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Can’t get no satisfaction?

December 2008

An article in the December 2008 issue of Today’s Hospitalist talked about patient satisfaction surveys. This tool from the business world has become an integral part of evaluating the services provided by hospitals in general–and of hospitalists in particular.

The article mentions several approaches to improving patient satisfaction scores. One approach recommends modeling the physician-patient encounter on an “automobile showroom,” where the physician explains to the patient and the family that they may receive a survey, then encourages them to respond positively if they were “satisfied” with the care they received.

During the long, arduous road to becoming a doctor, we face many “evaluations.” Our grades, our MCAT scores, our residency assessments–they all try to determine if we are doing a good enough job and achieving a pre-established set of goals that will enable us to move to the next level.

But patient satisfaction surveys in medicine are something new. Admittedly, we grew up in the paternalistic mode of medical instruction in which we revere our professional forefathers (the naming of diseases and syndromes is a type of fetishism) and expect our patients to display a sort of devotion-in-kind. Our diagnoses are pronouncements from high-above; our prescriptions the magic potions needed to expel the evil humors that cause headaches, fevers, rashes, etc.

Luckily, this antiquated mode of thought is being replaced by patient-centered initiatives that re-engineer the patient-physician relationship, making it a true partnership in which both parties collaborate to improve and sustain the patient’s health.

So what is wrong with patient satisfaction surveys?

I’ve heard all the reasons to grouse about these questionnaires, and they are all valid. True, most patients don’t fill them out and the ones who do usually have an ax to grind. That skews the n of the sample size toward those who will give negative scores.

True, scores may not represent the true performance of the hospitalist because many of these patients come to the inpatient unit after a long wait in the emergency room with all those delays, complications and extra headaches. True, you are not these people’s regular doctor. So how can you know them as well in the few hours you spend by their side as their “real” doctor, who has known them for many years?

Those of us in pediatrics have a slightly different problem because we usually cannot get the true measure of satisfaction from our younger patients. That means we have to rely on the opinion and judgment of parents and relatives, which is probably a good thing.

I’d hate to have to ask for a baby’s opinion of my care after several attempts to obtain blood, spinal fluid, snot, stool, etc. And I bet circumcised boys don’t have a high opinion of anyone. That’s probably why they pee on everyone who changes their diapers. (Now, that’s an accurate patient satisfaction score!).

I recently spent the night in the hospital with my oldest son, who has asthma. We traveled every possible health care route, going from his primary care doctor’s office via ambulance to the emergency room and then to the pediatric unit for overnight observation.

I have not received my satisfaction survey yet but I was extremely proud of everyone who took care of him. And I will return it with high scores.

But if I weren’t a doctor, would my perception be different? I’m not talking about professional courtesy or anything like that. I am talking about the little things I saw that I accept as “normal” for our hospital but that someone else could construe as a bad experience. Those include uncomfortable beds, frequent vitals checks, the size of the rounding team, the fact that everyone was in a hurry–all aspects of care that can certainly influence a patient’s satisfaction.

One recommendation made in the article, which I already do and encourage residents and students to do as well, is to sit down when talking to patients. Standing, we are lecturing, paternalistic, holier-than thou, in a hurry. Sitting down, we have time, we listen, and we decrease the physical space between provider and patient. Proximity is an important element of any relationship; it is what proves that a relationship has been established, that it is important and that it matters.

So, how about those scores? As more and more health systems rely on them, it is important to understand these surveys are just one more of a multiple of metrics available to evaluate your practice. I would suggest looking at scores not as assessments of individual performance but as flags that indicate problems in the system that can be changed.

Our initial, human reaction is to view satisfaction scores just like we viewed our MCATs or medical school grades, and that’s what we’ve been trained to do. But maybe we should look at them instead as opportunities to enhance our standing within the hospital.

Sounds self-serving? Maybe. But that approach can improve your scores, and patient care will be better. And maybe, just maybe, it will allow you to hire that extra hospitalist you need or receive a higher bonus than in previous years.

Whatever your motivation, and it does not have to be altruistic, patient satisfaction is becoming more important in the deliberations regarding the quality of care you provide. Ignore them at your own peril.