• Mitch Keamy Photo Mitch Keamy is an anesthesiologist in Las Vegas Nevada Andy Kofke Photo Andy Kofke is a Professor of Neuro-anesthesiology and Critical Care at the University of Pennslvania Mike O'Connor Mike O'Connor is Professor of Anesthesiology and Critical Care at the University of Chicago Rob Dean Photo Rob Dean is a cardiac anesthesiologist in Grand Rapids Michigan, with extensive experience in O.R. administration.

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I completely agree that conceptualizing patients as customers is a bad idea, but with so many patients adopting this model in their attitudes to receiving care, I think we also as clinicians need to make sure we don't fail to hear and respond to their concerns. I was just on the comments section of and was horrified at how much certain patients who have felt un-cared for, un-listened to, and in fact violated, HATE us so much as a group. There has to be a way to communicate better but also affirm that we are NOT there to jump when they say jump, but rather to provide expert care to the best of our knowledge and ability.


I am respectfully disagreeing with the idea that patients are not customers. I am an anesthesia customer/patient. I have a right to change my anesthesia provider if he/she doesn't want to do what I know is best rather than what they THINK is best for me. (Or what they WANT for convenience sake) That is what makes me the client, not the victim.

Mitch Keamy

A customer implies some sort of commercialized relationship to me; I can do something to/for a customer (sell them cigarettes? do an elective case on a full stomach?) that they might agree to, even desire, despite the fact that it is not "the right thing;" not safe, not appropriate. I owe a higher moral duty to a patient than I do to a customer. I have, and always will, refuse to do things to/for patients that I do not believe are appropriate, regardless of what they might want. If it costs me business, so be it; that's not why I do what I do. The patient physician relationship involves a moral covenant. Such a covenant does not exist in the client relationship. To my thinking, relabeling patients as customers is profane; it industrializes a sacred relationship for the purposes of corporate medicine-the purposes of the HMO's and for-profiteers eating away at the soul of medicine to fund their private jets. The HMO's and insurers that pay me on behalf of my patients are my customers. How do I denote a higher duty to my patients, or do I just compromise my patient's "customer" needs with the insurer's needs as another customer? Believe me, the folks that are trying to substitute the concept that patients should be treated as customers know exactly what they are saying and why...Sorry for the rant, but that's the way I see it. I have a large file of stuff on the covenant in the patient physician relationship. The most articulate was Chicago's late Cardinal Bernardin. Let me know if you want a fax/PDF.

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