The full content of Annals is available to subscribers

Subscribe/Learn More  >
On Being a Doctor |

Customer Disservice?

James L. Glazer, MD
[+] Article, Author, and Disclosure Information

From the Maine Medical Center, Portland, Maine 04101.

Requests for Single Reprints: James L. Glazer, MD, Maine Medical Center, 272 Congress Street, Portland, ME 04101; e-mail, glazej@mmc.org.

Ann Intern Med. 2006;144(1):61-62. doi:10.7326/0003-4819-144-1-200601030-00012
Text Size: A A A

Humming a little tune as I rounded the corner and headed down the homestretch of my afternoon in the office, I plucked a chart from the wall outside of room 14. Carol Todd, a woman of 48, had come to see me about “cellulitis of the scalp.” My nurse had scrawled a question mark after her history, and then an exclamation point. I shot a quizzical look into the nurses' pod at her. She rolled her eyes at me and mouthed the words, “You'll see.” I knocked on the door and entered the examination room.





Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).


Submit a Comment/Letter
Customer disservice!
Posted on January 28, 2006
Cesar Prinzac
Clinica São Vicente - Rio de Janeiro- Brazil
Conflict of Interest: None Declared


It's clear that social and psychological problems can not be addressed on a 30 minutes office visit. The vignette patient, like many around, will continue to confront doctors and will not have her real problems solved.

Probably after years of this model of office visits Dr. Glazer would still lack the intimacy necessary to convince her not to take a drug.

Treating patients as numbers or charts make it really hard to create a relationship based on friendship.Humanized medicine will be romanticized on medical novel from the 20th century.

The current customer service approach is not ruled by medical evidence, but on a client satisfaction policy. The bureaucratic system overrules our medical ethics.

Unfortunately it takes too much of our time to convince a patient about their real needs. On the frontline it is much easier to prescribe a statin or an antibiotic than to teach someone about real therapeutical choices. In an E.R. visit the waiting room will not permit you to spend your valuable time with such a patient, unfortunately. My pessimistic conclusion: The good fight is lost. But we can still have our clear conscience, as long as we believe and practice an ethical and professional medicine. Dr. Glazer may sleep like the just.

Conflict of Interest:

None declared

Giving in and giving up
Posted on February 2, 2006
Victor G Ettinger
Kern Medical Center
Conflict of Interest: None Declared

After reading the two articles and the commentary in the 'On Being a Doctor' section of the first Annals of 2006, one wonders why anyone would want to be a physician in this day and age. Dr. Glazer caves in to some ignorant, lazy beaurocrat and does something he knows is wrong. Dr. Cavanaugh treats his watch and not the patient for the same reasons as Dr. Glazer gave the second patient the unneedded antibiotics; it was easier/faster.

What happened to 'do no harm'? What happened to taking care of patients? We are no longer professionals giving people necessary care; we have become the purveyors of canned healthcare, no different than the storekeeper selling bread or booze.

Why did we agree to let this happen to us? When will we stand up and say 'We are physicians and we won't take this anymore'? It is ironic to me that just this week I discussed with my wife the idea of quitting, giving up because of the broken system we work in. No one seems to actively care about patients anymore, just push the numbers at 7 or 10 or 20 minuties per 'client', no longer patients, friends, collaborators, etc. Do what you have to do; do it fast and do it cheap.

Oh well. After all this time of trying to help other people, I think it is time to help myself and say goodbye to the dysfuntional system that is Medicine, USA.

Victor G. Ettinger, MD, MBA, FACE Chief, Division of Endocrinology and Metabolism Kern Medical Center Bakersfield, CA 93305 Assoc. Professor of Medicine David Geffen School of Medicine at UCLA

Conflict of Interest:

None declared

Submit a Comment/Letter

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.


Buy Now for $32.00

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Topic Collections
Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.