Patient Partnerships and Patient Satisfaction — are they the same?

If you had to deal with a “spousal satisfaction score” on a monthly basis, would this improve your interactions with your spouse? How about a “colleague satisfaction score”? Would you find it helpful to your psyche or would you resent your colleagues monthly critique? Increasingly this is how I feel about patient satisfaction surveys and physician rating sites. How much value are those instruments? Interesting a study from UC-Davis demonstrated an inverse relationship between patient satisfaction and good care. It makes sense, especially in an ER setting with hurried, relatively impersonal care, patients whose surveyexpectations are not fulfilled will be unhappy. The classic example in my world is the patient who comes in with a viral upper respiratory infection insisting on a “Z-pack” antibiotic. Seriously, it still happens. Will they leave and go to Angie’s List and give me a bad grade? Did I do the right thing by refusing the antibiotic AND discussing why? Did I try at great length to help them understand the danger? Despite my explanation, were they still upset they didn’t get the med they wanted? Fortunately I am not yet discussing Press Ganey scores in the hospital lounge with my colleagues but we do offer a Target gift card to random patients who take a survey from my office.

Partnering with patients does not imply that we are always satisfied with each other, just as I am not always satisfied with my spouse’s behavior. We work together to improve healthy behaviors, we trust each other to find the best path and we compromise expectations by taking into account factors that impact health. If I am worried about satisfaction, it is easier to hand out that antibiotic script than spend time explaining why a viral illness doesn’t require one. Or give the patient that antidepressant she expects because the TV says she’ll feel better, instead of understanding the reasons behind unhappiness that doesn’t require medication.

In spending enough time with patients to hear their stories, see their body language and listen to the undercurrents in their lives–this might improve my satisfaction scores and ratings, but not necessarily. It will enable me to give the best care regardless of my score. This is my goal. Hopefully, no one will push me toward another.

1. The cost of satisfaction: a national study of patient satisfaction, health care utilization, expenditures, and mortality. Fenton JJ; Jerant AF; Bertakis KD; Franks P. Arch Intern Med.  2012; 172(5):405-11 (ISSN: 1538-3679)





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OUCH I must be a horrible doctor

Recently I began reading Dr. Kevin Pho’s book, Establishing, Managing and Protecting Your OnLine Reputation. Last year I had encouraged patients to go to the Healthgrades to rate our office. It was helpful. My staff’s friendliness needs some improving. My ratings were good but not fabulous. That got me to thinking about how to improve. Maybe it’s because I am too straightforward? Am I not kind enough? Does my face show disappointment or frustration? 

The worst was looking at the site. There were only three ratings and the last one was abysmal, left in March of this year. I can’t help but wonder what I did to anger  someone that badly. Was it the patient who left in a huff because a medical student came in first? (Yes, we warned him but apparently he expected me to accompany the student so we didn’t properly explain it). Or the patient who was furious because I wouldn’t give her a handicap sticker when her cardiologist refused to? Or the patient that I discharged from my practice when I found out he lied to me about his past drug history? The site itself is poorly monitored. It lists my internal medicine associate as a gerontologist with no address, my family practice associate as practicing at an address that she left five years ago, and my address is listed from four years ago. When I sent an email no one answered it. 

Most of the other sites listed were without reviews. It makes me wonder, with so many rating sites, how helpful can they be? Additionally our patients are asked to fill out a survey on Survey Monkey but the doctors aren’t given the results. What good is that? 

Pondering my ratings I wonder, would using Motivational Interviewing improve how patients perceive my suggestions and bring something more tolerable and more workable for them? It’s my hope to motivate, not lecture patients. If I see them as partners in their care, how best do I encourage their participation and help them?
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A Humbling Experience

As Physicians are becoming aware, consumers of health care products (better known as patients in my world) are increasingly likely to leave reviews of their physicians on sites such as Healthgrades, RateMDs and Vitals. Of course the angry patient is more likely to vent criticism than the satisfied one unless the physician’s practice is actively encouraging patients to go to the sites.

I use a service that emails me once a week with my data listings on several rating sites, including the ones included above. Rarely is there anything new but yesterday my email indicated a new evaluation. I clicked on the link and found the following comment, “Rolled her eyes at me with her head bent down when I told her I thought I had something going on–I presume she thought I couldn’t see that gesture.” Ouch! It is certainly not inconceivable that I did that. It is, however, very unprofessional. Was I burnt out that day? Was I actually rolling my eyes at the computer that tries my patience on an on-going basis? Had it been a horribly unproductive day and I wasn’t listening the way I should have been? Whatever the reason the behavior was completely inappropriate. I believe in patient-centered care. No matter what was going on with me that day, my patient should not have felt undervalued and patronized. In checking the patient schedule from the day the review was written and the day before I could find nothing outstanding. Fortunately the review site allows physicians to comment (many don’t) so I took the opportunity to apologize. More importantly, this gave me an opportunity to think about my reactions to patients and remember to pay more attention to my interactions, especially on days when I am frustrated or tired.

Physicians have long been protected from such reviews but as more and more “quality” data is released to the general public by the Centers for Medicare and Medicaid (CMS), not only will specific comments from patients be available but sites like Angie’s List and Consumer Reports will use that data to rate physician practices.

It’s a scary world to physicians, but frankly some days I need a little constructive criticism. The good news is when I get this critique: “Excellent physician. Will not tell you what you what to hear but tells you what you need to know. Does not claim to know it all and will refer to specialists (the best available) without a second thought. I trust her with my life and have for 19 years.” 

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