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    Service secrets: Lessons for physicians from McDonald's

    An emergency room physician shares the link between happy meals and happy patients.


    As the father of four kids, I go to McDonald's more than I would like to admit. And I hate McDonald's. It might as well be prison food. After all, prison food certainly can't taste worse than McDonald's, and death-row inmates probably don't die as quickly as adults who know Ronald on a first-name basis. And the price? Don't tell me it costs more to feed a prisoner than it does to shell out for four Happy Meals.

    So if McDonald's is so bad, why is it so popular? The answer, I figured, as I pulled away from the drive-thru with another bagful of bland meat, is service.

    In prison, you are a number. In prison, you have no choices. In prison, you have no control. In prison, time is your enemy. You are deprived of the first thing we achieve as a human being and the last thing we want to lose before dying: autonomy.

    At McDonald's, you are not only given choices—you are made to feel special. And not only are you special, you have come to a place to be made happy. Inside those Golden Arches, time is not your enemy, and promptness is part of the service. You may be broke, lonely, or hooked on heroin, but you know you are welcome at McDonald's to have a choice, feel special, and experience a happy meal at a happy place.

    Now what in the world does this have to do with medicine, the hospital, and—of all places—the dreaded emergency department, where first-year residents are caged for the night sewing up drunks, setting bones, and admitting drug overdoses? I have a few secrets I would like to share that few who are newer to medicine truly seem to know—secrets that can dramatically change the way you and I practice medicine.

    SECRET #1

    Eighty-five percent of all patients you meet in an emergency situation will get well without you doing anything.

    • Most ear infections, throat infections, sinus infections, bronchitis, and bronchiolitis will go away, even if it's bacterial.
    • Most babies, now and throughout the history of the world, are delivered without medical help.
    • Most stroke victims are quite functional one year post-stroke without therapy, and there really is very little therapy in spite of all the advertising.
    • Most lacerations will heal without suturing—we just close them to look pretty.
    • Even most trauma at Level I medical centers is nonsurgical.
    • Low back pain, even with sciatica, will do just as well with nothing as with surgery.
    • Among the 15 percent of patients who actually need our help, we run the risk of medically, emotionally, and financially devastating them to the same degree that we may help them.

    So if most people do not need physicians, even in an "emergency," and we have the potential to harm them to the same degree that we can help, why do patients come to the ED?

    SECRET #2

    Most patients come to the ED in response to pain and/or fear. If you can offer effective, quick pain management and can communicate in a way that alleviates fear, you will do more to help the majority of the patients you see than you could using any other skill, procedure, or medicine.

    SECRET #3

    Patients determine how good you are as a doctor in pretty much the same way that other staff—even other doctors—determine how good you are: by the way you treat them as a person.


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