When I patronize a restaurant, I am fully aware that the restaurant staff’s goal is to serve me quickly and efficiently with few (or no) mistakes.  Regardless of how ravishingly starved I feel, my severe hunger pangs do not propel me to the front of the line, nor do they make me more of a priority than another customer, no matter how much I moan and cry in agony.  If I choose to behave in this manner, all I manage to do is become a flashing red dot on the manager’s radar and generate some eye rolling from the spectators.

Instead, I give the greeter my name, wait my turn to be seated, and try to be patient while creating crayon works of art with my kids.  I have been known to show angst at other patrons who believe they are of a higher caste and deserve faster and more catered service.  These particular patrons may have this attitude for a multitude of reasons.  Having experienced a short career in fast food at age 16, I realize that waiting is inevitable during peak meal times.  I also understand that mistakes will be made as humans are still running the show.  Knowing these facts, I choose to go to a restaurant for my meal and know that patience will be needed.  It is a privilege to have the opportunity to have someone else serve me, deal with my demands, and clean up my mess.

But isn’t health care a right.  Everyone deserves to have quality health care, especially in the most dire circumstances.  Health care providers are in an industry of service as well.  The harsh reality is that, despite our human rights, this service is frequently used as a privilege which subsequently turns into abuse.  What many health care consumers may not realize is that the high cost of their own health care is partly due to abuse of systems and health care services.  We, as a society, are creating our own monster … and feeding it.

I would like to think, as the general population may, that people do not choose to go to a hospital in the same way they choose to go to a restaurant.  I would like to think that people actually do not go to a hospital unless they really have to.  My experience lies in emergency health care and has proven to me otherwise.  A large part of emergency patients actually do not have an emergency.  Oftentimes patients arrive in an emergency department with complaints such as tooth pain, infected piercings, hangnails, chronic pain, skin cancer checks, or drug seeking behavior (just to name a few).

More each day, privileged behavior seems to show its evil head.  Unlike the restaurant industry, health care is not first come first serve.  One may not make reservations to an emergency department.  One does not become more important because he complains about the wait.  Emergency personnel also do not care if a patient is someone of “status.” The sickest go first.  Period.  Even if someone else has waited three hours.  This triage system seems to make sense and has worked for a long time.  And it only seems right that the sickest goes first in this particular industry, right?  But does the need to chase customer satisfaction in a privilege-based society trump this system?  Read on.

As a result, some patients may lie about their symptoms to get in faster.  If they do, in fact, get in faster because of a more serious complaint (even if faking is suspected), their medical work-up is more extensive so as to perform the well-refined lawsuit prevention medical practice.  This defensive practice includes additional blood tests, radiology tests, medications, procedures, etc. (all of which are unnecessary), which make that patient’s visit more expensive, even though they actually came in for something minor.  This defensive practice has lovingly been termed “the million dollar work-up.”  Patients have been known to call an emergency department in advance to warn staff of their upcoming arrival and to please have a wheelchair and a room ready for them.  Unfortunately, it is common practice for “frequent flier” patients to sit in a waiting room and moan and cry in angst of someone else being taken in first.  These patients have earned themselves a flashing red dot on the radar and some eye rolling from the waiting room and the staff.

Health care personnel are split up into specialties for a reason.  Would you go to an orthopedist if you are having chest pain?  Would you see a podiatrist for glaucoma?  What about a gynecologist for your brain cancer?  Do you think about seeing an emergency physician for medication refills or because you noticed a lump in your breast seven months ago?  I didn’t think so.  You also do not drive across town to the Italian restaurant if what you really crave is Mexican food.

There are a lot of extenuating circumstances which are understandable when they force some patients to the emergency department.  However, when patients use the emergency department as their primary care source, costs are inflated because an overwhelming number of those patients are uninsured, low-income, or use government assistance.  When the government is involved with issuing reimbursement to the hospitals, they can also dictate what items are eligible for reimbursement.

Now hospitals must reach a certain level of patient satisfaction before gaining full reimbursement from the government.  And this satisfaction score applies to all patients, not just the ones who receive government assistance.  The expectation has been set that health care personnel will serve patients, deal with their demands, clean up their messes, and smile about it.

Laws are in place that prohibit an emergency department from turning anyone away without a medical screening.  This law was created with nothing but wonderful intentions and assumes that everyone who goes to the emergency department actually has an emergency.  A new generation of patients was born.  Knowing that clinics may turn them away, clinics have longer wait times, and test results take longer when obtained through a clinic, patients have chosen to utilize the services of highly trained, specialized emergency health care personnel for their primary care needs.

Is it fair to expect a nurse to serve your demands of amenities and clean up your messes (which are a far cry from messes made in a restaurant) when she is trying to assist with life-saving measures on a different patient just down the hall?  Not only is she attempting to practice her specialty of emergency health care, but she is also being held to an expectation to please patients who do not have true emergencies.  In order to assist her hospital in reimbursement payments by boosting customer service ratings, she has to choose between pleasing non-emergent patients who are abusing their right to use the emergency department and very ill or injured emergent patients who actually need her help.

If your mother is in the hospital having a heart attack, would you rather the doctor spends his time helping her or trying to please the non-emergent angry patient who did not receive his warm blankets quickly enough?  Is that time taken away from your mother for the sake of obtaining a higher score?  Maybe, when you are talking about some big money reimbursement.

The doctors and nurses will choose the emergent patient, just so you know.  Someone may go without amenities for quite a long time while they are helping to save a life.  That disgruntled patient will complete a survey which reports a low score for customer service.  Hospital fees may not get fully paid or reimbursed.  Your insurance premiums may go up.  Hospital staff may not get raises.  The abuse of the system continues.

Hospitals have begun to cater to non-emergent patients though.  Some emergency departments now have separate sections of the department dedicated to non-emergent patients so their door-to-treatment times are quicker.  Under the model of the older system discussed earlier, these patients are non-emergent; therefore, they would wait longer.  Under the newer model, because they are non-emergent and meant to move through the department quickly (so as to satisfy them), other more emergent patients actually still wait for the main emergency area because their more emergent status means they need a different section of the department with a higher level of care.  Correct me if I am wrong, but that seems a little twisted.  But it helps the customer satisfaction scores by satisfying even the patients who do not really need emergency services; the end justifies the means.

So the question begs:  Is health care a right or a privilege?  If it is a right, should the same expectations be placed on health care as they are on privileges such as a patronizing a restaurant?  Should hospital wait times be publicized for health care consumers so they expect rapid service when in all actuality they may end up waiting and becoming dissatisfied?  Should health care facilities cater to patients for the sake of a high score?  Is it right for the world of health care to continue enabling behavior that fosters this environment of entitlement?

You are now challenged with these questions the next time you or a loved one goes to a hospital simply looking for quality health care and knowing what is behind the scenes.  Ah, the complexity of a simple human right.  It is just not that simple anymore.

Leigh Abilland is the author of Yes, I Know You’re Dying.