It was with reluctance and more than a little embarrassment that I approached the salesperson at the Nordstrom's department store. More than a year earlier I had purchased a pair of expensive designer shoes, worn them once, and decided they were not for me. They were not comfortable in fit or in style. I explained that I worn the shoes and did not care for them and that I would simply like to give them back. To my surprise, the salesperson, after listening patiently to my explanation, immediately issued me a store credit for the entire purchase price. Nordstrom's had a policy of 100 percent customer satisfaction, she said, and all of the employees were empowered to do whatever it took to achieve that goal. I left with a new pair of shoes and a tie and a new appreciation for this company's commitment to customer service.

My experience was exceptional, but I have had others because the best companies strive constantly to provide superior customer service. They court consumers everywhere and every day. Hotels remember our names, park our cars, and provide meals of our choice on our schedule. Retailers accept returned goods they never sold us---and with a smile, no less. Manufacturers are available to us through service centers 24/7. Businesses of all types train their employees to keep us happy, to assure superior service, and to seek lifelong relationships with us. We are recruited, polled, pampered, wowed, and told we are always right---with one glaring exception.

When we enter hospitals, we are patients, not customers. With that one word change, the contract, the expectations, and the service obligations evaporate. As patients, we are considered to be unqualified to judge the quality of our experience, and our opinions are either not sought or are easily dismissed. The traditional hospital focuses on compliance with technical standards, not on meeting service standards. As long as our caretakers diligently document our temperatures, measure our intake and output, produce high-quality pictures of our insides, and provide the right medicine in the right quantity at the right time, they are meeting their standards and those of JCAHO and CMS. Meanwhile, we patients are put in disrespectful, semiprivate institutional rooms, served bland food, and wait for overworked, demoralized nurses to answer our bells.

Surveys have shown what we want from our hospitals: A private room with residential ambiance, good food, quick nurse response time, a design that welcomes visitors, and control over light, temperature and sound. We don't get them, though, because we are patients, not customers, and customer service is not in the traditional hospital-patient contract.

But other industries provide technical excellence, regulatory compliance, and superior customer service. Why not hospitals? Why do hospitals get to call us "patients" and not "customers" and to dismiss any responsibility to provide a superior experience?

We patients want a new contract. We want clinical excellence and customer service. We want hospitals to take responsibility for how long we wait, for the institutional rooms they put us in, for the food and the ambiance, and for the staff's attitudes. We want regulators to develop service standards in addition to technical ones. The healthcare winners of the future, surgery centers and surgical hospitals, understand this, and they have adopted the broader view of the patient as a customer. Hospitals should follow suit and commit to customer service standards now. We've been patient long enough!

Alan H. Pierrot, MD, founded the Fresno Surgery Center and its internationally acclaimed, customer-service driven surgical hospital model.