Against customer service

This essay examines the nature of service in medicine and the relationship between service and profit. "Customer service medicine" is identified with the interrelated views that 1) profit is or ought to be healthcare's fundamental concern and 2) the quality of medical service corresponds to the degree to which it produces a feeling of approval in patients. This position is contrasted with the more traditional "beneficence model," which holds that 1) service ought to be healthcare's fundamental concern and 2) the proper criterion of quality medical service is the alleviation, mitigation, or prevention of the human suffering that occasions illness. Five shortcomings in the customer service model are identified: 1) customer service advocates often appeal to an unsound "efficiency argument"; 2) the prioritization of profit over service will vitiate patients' legitimate trust in healthcare; 3) the prioritization of profit converts medicine from a "practice" into an "instrumental activity"; 4) the prioritization of profit countervails the values of continuity and thoroughness; and 5) the notion of service as customer satisfaction derives more from the exigencies of turning a profit than from an analysis of sick persons' needs.