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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Thoughts on a Bad Review

IMG_1474It’s a Monday. Drinking my coffee and in my email is the weekly update from There is a new listing on one of the MD rating sites. I groan inwardly. By working hard to maintain patient-physician partnerships it’s easy to fall into the trap of believing it’s possible to please everyone. When staying abreast of new developments in one’s profession and practicing evidence-based medicine where it is appropriate, one thinks the bases are covered. Staying on time in order to avoid wasting my patients’ time is a priority. Encouraging patients to use exercise and dietary changes to control and reduce the development of life-threatening illnesses isn’t what every patient wants to hear though. And let’s face it, I am human. Sometimes when I see patients, it’s with exhaustion. Sometimes it’s necessary for me to get to a meeting or go home in time to take care of something. None-the-less I try very hard not to allow my impatience to show in the exam room, that’s unprofessional. But this morning there is the knowledge that patients generally don’t post online reviews unless they are unhappy gnawing in my brain. Sometimes I ask patients to review us, but I haven’t done that recently. Indeed the review is terrible. I recognize the name of the individual who posted it and am somewhat surprised. They’ve  been a patient for 10 years. It is a sad commentary on our medical relationship that after knowing someone for 10 years there isn’t enough of a comfort level to yelp (1)bring concerns to me instead of writing it in public. I look at the interaction in the EHR. Nothing jumps out at me, it was not a day I was rushed, there was discussion about an unexpected medication cost. What am I missing? How did the interaction go badly and I missed it? My office manager will reach out to the patient and ask questions. Hopefully this will improve our care (the staff was rude too, according to the review, so that may have set the stage for my failure).

Intellectually I know that the great majority of my patients are satisfied with my care (we’ve done a variety of surveys that tell me that). As written above, it’s important to me to deliver competent care that includes partnering with patients to ensure that their questions and needs are addressed. I think I’m doing the best that is humanly possible and recognize that the human element ensures that I will sometimes fail—despite knowing all this my sleep will be interrupted tonight.

And I guess that’s OK. That’s how we improve our skills.

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