The Physician Barista | Guest Blog

It's a sad commentary on the status of medicine when physicians are being compared to baristas. But when our patients have a less than 30% real literacy rate, we need ask them more than "regular or decaf?"

My ears perked up on a recent morning as I listened to NPR Marketplace. There was a short blurb about Starbucks baristas being better able to explain to a customer the problem with their coffee than a physician is at explaining to patients the nature of their problems.

For the most part (with few exceptions) baristas — however Starbucks may choose to educate them — throw away their bad beverage results. We have no such luxury. Our patients come to us, not with a menu of problems, but with problems in place, including their culture, language, bad habits, poor maintenance, education and social ills. For the most part they expect US to fix THEM — not their drink. Although there is a move to transfer some responsibility to the patients, I see it as a slowly evolving process.

When our patients have a less than 30% real literacy rate, we need to ask them more than “regular or decaf?” When they come with uncontrolled hypertension and diabetes, more than “which flavor pleases you?” Overall, I resented the tone of the piece. We put in, as my son oft says, “years of evil medical school,” followed by years of re-learning re-educating, re-training, mentoring and being mentored, and still we have “doubt.” I doubt that the barsita education prepares them for more than pulling the handle and “thank you.”

Administrators have long taken the tack that we, the providers (how I HATE that word), are units which can conform to the classic marketplace systems. AIDET: Acknowledge Introduce Duration Explanation ThankYou. We are constantly pressed to do more with fewer hours, see more patients, provide more services, educate the patients more thoroughly with an increasingly clipped time to push more units through the system.

I do hope we don’t come to classifying our patients as Grande/Venti/Trenta. It’s a sad commentary on the status of medicine when we compete with baristas.

Dr. Buchbinder is a board-certified Podiatrist practicing within an FQHC (Federally Qualified Health Center) in Hartford, CT. He is director of the FreeMED Software Foundation, a nonprofit dedicated to making accessible and extensible medical records available worldwide. Dr. Buchbinder also blogs at A view from the provinces: A new Yankee’s view of the world.

  • McD says:

    Alabama Med Student here….tomorrow we will be implementing the Grande/Venti/Trenta patient classification system on our internal med clerkship. Starting at Grande is quite appropriate in this case (as opposed to sizing at Starbucks).

    • John Stevens says:

      Although I don’t compare physicians to barristas, I do think the physician predominantly owns:
      1– low physician performance — It is what has lowered the quality of health care, even though they are grossly over paid for what they do for living.
      2- restricted the entrance the amount of doctors into the profession so they could keep prices high. Many qualified applicants are rejected to minimize the supply of doctors so they rates are high
      3- falsified level of effort of practice to inflate prices as evidenced in the RUC committee
      4-Often determine treatment or lack of treatment by the amount of fee they will get. One of the reasons why physicians are overpaid is because rather than spend time treating the person they don’t do bloodwork or other procedures so they can suck more fee an hour seeing another patient.
      5– I had an aunt who practiced from the early 60’s to the mid ninetiness as a physician who head up a medical department in a big city hospital. Ultimately she had over 140 staff in her department– the majority of them were doctors. What she said was the thing that changed over the years was the type of doctor entering the field. Most of them focused on how much money they could make; not about patient care. It was a “lesser generation of doctors”. She further said that people didn’t go into medicine to make money in the past because it really wasn’t that profitable. In the 70’s and 80’s the money started coming in and that’s when medicine had a lower quality doctors that were way overpaid. As an FYI she donated a 25% of her salary back to the hospital. So what will be happening now is only what doctor’s brought on themselves: lower trust in the physicIan population; much lower pay, and physicians will have to achieve certain performance goals (since their quality was low).

  • Bryan Hagen, NP says:

    I find myself both agreeing and disagreeing with you, Dr Buchbinder. True, the tone of the NPR piece was a bit trite and overly simplified (no doubt tailored to its audience, despite NPR listeners’ higher than average level of education). However, there is a point to be made from this short discussion. No, I do not believe that physicians (or mid-levels like myself) should be compared to baristas. Yes, I do believe it is our responsibility to understand the limitations in communication that are inherent in the populations we serve, and do these good folks right by tailoring our patient education to their level. By doing this, we can accomplish two things: increase patient compliance and understanding, and develop a stronger rapport and level of trust between patient and “provider”. I can understand that, serving at an FQHC, you very likely see a higher proportion of patients with lower literacy, and this can be frustrating. On the other hand, and with all due respect, catering to their level of need is the job of a provider no matter the circumstances.

    • MeatB says:

      You’re a mid-level provider? Do you provide mid-level care?

      • Bryan Hagen, NP says:

        Typically, in talking with physicians, NPs and PAs are described as “mid-level”, owing to the shorter extent of our clinical training. That’s why I chose to use it here in a physician-oriented forum. However, I work in a state where my prescriptive privilege is completely unrestrained, and no collaborative agreements are required. I operate completely independently, and thus, I would say that I serve my patients as more than what one might consider “mid-level”; rather, I operate as a comprehensive, “full-level” provider.

  • Med Student says:

    With the whole patient compliance idea, has any one thought “maybe there are a lot more people out there that do not want to get better and are just pressured socially into seeing a clinician”?

  • Tom Gutowski says:

    It is sad to say but there many times in a week when I feel like saying “Would you like French fries with that?”




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