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Views And Reviews

Professional judgment v customer expectations

BMJ 2018; 360 doi: (Published 28 March 2018) Cite this as: BMJ 2018;360:k1366

Is the customer always right?

I sympathise with Rosen's concern on the conflict between professional judgement and customer satisfactions, and call for a solution.<1> Unfortunately, it appears that our new generations of doctors are being taught to be good customer service providers more than responsible professionals.

I remember once in a communication workshop in medical school, I role-played a GP who faced a disgruntled patient complaining about my colleague's thick Asian accent. I was required to be sympathetic and apologetic to this patient, or else I could be accused of being unempathetic and defying the GMC Guidance on Good Medical Practice. In other communication workshops, I role-played a GP facing hostile pushback from an arrogant paramedic, a young doctor being undermined by a senior colleague, and a medical student being disrespected by an expert patient. In these role-plays, I was taught to be polite rather than standing up against the bullies.

These communication workshops are usually led by facilitators who had no medical training and side with the "customers." I appreciate how these workshops help physicians' negotiation and conflict-resolution skills; however, should these workshops also address the aggressive behaviour of instigators? These instigators probably need communication training more than physicians do.

Nowadays, with the ease of social media, "customers" can easily tarnish physicians' reputation with verbal attacks online. In contrast, physicians can be villainised for exercising their rights to remove aggressive customers from their practice.<2> I understand the modern practice model is to discourage medical paternalism. However, I agree with Rosen that a line needs to be drawn between professional judgement and customer sovereignty. As the President of Association for Patient Experience once said, "Patients are always first but not always right.<3>

1. Rosen R. Professional judgment v customer expectations. BMJ. 2018;360(k1366).
2. Stokes T, Dixon-Woods M, Windridge KC, McKinley RK. Patients' accounts of being removed from their general practitioner's list: qualitative study. BMJ. 2003;326(7402):1316.
3. Patients are always first but not always right. Cleveland, OH, USA: Association for Patient Experience; 2013 Aug 27; cited [2018 Apr 7]. Available from:

Competing interests: I have received salaries from working as a medical doctor, but I am not paid to write this letter.

07 April 2018
Eugene Y.H. Yeung
Medical Doctor
Royal Lancaster Infirmary
Ashton Road, Lancaster, LA1 4RP, UK