Difficult Interactions in Medicine: Lessons to be learned from the food service industry?

She sat in her crisp, white coat, probably not much older than I am now, leaning back with all of the assurance of someone who recently completed a cardiology fellowship, newly hired by the academic medical center to which I was applying for residency. One of the first of many interviews for me, the conversation was anything but smooth. She clearly wasn’t sold on me. To remain genuine and avoid canned responses, I never bothered to research popular interview questions. Unfortunately, that also explains why I fumbled a little bit when answering “What three people who are not alive would you like to meet?” 

I had just about given up on getting a good review from my interviewer, especially considering that she had already met some of my brilliant classmates whose parents worked for the same institution. But she had one more question for me. “So,” she said, twisting her chair to the left with her arms crossed, looking at me a little sideways. “What makes you think you would make a good doctor? What have you done in the past that makes you think you would be a good physician?”

My answer was ready…and not because it was rehearsed. It wasn’t the volunteering in nursing homes and Habitat for Humanity. It wasn’t the good grades. It wasn’t even because I was a caregiver at one point or because I had spent countless hours in labs.

 “Waitressing, actually.” I said this without hesitation and with an even tone. “I learned a lot by interacting and talking with customers.” I knew I was taking a chance with this seemingly unsophisticated response, but I didn’t seem to have much to lose at this point.

“You know,” she said, looking surprised, suddenly animated, and mildly… exasperated? She turned to face me square on now. “My best friend keeps telling me the same thing. I don’t get it, but she keeps telling me that it’s true.”

And then the ambience changed.


This having been my – paraphrased – experience years ago, I could not ignore a recent article entitled: “Do Starbucks Employees Have More Intelligence than Your Physician?

The short answer is: Yes… and No, of course.

Articles like this paint a sharp caricature of the emotionally “unintelligent” physician. Here, Dr. Peter Ubel points out that Starbucks employees “undergo rigorous training in how to recognize and respond to customer needs,” and he describes the Starbucks solution for dealing with unpleasant interactions, called the “Latte Method” (listening, acknowledging, taking action, thanking, and explaining).  He contrasts this with the physician whose nose is buried in labs, insensitive to the emotional needs of his patient.

Needless to say, a barista’s work and a physician’s work are not quite the same. A negative interaction within a doctor-patient environment is less like one in a food service industry and probably more similar to one experienced, say, by an airline customer service representative and a customer who finds himself unexpectedly stranded after his flight is cancelled, trying to get home in time for his mother’s funeral. (A free coffee rarely solves this sort of problem.) The intensity of emotions tends to be quite high, the variables are many, and there can be a certain level of uncertainty that is uncomfortable for both parties involved. AND, there are multiple other people waiting in line with other high-intensity needs. There are certainly some doctors who seem oblivious to the emotional state of their patients. But there may be other factors, as well. For example, a burned out physician will find it difficult to empathize, and physicians who are essentially running on hamster wheels may feel too pressed for time to address complaints effectively. That being said, I happen to like the “Latte Method” described in the Forbes piece, as it can be applied to various aspects of our personal lives and across different industries.

A lot more work should be done in early medical training to help future doctors acknowledge and effectively deal with the unpleasant interactions between doctor and patient. Out of training now for some years, I was interested to hear about a group called The Balint Group, which focuses on exploring the doctor-patient relationship. Our clinic, The Polyclinic, has a Balint Group, so I decided to join and explore this subject some more. In this group, the meeting begins with one physician presenting a recent difficult or uncomfortable interaction. The rest of the physicians then discuss it by exploring both sides: what it must be like to be the doctor and what it might be like to be the patient in the case. It is very non-judgmental and not meant to be a problem-solving session. While many times there is no one right answer, the mere act of thinking about and discussing this topic can help improve interactions during the regular workday. I would recommend The Balint Group to any physician with an interest in the doctor-patient interaction.

Perhaps Dr. Ubel is on to something when he suggests that Starbucks employees have more emotional intelligence than physicians. Until these goggles that help detect facial cues become available and universally accepted, doctors will have to rely on their own radars, which may be fine-tuned with some more training. While I am not sure I could survive the Starbucks pace at this point, I did sign up some time ago to be a volunteer server for a local culinary and job training and placement program called FareStart. Who knows? I may come back a better doctor for it. 


7 thoughts on “Difficult Interactions in Medicine: Lessons to be learned from the food service industry?

  1. Although this was written some time ago, it was just brought to my attention again. It is interesting – ironic really – how “emotional” both physicians and patients are about this topic. Anyway, we did have one of our hospitalist bloggers touch on this subject back in March 2012 (shows how this topic was and continues to be a hot one) and from his view, while “nobody argues that our health system must improve its relationship with our patients,” it is also “demeans patients by putting them in a category of consumers.” Dr. Nazario writes that the industry must focus on creating a true partnership between providers and patients, free of pandering and paternalism. That should be the true patient experience. http://bit.ly/patientexperiencepandering

  2. Dear Linda,

    You have pointed out a very important issue that I have been struggling to convey to my students– connect with the patients and feel their pain.

    I noticed my problem in this area during residency, and by the start of fellowship training in Rheumatology, I had already started fine tuning my LATTE skills. You see, a rheumatologist, like any physician, needs to have well developed “communication skill” and a keen empathy to help the patient feel their immediate health issues are recognized and properly addressed; however, unlike an intensivist, hospitalist or a surgeon, a rheumatologist also has to have the ability to build a long term relationship with the patients that will (most often) last a lifetime. This “lifelong” relationship, requires a deep understanding of the patient’s family, social, financial, psychological, emotional, physical, and personal needs.

    A rheumatologist becomes like family- has to make sure the patient makes it to her grandson’s 8th grade graduation, and understand how important it is for a young woman’s “butterfly rash” to clear up for her best friend’s wedding. A rheumatologist needs to understand and address a patient’s entire circumstances, like other physicians, but is among the few specialties that interacts with the patient beyond the snapshot of an acute development. A rheumatologist is involved in a TV series, sometimes a soap opera, where a hospitalist takes a photo, and a surgeon makes a short film.

    So, I am well familiar with the point you make. In fact this was exactly why I chose my career path in medical education– to teach the medicine as an abstract art, and not a concrete “evidence based” science.

    All that said, I would like to set forth a very different side of the issue that deserves more attention than it receives.

    The doctor-patient interaction stands on two pillars: the doctor, and the patient, in the background of the healthcare system, which has three important players: CMS, insurance company and pharmaceutical industry. The role of the patient and the mentioned three players is often overshadowed by the misplaced emphasis on the doctors’ shortcomings and mistakes. Unfortunately, this has been inflated by the malpractice lawyers, who exploit the system more often than acceptable.

    I agree that the doctors need to better develop their interpersonal skills; but it is unreasonable to compare the heavy responsibility of a doctor with those of a person working in Starbucks, who has a momentary interaction revolving around “culinary pleasures”. This comparison is unfair, and disrespectful…

    As a practicing/teaching academician, who works with the patients of the “inner city Philadelphia”, I face so many challenges beyond the usual time restriction, administrative/bureaucratic responsibilities and shrinking budgets. Trust me, there are many physicians like me, who have given up the falsely inflated “income” to give back to the world.

    First, a rheumatologist takes an income cut compared to an internist- the additional subspecialty training may financially disadvantage the rheumatologist. This is further restricted with the ever increasing requirements posed by the CMS and insurance companies to allow the ever shrinking reimbursement.

    Additionally, anyone working in Academic setting gives up 40-50% of income to enjoy the more altruistic goals. In return, they face increasing productivity benchmarks derived from private practice setting, without control over any of the administrative aspects of the work, added teaching and research responsibilities, beyond the clinical responsibilities that are no longer any different than the private practice load. However, they continue to accommodate the demands, because of their passion for being a part of medical education and research.

    Though one ca argue these are the “job hazards” of what we have signed up for, things have changed dramatically over the past decade. Nevertheless, this is only to paint the background picture of a two-sided relationship between the doctor and patient, both of whom are affected by the above factors. Thus, it is unfair and undeserved to compare the depth and extend of a physician’s work and responsibility to that of a food industry worker.

    The main problem is that the role of the patient rarely receives due attention. I care about all my patients very compassionately; though they play an equal role in the interaction. A patient’s role involves compliance with the instructions, respectful and appreciative attitude, active but realistic involvement in treatment decisions, and appropriate communication of their questions and concerns. The patients in general have become more demanding but less compliant, more entitled but less appreciative, more “questioning” and less “asking questions” and more interfering but less “involved”. The healthcare culture is a major contributing factor for healthcare disparity– a physician, no matter how compassionate and devoted, thrives on the positive interaction with their patients. Some patients have “demands” rather than requests. They are always unhappy with any care they receive.

    I have been commended by many to be compassionate and very caring, but frequently come across unrealistic expectations, disrespectful encounters and excessive demands of the patients… it is an added challenge to a mounting list of restrictions and barriers by the background players in healthcare business.

    So, when a dedicated and compassionate physician feels abused by the system and the patients, how do you expect the young trainees to feel motivated to buff their communication and listening skills, especially when a fellow physician considers them to have less emotional intelligence than a Starbucks worker?

    Soon, the need for “physician advocates” (as opposed to a patient advocates) will become very real.


    B SA

  3. Thank you Doctor P. Changing your family physician can be challenging. In the beginning you feel funny about leaving a person who has tried to help you. However I was not comfortable with the personal connection. Honestly although he was an excellent technician he wasn’t very kind or understanding. I finally realized how much that type of interaction meant to me. So I went to my first woman physician,my wife’s doctor, and was very surprised to find how compassionate she was. Finally I do have men specialists that I go to but my last two internists have been women doctors and I think that has made a positive difference when I visit the office. I should ask my doctor if she ever was a waitress.

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