The McDonald’s Paradox

Left Without Being Fed

Consider a typical fast food restaurant.  On any given day they are staffed to quickly and efficiently handle a certain number of customers and to this end do their employees, many working at the first job in their life, toil mightily.    It’s hard work.  I’ve done it.

Suppose for some reason; rock concert in town, confluence of tour busses, rumors of the Apocalypse…use your imagination, suppose they get a sudden surge of customers and go into overdrive to feed them all.  After the deluge at the end of the shift the manager might gather the crew and say, “Folks, good job.  We usually only see 250 over the lunch hour but we saw 600 today.  You all kicked some ass and took names.”

High fives all around.  Guilty pride in a job well done because it’s McDonald’s and you’re supposed to hate working there.  Does anybody care that one or two customers, on walking in the door and seeing a long line at the counter backed out and went someplace else?  Of course not.

Now consider a typical Emergency Department.  On any given day they are staffed to quickly and efficiently handle a certain number of patients and to this end do their employees, all of them highly trained with many years of experience in nursing and medicine, toil mightily.

Suppose for some reason; rock concert in town, intersection of train with tour bus, rumors of the Apocalypse…use your imagination, suppose they get a sudden surge of patients and go into overdrive to treat them all.  When the shift is reviewed the administrators note that a couple of people signed in and, after seeing the packed waiting room, decided they didn’t really have a discernible emergency and went home…the dreaded Left Without Treatment (LWOT) or Left Without Being Seen (LWBS).

Oh the rending of garments and the gnashing of teeth!  Oh the humanity!  The number of LWOTs is a metric and by this do the pasty bureaucrats who run the place measure the quality of the Emergency Department. The shift is now regarded as an utter failure.  Heads will roll. The nursing manager is seen to sweat and tremble in fear as she calls in her subordinates to give the bad news.  Dark rumors circulate of displeasure at the highest levels.  Nursing cutbacks are threatened to fix the problem.   Even my bonus trembles in its golden cage.

But you know, we saw 120 patients in a shift that is only staffed for seventy.  Sure, some of them were nothing; cough, cold, fever, but quite a few were undifferentiated train wrecks and the ambulances never really stopped rolling in.  So what if a few people decided not to wait and left?

I guess the customer-service model breaks down in the lunatic world of the goat rodeo. At no other profitable activity would a crew delivering an unthinkable 58 percent increase in productivity with no additional resources be made to feel like they had failed.  In the real word world they give awards for this sort of thing.  In American Corporate Medicine ruled as it is by plodding and unimaginative bureaucrats who have no real knowledge of medicine this is viewed as a deep personal failure of every individual involved.

The story has to be got straight:  Is medicine a customer service business with “clients” and customers instead of patients or isn’t it?

7 thoughts on “The McDonald’s Paradox

  1. Doesn’t leaving before seeing the doc kind of indicate that their problem likely didn’t need to be seen in the first place, at least at the ED?

  2. As a pharmacist, I deal with a similar situation. We’re staffed to deal with average amount of rxs we should be able to handle. When flu season rolls around, we see a huge increase in volume without the necessary adjustments for staffing and we’re being questioned by the district trolls why our wait times were so long?

    BTW, is there a LWOP (Left without Percocet) metric?

  3. What if McDonalds had Press Gainey to deal with? What if Press Gainey had to feed anyone who comes in regardless of their ability to pay? What if McDonalds had to not only feed them but provide for their other needs according to JACHO and CMS guidelines?

  4. Lmfao McDonald’s on December 21st 2012 is probably like working a u-michigan dorm cafeteria on football Saturdays an hour before the game, with the entire freshman class demanding their brunch and cursing at student workers for not filling the mayonnaise within 14 seconds of being asked. The only difference is me knowing I have hours of engineering homework ahead of me while my friends find girls and drink the entire weekend. I never thought this kind of stuff could get worse with age if I go to med school, unless surgery or trauma is any different. A biomedical/materials engineering job is starting to sound a lot like paradise.

  5. “The story has to be got straight: Is medicine a customer service business with “clients” and customers instead of patients or isn’t it?”

    It shouldn’t be, but it is becoming so. May lightning strike me dead if I ever refer to a patient as a client.

  6. I cringe every time I hear patients referred to as ‘customers.’ Of course someone is going to be displeased when I don’t give a Z-pack for a viral URI, and nicely tell them to quit being such a pansy, or if I don’t give them Norco when they tell me their pain is an 8/10, then go back to casually watching Oprah on their IWhatever, after sauntering back from the vending machines. Does it make me a bad provider, though? I would argue the exact opposite, that it points to an honest provider.

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