When They’re Lopping Off a Breast, the Customer Service is Terrible

Real-life diary of a longtime colleague and client whose wife was diagnosed with breast cancer only a few weeks ago


Visiting plastic surgeon #2 to discuss mastectomy reconstruction…

Strike 1: No directions other than address. Google did a shit job of getting us there, and it was a confusing, circuitous route to access the building.

Strike 2: $200 fee for an initial consult.

For… what, exactly?

Strike 3: 12 page stack of forms to complete. Could have been sent in advance.

     Wife: “Well, with everything going on, they might have sent them to me, and I just missed it.”

     Me: “Even if they had, they couldn’t have called the day before to confirm receipt and remind you? Whose life is made better by doing it this way?”

And now that these 3 events have raised suspicion, included in the packet: a form indicating that this physician carries no malpractice insurance. 

Was that designed to inspire confidence?

Strike 4: 17 minutes later we hand in the paperwork. No other patients have been seen this whole time. We’re the only ones in the waiting room. Occasionally, a medical staffer returns from lunch, carefully avoiding eye contact.

No movement, no progress, no indication of what’s next.

Do all physician’s offices suck this bad?

Strike 5: The floor is dirty. You can hear and feel the grit under the soles of your shoes.

They handle minor procedures in here, don’t they?

Strike 6: No indication as to when the hell we’re actually going to see someone who self-identifies as a physician.

2 outs, nobody on.

Strikes 7, 8, and 9: The physician finally arrives.

She’s accompanied by a woman who squeezes a gigantic cart through the door. The doctor leaves her to sidle in on her own.

A small computer sits atop the cart, which seems 6x larger than necessary. She is apparently the doc’s scribe.

The physician introduces herself, but not her assistant.

Strange: she’s going to be in the room during a conversation about a life-and-death matter – yet isn’t given a title or a name, or even a greeting.

The doc asks some questions, reviews the chart, and starts discussing options.

She pulls out an old photo album full of pictures of “successful” outcomes.

These women look like war casualties.

If these are the “success stories,” what do the not-so-successful look like?

This is the kind of work I would expect to see in Walter Reed. Making the best of a bad situation, I suppose. Still, shocking images which I’ll likely not forget.

She then goes on to show a few botched procedures that came to her to be fixed.

One shows a flap procedure gone wrong. This is where they take tissue from another part of the body and attempt to graft it onto the breast.

The deep, dark, charcoal black patches of skin. Gristly, defined. Clearly, she’s trying to sell against that idea. As she never showed us a successful example.

The photo album contains very few examples of breasts similar to my wife’s, so she tries to open a PowerPoint presentation on her computer.

Yahoo! keeps prompting her for a password, and she can’t seem to get in.


She eventually gets in, and then shows us more examples, having to skip the ones that aren’t representative.

For as long as she’s been in practice, this stuff couldn’t have been organized into different types for different patients?

I begin to wonder how many procedures she does in a given year.

       Wife: How many cases do you typically do in a year with the surgeon we’re working with?

       She stumbles…

      Doctor: Maybe one or two? 2 to 4?

What little confidence we might have had is evaporating.

Based on the vibe in the room, I think it’s clear – at least to me – that we won’t be doing business.

This seems to be confirmed by the very little direction given just prior to the physician’s exit.

My wife removes her physician-issued crêpe paper tube top/shawl/ oversized dental bib and I hand over her bra and blouse back to her to get dressed.

I’m gonna miss you, Lefty. Fell in love with you the first time I laid eyes on you. A day that will live in my mind’s eye until the day I die – a vision of perfection. 

You nourished and sustained life for my three children, provided hours of pleasure for me, and provided a conduit to please my wife. 

It’s been a good run, but that run will soon be over.”

We walked back down the hallway to the receptionist desk, expecting to be given some sort of direction.

The medical receptionist, facing my wife, avoids any and all eye contact, or any indication that she is aware of our presence.

I’m done, so I walk out into the hallway and proceed down the stairs to retrieve the car.

My wife arrives.

    Me: Did she tell you what the next step is?

    Wife: No. She was still on the phone when I left.

The evidence continues to pile in, confirming my hypothesis:

Medical receptionists undergo a humanity removal procedure prior to taking office.

Revisiting plastic surgeon #1…

10:30 appointment to discuss treatment plan options now that *some* test results are in and second [third?] meeting with hacksaw artist, I mean, cancer surgeon.

We arrived late so I could complete a business call. Wife had called to let them know.

Just 10′ from the office door, the receptionist calls to see if we are coming.

Had she forgotten my wife’s call?

This time, we were accompanied by one additional patient in the waiting room. Eighteen minutes later, this  patient walks out without comment.

A nurse dressed in chartreuse scrubs darts through the waiting room and sticks her head out  the door.

“Loretta! Why didn’t you text me?

Minutes later, the nurse returns.

Loretta is gone.


I turn to my wife:

“This appointment is for 11:30, right?”

She rolls her eyes, shrugs and smirks through her surgical mask.


“Welcome to the healthcare industry.”

My wife approaches the sliding glass partition separating the patients from the office staff.

Wife: The Aetna website says Dr. R is out of network. Is that right?”

           Receptionist: “No, we’re definitely in network with Aetna.”

A second nurse later confirms that they’ve been doing business with Aetna for 12 years.

Is this the first time this has come to their attention?

Isn’t this likely costing them patients?

Does anyone here give a damn, even about their own practice?

I can see why she’s always saying, “I just want to get this over with.”

Honestly, I’m not even sure the strike count metaphor works.

Who’s pitching?

Who’s the batter?

I suppose the patient is the pitcher, as the physician is swinging and missing here.

Probably more accurate to say some of these are called strikes instead of swings and misses.

Thing is, the customer doesn’t win when the provider strikes out.

Or maybe they do?

Perry here: Our goal is to fund cancer research that will put an end to this insulting, dehumanizing, catastrophically expensive, and ineffective system.

If you’d like to help us, go to


Perry Marshall

NASA Jet Propulsion Labs uses his 80/20 Curve as a productivity tool. His reinvention of the Pareto Principle is published in Harvard Business Review. His Ultimate Guide to Google Ads is the best-selling book on internet advertising. A business strategist and electrical engineer, Perry founded the largest science research award in history. The $10 million Evolution 2.0 Prize will be judged by scientists from Harvard, Oxford, and MIT. Seeing that existing financial incentives favor prolonging cancer rather than curing it; and realizing the medical profession has incorrectly defined the disease in the first place... he chose to apply entrepreneurial thinking to the problem.


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