By Joel Theisen, RN

American business is delivering one of history's greatest revolutions in customer convenience -- except in our industry, the one that needs the biggest change of all.

For the first time we can shop for just about any product on Earth with a basic cell phone that fits in our pocket or purse. We can stream the TV show or movie of our choice at our most convenient time. Instead of waiting in the rain or snow to hail a taxi, we can have a car pick us up at our preferred location, or have another vehicle deliver our groceries, a dinner from a restaurant, or fresh flowers from South America.

What we apparently cannot do, however, is make medicine convenient for our customers.

Healthcare may be the biggest business in the wealthiest nation on the planet -- 17.3% of the U.S. economy, worth a total of $4.5 trillion a year, or $13,493 per person -- but it is still a massive pain in the neck for our patients to come see us. Polls show most Americans are not happy with their healthcare, and there's little doubt why -- it's expensive, complicated, and really, really inconvenient.

In 2024, even the worst-rated cable TV company, home Internet provider, or electric utility will generally give you a 4-hour window when they're likely to reach your home for a repair. Meanwhile, healthcare is not going to do a house call unless someone's life is in danger. Most of the time, those who need non-emergent care have to call the doctor's office, wait on hold for a long time, talk to a non-medical staffer at the local front desk or overseas call center, be screened if they need a referral, and then hope to get an appointment, possibly with a doctor but more likely with a physician's assistant or nurse, several days or weeks out.

When the appointment day finally arrives, they'll have to check in at the front desk, serve up a copy of their insurance card, fill out paperwork (even if they've filled it out before), and then hang around the waiting room until they're finally seen by a series of nurses and medical techs before the doctor arrives.

And that's just for a non-urgent appointment. If a sick or injured person needs an emergency department, the average wait time nationally is 2.5 hours. Frustratingly, the typical hospital waiting room time is about the same as an entire nine-inning Major League Baseball game. (Maybe that's why people in the emergency department are called "patients.")

What other business treats its customers so poorly, so frequently, and so predictably?

The other industry that dominates the bottom of consumer rankings is airlines, but there's one major difference: airlines will at least tell you how much their service will cost with an advertised ticket price. Doctors and hospitals can't even do that -- medical service providers are usually clueless about the price that will be charged to customers. Their bills go out well after the fact, calculated under some mysterious and often secret process, making it impossible for consumers to comparison-shop based on price.

Too often the arrival of the healthcare bill, often sent by snail mail weeks or months after the service was provided, marks only the beginning of the most infuriating medical customer service nightmare -- fighting with the insurance company about who is actually going to cover the charges. Why is any of this considered normal?

Most people in medicine chose this career to help others, not stymie them. It's the business side of medicine that is making life miserable for customers.

The surprise here is that people have put up with it for so long. Health executives haven't felt pressure to improve customer service because right now there isn't a better alternative. That is a foolish and shortsighted belief. Remember: Cable TV isn't the only business where, in the not-too-distant past, executives convinced themselves it would be impossible for customers to cut the cord and replace them with a competitor focused on convenience. It's time for the medical business to view customers as people with busy lives, not just a collection of body parts that periodically breaks down and generates revenue.

To improve customer service, medicine should borrow good ideas from other industries. Computers and cell phones can help eliminate some unnecessary commutes -- we should further embrace telemedicine where appropriate. Neighborhood-based healthcare, including community paramedicine, can allow more people to be treated in the comfort of their homes instead of the hospital emergency department or acute care facility. And medicine needs to find a way to recruit and retain more doctors and nurses -- it's unacceptable for customers to wait 9 months for a basic dermatology or general practitioner appointment because of staff shortages.

Those changes will help in the short run. Longer term, however, I believe many customer service problems will be solved by changing the economic incentives. It's time to move from the current fee-for-service philosophy, which pays more for churning out more tests and procedures, to a results-based health philosophy, which rewards professionals for keeping customers healthier. Value-based care should force health systems to focus more on what customers want.

The U.S. medical system has led the world for years in innovation, training, and technology. It's time for us to catch up on customer service.