hospital. You told me that I have to do (X, Y, Z), so I give it all a try, so I might not have to go where I was treated so badly and couldn't get what I wanted.
These observations prompted me to ask a silly question: can "customer service" paradigm actually attract chronically sick patients with significant knowledge about the system in hospitals and therefore negatively affect their health on the long run? And, as an opposite, can lack of "customer service" prompt these patients to finally take better care of themselves and therefore provide significant benefits for them?
I would be thankful for others' observations and ideas about this topic. "Customer service" is pushed down the throats of all health care providers nowadays, but I never saw any research showing its benefits or lack of them in terms of long-term disease process.
