If only healthcare was as easy as getting a manicure…

During the Thanksgiving holiday, I had the opportunity to get my nails done.  As I visited the nail salon, I could not help thinking how easy it was to walk into a new city and find a place to get your nails done.  While I knew of this place primarily through word of mouth, it was also highly recommended on Yelp. As one Yelper writes, My favorite thing about this place should be the amazing decor and time and attention each nail tech puts into his/her work, but it’s actually the owners that make it great. I love seeing them each time I walk through the door. I tend to arrive right before they close, and they never turn me away, or hurry the service along.”   Here are a few things that I noticed that healthcare could learn from.

  • Customer-oriented– As soon as I walked in, I was offered my choice of beverages and asked to pick a color which there were many to choose from. 
  • Access to a technician – As soon as I was done picking my color, my nail technician was ready for me – no wait!  There were over 40 seats and almost all of them seemed filled on this busy Wednesday before a holiday.  This place was not a small shop but a large well oiled machine.   
  • Certification prominently displayed – All the nail technicians certificates were on the wall and actually their state certification number was listed as part of their badge.  For one nail technician who forgot her badge that day (or maybe it wasn’t made yet?), she wore a paper name tag with her number on it.  It definitely provided me with some reassurance that these were trained professionals.
  • Teamwork – The first step in getting my nails done was a lotion and heat treatment which was applied first by one technician.  After that was done, the nail technician sat down and asked me whether I how short I wanted them and I responded with ‘short.’  
  • Benefits of a large employer – I got in a conversation with my nail technician and found out that she had been working there for six years.  In fact, this nail salon was a chain of 12 nail salons all over the country primarily associated with malls.  While she did previously own her own nail salon, switching over to be an employee at the large nail salon meant that she could focus her attention on doing nails and did not have the hassle of running her own business. The benefits were good and she also had flexible hours so that she had the resources and time to care for her sick grandmother.
  • Focus on perfection – Before she applied the nail polish I selected, she confirmed that this was the nail polish that I indeed wanted.  Before she applied the coat, I went ahead and paid as to not ruin my nails.  After my nails were done, my technician walked me over to the nail dryer and brought my shoes and purse so that I would not have to ruin my freshly glazed nails. 
  • Open to feedback – While at the nail dryer, there was a comment card for feedback that you could turn in to reflect on your experience.   
  • Affordable – With all this great service, I was expecting to pay a pretty penny and was pleased that it was only 12 dollars!

Alas, if only healthcare was this simple.  Getting your nails done is also a splurge or luxury and certainly not an essential health benefit.  After all, there are not ‘emergency’ nail salons open 24 hours for nail emergencies that will take anyone no matter how poor or ungroomed they are.  Moreover, the nail technician did not need to take a detailed medical history, reconcile my medications, review my preventive care, and perform a thorough physical exam, and complete additional paperwork to ensure proper payment.  Of course, what’s interesting is that it’s certainly not out of the realm of the possible.  A recent study (aptly named the BARBER-1 trial) showed that men who receive preventive care at the barber shop had lower blood pressure.  The promise of health benefits during barbershop visits has been the impetus for longstanding programs like our own community’s Project Brotherhood.  I doubt we’ll be mixing pap smears and nail salons anytime soon, but it is a place where health screenings have been performed with referral to medical providers.  After all, nails are the window to the certain health diseases and no mention of healthcare and nails would be complete without a run down of some of the famous ones. 

 –Vineet Arora, MD



  1. Interesting points! One thing that really struck me about this blog posting was your method of finding the nail salon. Not only did you use word of mouth, but you used of “Yelp!,” and internet based search engine with customer reviews. I know having online ratings of physicians is something that is not always looked upon fondly by medical professionals.

    One point is that one bad experience with a patient can color the way many see you. Another is (along the same lines as criticisms against the idea of paying-for-outcomes) that such ratings could also discourage physicians from taking difficult cases with poor prognoses, as their ratings could be lowered. How can we make medicine more customer oriented/internet friendly with these concerns in mind?


  2. Hi EAG – One thing I heard that is in the works is “Physician Compare” by CMS which will have publicly reported data for individual physicians…but personally I still think word of mouth is most powerful for choosing a doctor. But you’re right customer ratings of docs is a polarizing area since many doctors want the ability to police this information to prevent the bad review from hurting them too much. Issues of cherry picking are always a concern with quality reporting or P4P. The key is to have a way to not focus on measures that are influenced my sicker patients or to use sophisticated risk adjustment. Interestingly, the newest measures on hospital compare focus on things like whether the hospital room was clean or whether the nurses or docs answered questions so using measures of patient experience that don’t reflect illness per se is another way to make things more patient centered. – thanks! Vinny

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