How Satisfied Are You?

Chicago Sky“A diplomat is a person who can tell you to go to hell in such a way that you actually look forward to the trip.” – Caskie Stinnett

I was listening to a physician friend of mine a while back complaining about how the focus on patient satisfaction scores was forcing him to prescribe antibiotics and refer for procedures that would not otherwise be indicated.

Because he was afraid.

Of a piece of paper.

In fact, apparently, he is not the only one speaking up on this. Do a google search.

Quite frankly, I have very little patience for this sort of thing.

Are patient satisfaction scores always fair?

Hell, no.

I have been dinged because a patient didn’t like how much their MRI cost. Not my fault. That is an insurance benefits problem that I have no control over. Or there was the time someone wanted large quantities of a controlled substance I don’t ever write for prescribed to them for a questionable diagnosis. They didn’t like me saying no very much. At all.

I could go on.

To say that I don’t care what patients think of me is not really true. I care very deeply. Every negative survey really bothers me. I will tell you why.

Because I feel like a failure.

There is still art in the practice of medicine.

The art is earning trust.

I have people from time to time who are upset that I do not write antibiotics for their two days of upper respiratory symptoms.

More often they are appreciative when I explain that antibiotics won’t help them get better at this stage and that inappropriate use means that they or someone that they love may develop an infection down the road that we cannot treat with ANY antibiotics. We work together to treat their symptoms while their body fights off the infection, knowing that antibiotics are available if needed down the road.

Generally, patients respond very well to explanations.

For a doctor to say that they feel trapped by a patient satisfaction survey suggests they are are not really trying.

That being said, physicians who argue otherwise like to point to a fascinating article, The Cost of Satisfaction: A National Study of Patient Satisfaction, Health Care Utilization, Expenditures, and Mortality.

“Conclusion: In a nationally representative sample, higher patient satisfaction was associated with less emergency department use but with greater inpatient use, higher overall health care and prescription drug expenditures, and increased mortality.”

Translated: If you are happy with your doctor, you are spending more on your care and are more likely to die.

Does that just mean we are all pansies? Do we believe patients are too stupid to understand? Are we pushovers who really think patients just want us to give them what they want?

Is that what patients want?

If we ALL use evidence based medicine, if we all consistently educate our patients to change their expectations about their care, can’t we improve care, costs, and patient satisfaction?

Maybe I am just being naive.

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35 thoughts on “How Satisfied Are You?

  1. This is probably silly, but how do patients find surveys to fill out about their providers? I’ve never received such a survey.

    Also, on a slightly related note, have you ever received a thank-you note from a patient? Is it appropriate for a patient to write a thank-you? I wrote my OB a thank-you note after she delivered my baby. Maybe the nature of the care received during pregnancy/birth is different than in many physician-patient relationships because an OB patient sees her doctor a lot in a short amount of time.

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    • Patients get randomly selected to participate in a survey if your provider is using Press Ganey. Not all providers measure patient satisfaction. You are more likely to see this if your provider works in a large physician group.

      It it totally appropriate to give your provider a thank you note! We love them. In a world where we are constantly being measured on patient satisfaction and quality measures (like how well patients are doing on their diabetes numbers), it is easy to get lost in all of the negative. When I started practice I got 1-2 thank you notes per month. Now, ten years later, not a single one in over a year but my patient satisfaction scores are better than they have ever been. They say thank you during the visits but I don’t get notes or Christmas cards anymore. Maybe patients feel the surveys take the place of thank you notes? Times change, I guess. But if you like a provider, no matter what the specialty, DO let them know! You just might make their month.

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  2. I don’t know if you are being naive or not, you sound like my kind of doctor. I only go in when I am near death (I may be slightly over dramatic), he knows that and prescribes what is necessary. He doesn’t nag…last visit “you have put on some weight”….”yes i quit smoking” ……”that’s great,but keep an eye on that”….”Oh believe me, I am!” He has given me samples when I didn’t have insurance, he honestly tries to make it better. I would give him an A.

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  3. I think with the advent of social media and electronic comminication the “thank you” note is becoming a foriegn entity. Not getting a note might have as much to do with changing mores as anything else.
    I only see a witch doctor for my medical concerns and I thank him in chicken innards. He’s great.

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    • Witch doctors are also useful for placing curses on those you hate so good choice!!!

      Personally, I would love to be able to barter services. Bring me a big basket of veggies from your garden and I will help you with that ingrown toenail. But under the current system, that is essentially illegal…. Unless I choose to accept no insurance at all.

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  4. I think part of the challenge for physicians is that patients bring a whole lot more to the office than their upper respiratory symptoms or other current ailment.They pack all the other issues and sources of disappointment as well. A lifetime of anxieties, sometimes. Don’t you have a pill for that?

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    • Probably about 1/2 of what I deal with is directly related to depression/anxiety/stress. And I typically have patients who whip out a two page complaint list during an office visit… trying to get their money’s worth. I can’t say I blame them. I am cost conscious like that, too! But it does make for a rushed visit when I don’t have advanced warning. It is a fun job! Lots of challenges to keep you on your toes as you are balancing patient satisfaction.

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  5. My favorite doctor is one who will talk to me and help me understand. I try to be proactive so during my yearly visit I come with a list of questions. Sometimes he will agree and sometimes he will explain why it’s not a good idea. Last visit he took me of the low dose daily aspirin because the new thinking is that it is not appropriate for everyone. He explained it and I was all to glad to eliminate it. I do have friends who think antibiotics are the answer to everything. I hate to take them because them make me sick. Having said all that, I left my last doctor because I hated his office staff and always had to wait even when no one was in the office. He has since left that practice but I felt badly that I didn’t tell him his staff was overly cranky.

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  6. As an expert (I.e., all too frequent) patient, I have never once been asked what I think of a doctor or his/her staff. I do, however vote with my feet. I will leave a doctor if he or she doesn’t take care of me.

    I just left an endochronologist who had been treating my thyroid issues. I needed a medication refill and she would respond to neither me nor my pharmacist. I tried for two weeks, daily. The day I took my last pill, she authorized a refill. I contacted her office and explained exactly why I was leaving her practice.

    That brings me to another complaint about doctors — especially specialists. They think you have only one health issue. Or one important one, anyway, and they ate treating you for it …

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  7. I wish more physicians were like you.
    I’m a pharmacist that works at a pharmacy that gives away certain antibiotics for free. Since we began doing this, physicians have been prescribing them more and more for that two day respiratory infection you mentioned. Nightmare! This is going to come back and bite. Hard!

    Thanks for stopping by. I look forward to reading more. B Blessed, Lilka

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  8. I use doctors only when required (by work, physicals), or for surgical issues. I am rarely ill. I use a DO, because he has always supported natural approaches, doesn’t force me into procedures that are against my wishes, and works with me. Since he only sees me about once every ten years, we’re good 🙂 He has always respected me as a thinking individual who wishes to participate in her health, not be told what to do.

    Recently I had to deal with a walk-in clinic as my DO’s office was closed (weekend). I encountered the rudest, snidest and incidentally, incorrect doctor I’ve ever had to deal with. He mis-prescribed (I didn’t take it) and misdiagnosed, and mocked me in the process. I guess I know why he’s working in a walk-in clinic on a Sunday, but it is one I’ll never visit again.

    I wish there were more doctors like you; perhaps my antipathy towards allopathic medicine might be assuaged somewhat.

    ~SE

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  9. I agree with you to a point. You are assuming patients involved care about their health, and have a desire to achieve good health. Not all do, and I didn’t realize this until working in healthcare. What bothers me most about patient satisfaction surveys though…is the hospital patients, the frequent fliers who literally call the ED to find out which doctor is on call, because they know who will give them Dilaudid. The ones who know how to work the system, when the “regular” patients end up getting less resources than they deserve because we are afraid of having the ombudsman called. It seems like I see more and more of this, and although it CAN’T be the majority of patients in the hospital, some days it seems like it. I am not completely jaded, although I am sure I sound that way. I just don’t think it’s fair that the healthcare providers are the ones ultimately responsible for the health of patients, the buck stops with us….when in most cases, the patient should also be just as concerned about making the right choices for their health and being just as concerned. We definitely should educate and work together….but what to do with the amount of noncompliance because it’s expected that we can fix anything that people don’t have the time or desire, or willpower to work on for themselves too?

    Liked by 1 person

    • You make a valid point. I am working primarily at this point with insured middle class educated patients who can be reasoned with and certainly not in an inpatient setting. I was out of all of the other before Press Ganey became the norm. The ones that I hear complaining the loudest are not fhe ER docs or the hospitalists, they are instead the ones working with the same demographic that I am. I hear you about those certain frequent fliers… There should be a way to flag the system but there is not. “Get the good people to return surveys!” Right. By shoving it in their faces, asking them to complete it at every encounter with a human in your practice, placing signs all over the place… Like that engenders good will.

      Liked by 1 person

  10. Pingback: Smoke Screen | Behind the White Coat

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