We’ve all been there – we enter a shop or restaurant and … no one seems to care. We’ve all just learned to deal with that type of an experience.

But what happens when you encounter this environment in a doctor’s office or a clinic? If it’s the first visit, we are undoubtedly anxious. We also might be anxious because something hurts and we have no idea what’s happening. Isn’t that why we came to see the doctor in the first place?

That anxiety is exacerbated by how we are greeted at the front door, whether through the all-unknowing telephone audio response system, or the actual door. If we are not necessarily used to using electronics, we don’t know to look for the kiosk, although we might be lucky if there is a tablet set in front of the door. If we are anxious, we generally look for a friendly face to help us navigate. Or at the very least, we’d like to see someone who might smile and say “hello.”

Then, once you sign in, what happens next? Take for example, something that happened to my wife and me recently – she was referred to a world-class specialist for a very scary eye condition. The appointment was scheduled for 9AM and when we got to the clinic, the very large room was packed, which heightened our anxiety. The electronic kiosk was almost hidden (if you didn’t know where to look) and then finding a seat was difficult. Roughly an hour and half after registering, she was called into an exam room for an initial evaluation and then sent back to the waiting room. But no one told her what was next. An hour or so later she was escorted for another look into an ocular machine and then she came back to the waiting room. At 3PM she was escorted to the final treatment room and told the doctor would see her next. The wait there was only 30 minutes (!) before she saw the doctor. At least someone told us what to expect, mostly.

The care was phenomenal, but the packed waiting room heightened her anxiety. Conversations overheard in the waiting room included: “it’s always like this,” “no one tells you what to expect,” “they schedule everyone at once and then you have no idea when you might get seen,” and “I take the entire day off from work because I just can’t plan.”

This is an extreme case, but not dissimilar to what we’ve experienced when visiting our primary care doctors. You’ve been seeing this clinician for years but the front office staff seems to change every couple of visits so no one even says, “Hello.” While this doesn’t really affect your care, it does affect your state of mind.

Every patient has a different reason to see the doctor, and in most cases, that visit brings its own levels of anxiety. Some people had to spend hours just getting ready for the appointment.

For some this is a highlight of the week and preparation is important. Do you need assistance to get to the appointment? Do you have to take public transportation and how long will it take – how many bus transfers will you need to make? Should the front office staff be more cognizant of those concerns, and is this addressed in training and orientation? Would treating patients with a minimal amount of respect help to relieve some of the stress and anxiety?

There is very little research surrounding how patients and their caregivers are treated by medical office staff. Medicare’s Consumer Assessment of Healthcare Providers & Systems (CAHPS) does not include specific questions about patient experience with the front office; however, there are two questions in the CAHPS for Merit-based Incentive Payment System (MIPS) participants. Those questions address whether the front office staff were helpful and if they treated the patient with respect. I have not seen any data aggregating the findings from these questions and the research points to patient experience only in hospital settings.

In 2013, Merlino and Raman wrote about the drivers of patients hospital experience. They report that if patients don’t “feel that … caregivers are compassionate, that may heavily influence … overall perception of the experience. Since his relationship with health care givers is more prolonged (or permanent), he may need more of the ‘human side’ of caring.”

The Agency for Healthcare Research and Quality (AHRQ) developed the Ambulatory Care Improvement Guide to help health care providers. Chapter 6 of the Guide offers standards for customer service, explaining they may be “similar to ‘service guarantees’—a concept that frightens many health care employees because they do not trust that the systems they need to meet ‘guarantees’ that are in place. Organizations that maintain their focus on service often find that the standards evolve over time.”

AHRQ includes examples from organizations including Kaiser Permanente’s Pharmacy Department: “We will greet our members in a courteous and professional manner. We will listen effectively to our members’ requests and promptly take the necessary actions to assist them. We will keep our members informed of unexpected delays in service.”

As an aside, I don’t believe that new technologies will offer the personal solutions. Entering a clinic or doctor’s office is a human experience and presenting a patient an opportunity to “sign-in” online or check in at a kiosk removes the need for a personal interaction.

My personal experience is that within a strictly fee-for-service payment structure, the front office is not incentivized to treat patients or family members in any particular way. But my wife and I have seen, at least in the Minneapolis area, where most health care is provided through health systems, the competitive nature of the health systems almost require a high level of friendliness and respect. These systems could perhaps collect and use the CAHPS for MIPS data which may be why we have not experienced what we consider a lack of respect like what we saw in small or medium-sized practices while living in the DC area.

What this tells me is that, currently, any patient experience or satisfaction with front office staff is strictly anecdotal, reflecting personal satisfaction or dissatisfaction. And one of the few solutions we have received when issuing a general inquiry is “find a new doctor.” Like the example I shared above, many times that option is just not available – the physician is a specialist, other clinicians won’t take the patient’s insurance, or there are too few providers in a patient’s community.

I don’t believe that my wife or I are the only people who have experienced a lack of customer service in health care. I am interested in seeing if this is an underreported or under researched issue or just a personal concern. If you are aware of any research into customer service in health care or have your own experiences, I would appreciate hearing from you.