I'm going all in. We'll let your winners ride. Rain Man, David Sack. I'm going all in. And it's said. We open sourced it to the fans and they've just gone crazy with it. Love you guys. Queen of Kinwa. I'm going all in. Please welcome Tandis. Hi everyone. Hi everyone.

So what I want to talk about today is the problem that I'm obsessed with, which is bad customer service and healthcare. So I'd like to start out by walking you through a day at the doctor's office. It can look a little bit like this. You have to start out by making an appointment.

So you call in. You talk to someone very unpleasant on the phone. They put you on hold. You wait. There's bad hold music. You're waiting. You're waiting. They come back. You go back and forth a little bit on your calendars. You get an appointment. It's in 21 days. Now it's 21 days later.

You go to the doctor's office. Someone very unpleasant checks you in at the front desk. You sit down. Super depressing waiting room. Bad wall art. Very old issues of parenting magazine. Smells like Purell in there. That's fine. This is your hangout for a little bit now. And now it's maybe 30 or 40 minutes later.

Someone calls you back. As you may have guessed, they're very unpleasant. They take you back to the exam room. It's very small, blab, fluorescent lighting everywhere. They take your vitals. They hand you essentially a sheet of printer paper. They tell you to change into this. Now you're in sort of a secondary holding chamber.

Except this time you can hear the doctor in the other room. And they're saying, "Hey, it's so great to see you." And so you know they're just getting started in there, even though your appointment was an hour ago at this point. Pull up your phone. You start to go through your little question list.

Get up the courage. Get up the courage to ask everything you came in to ask. And then finally, the doctor knocks. Like you could possibly still be changing. He comes in. Does a little small talk with you. He goes and sits down. Starts asking you some questions. You're maybe like eight minutes into the appointment at this point.

And you're like, "Okay, also I have some questions." And you pull up your little question list on your phone. And you get through maybe like two or three of these questions. And then the doctor starts to give you a look like, "Let's wrap this up." And so you wrap it up.

You ask three questions. The appointment is over. You go outside. You check out. If you're lucky, they'll tell you how much you owe. If not, you will just find out later in the mail. So my guess is that maybe many of you in this audience have a concierge doctor.

But most of us have had some iteration of this experience at some point. There are a lot of terrible things about our healthcare system. But the one I want to complain about specifically today is why the customer service at the point at which you're actually consuming the healthcare is so appallingly bad.

And when I refer to customer service, that's anything that touches the patient experience while you're going to the doctor. So a long wait time is as much bad customer service as the unfriendly front desk person. There's this really great quote that I love from Bill Gurley, prolific investor, and my relationship hall pass.

I didn't know he was going to be here. The US healthcare market is the least customer centric of any customer service industry. We are so numb to the pain that we rarely object or complain. So that's part of what I think is so crazy about this is that we kind of just take it.

And so that got me curious to explore three questions that I want to go through with you here today. Number one, why are things so bad? How did they get this way? Number two, why should we care that things are so bad? And number three, what can we do about it?

What's a little something we can do to make it better? So let's start with why are things so bad? A big part of this is. Our customer service problem is really more of a consumer service problem. And what I mean by that is patients are consuming the healthcare, but they're not exactly the customer in the traditional free market sense of the term.

So who is the US healthcare system as we know is an employer sponsored model. This was not very well thought out. It's more of a World War Two relic that was came from a national mandated wage freeze in 1942. And we kind of just kept going with it. And now today, the doctor is not getting out of bed in the morning for your $15 copay.

They're really making their money off of the major stakeholders in the industry who are the employers and the insurance companies. They're the payers. They're the real customers in this story. And doctors don't love this either. By the way, there's major burnout in the medical community. But when you play this all the way out, you're left with misaligned incentives between physicians and patients.

Physicians in the traditional fee for service model, which is our predominant model today where physicians are paid per per patient encounter, they're incentivized by volume. And not by quality and not by good health outcomes. So it's no surprise that practices are not designed to cater to the patient. And once that becomes the norm, it becomes the culture, every doctor's office can get away with it.

And now you're left with these two really bad stats. The first one is in primary care, specifically, the average NPS for provider is three. That is so embarrassing. Number two, 96% of patient complaints are about the service itself, only 4% are about the care delivered. So patients are really noticing how bad the customer service is.

And yet, to go back to our earlier point, patients have this sort of Stockholm syndrome when it comes to going to the doctor specifically. We'll request a non-talkative Uber because we don't feel like chatting with the driver or we'll leave a very scathing Yelp review for a restaurant. But when it comes to this service, even though we're not an easy to please generation, we become very submissive.

And it's the most important service across any service industry. So this is not a good thing. Why is this happening? And why should we care that we're having such a bad time at the doctor's office? It's because bad service is bad for our health. So good medicine is a partnership between a patient who's coming in with real information on how they're feeling and then a physician who's coming in with real expertise to bring to that information.

And they work together. But if the patient is feeling very anxious and exhausted and the doctor is feeling very rushed and dismissive, you're left with losing a bunch of really important information that you need to make nuanced diagnostic and treatment plans. So to give you an example, doctors are far more likely to prescribe antibiotics in the afternoon than they are in the morning for the same patient with the same issues because they're just running late and they're dealing with decision fatigue.

If you leave with anything from this talk, it should be to make morning appointments. And then patients, on the other hand, know all of this and they've felt this before. And so what many of them end up doing is deferring treatment altogether. So patients feel like it's a hassle.

They don't want to take anything out of it. They will just text their med school friend. Health care has a patient buy-in problem because they've made the experience of going to the doctor's office so bad that we only go when we absolutely have to go. And what do we lose when we go when we only absolutely have to go?

Preventive care. And preventive care is really the reason it's so bad that we're not going to the doctor's office. We lose out on going when things are early. We lose out on all the upstream, life-saving, cost-saving benefits of prevention. So I'm going to hit you with three stats on that.

The first one is 40% of annual deaths caused by the top five causes of death in the U.S. are preventable with good preventive care. According to the CDC, for whatever that's worth to you, avoidable chronic disease accounts for 75% of our health care spend. And finally, on the other hand, patients with a PCP, a primary care doctor, spend 33% less on health care overall because they're front-loading that spend toward prevention.

So that's our final question. Is good service bad for our health? What can we do about it? The good news is this. We are starting to see more and more practices shift towards models that incentivize physicians to care about good customer service. So there are two models we can use here to change the compensation model to allow physicians to have time and space to think about service.

So the first one is direct-to-consumer. So that's making the patient the customer again in this scenario. And the second one is leveraging value-based care models where they ensure that they're not only the consumer but the patient. So we're not just saying, "Hey, we're going to give you a new patient.

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