I recently sat down with a surgeon colleague to lament what he described as a “surge” of new patients who had come to his practice with well-defined and specific demands for surgery.
Many of these patients had various painful ailments, and all had spent time online researching options. Each one was quite convinced that surgery would be the cure. For several patients, though, surgery wasn’t the right option and the surgeon would patiently explain his reasons for not doing the procedure. Occasionally patients agreed, but others would angrily leave the office to find another surgeon.

My colleague confessed that conflict was exhausting. It created bad blood leading to patients reporting low patient satisfaction scores.  The surgeon was adamant that providing un-indicated surgery was unethical, bad care.

How did the doctor/ patient relationship go so wrong? I’d argue that has a lot to do with a shared misunderstanding of doctor/patient transaction. Despite appearances, the surgeon and the patients weren’t actually meeting to discuss the buying and selling surgical services. 

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There’s a well-known Clayton Christensen business case study that describes a fast food chain’s problem of stagnant milkshake sales. The company had been trying to improve the recipe by querying demographic segments of its market, getting each segment’s thoughts on what they thought they wanted in a shake. Despite this, the changes to the recipe didn’t lead to improved sales.

Finally, a researcher found that 40% of milkshake sales at the chain were (improbably) purchased in the early morning. These sales were to consumers who wanted thick shakes to fill them up on the drive to work. Buyers wanted a “fun” breakfast that entertained them, while not making a mess of their clothes and car. Once the chain understood this, it changed the formula to create an even thicker and more filling shake. Sales rose when the chain understood the job the consumer wanted done.

The takeaway: It’s impossible to effectively sell a product without understanding the “job” a product is supposed to do for the consumer. The buyer might struggle to describe the a product he’s looking for, but can usually define the job he needs to be done. It’s the seller’s job to respond with solutions.

For my surgeon colleague: the key is to recognize that patients are presenting with a “job to be done” (musculoskeletal pain in this case). The physician and medical system need to respond by offering a solution, not necessarily the product the patient thinks he needs or the one that doctor has immediately available for sale. The solution won’t always be surgery, and may sometimes be physical therapy or alternate options. But letting the patient leave the office without a solution for the job at hand is where the disappointment lies.

The good news: as physicians migrate from solo practice into systems of care, more solutions will become options for the “jobs to be done” that patients present. Along these lines, it’s good to see multi-disciplinary centers of excellence emerge (such as the new multi-disciplinary musculoskeletal center of excellence at my health system) which approach patient complaints in an imaginative way, with a range of potential offerings.  The difference is in selling healthcare solutions, not products.

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