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Never Satisfied

September 3, 2014

I love it when Karen Sibert, of A Penned Point, gets mad.  Her words are truth, and I don’t just say that because she’s an anesthesiologist/blogger like me.  Yesterday she wrote a post about a recent article in the Wall Street Journal about doctor dissatisfaction (http://apennedpoint.com/his-diagnosis-is-right-but-the-treatment-is-all-wrong/).  Read it.

One of the articles Sibert cites has to do with patient satisfaction surveys.  This one, in The Atlantic, is by Richard Gunderman and relates to narcotic prescribing.  And let me just say that the terms “Patient satisfaction” and “Narcotic prescribing” go together like Obama and Cheney.  Here is what Gunderman says: (http://www.theatlantic.com/health/archive/2013/10/when-physicians-careers-suffer-because-they-refuse-to-prescribe-narcotics/280995/)

“Though attending more carefully to patients should strike any physician as a good idea, such perceptions are not always reliable. For one thing, a patient’s assessment of a physician visit or hospitalization can be colored by a variety of factors not under the control of either. For example, a patient frustrated by the difficulty or expense of parking may assign lower scores to every aspect of a hospitalization, including the quality of care provided by the physician.  Such patient satisfaction data are playing an increasing role in a number of important healthcare decisions. For one thing, physicians can be hired, fired, promoted, and compensated based in part on their patient satisfaction scores. Increasingly, these scores also determine how hospitals are ranked and paid. The Center of Medicare and Medicaid Services has been publishing this data and has begun distributing funds to hospitals based in part on patient satisfaction.”

Last weekend I went to a wedding.  My husband and I stayed at a very nice, modern hotel and as we were exiting the building we were commenting on how great the service had been.  Then my husband turned to the valet and asked to have our car brought up at a certain time.  The valet said “Just call us when you need it.   Here’s the number.”  And just like that, our whole experience of the hotel service changed.  The valet should have just said “Of course, sir, we’ll take care of it.”  It’s not like we were demanding special treatment.  That’s the level of service we expected, based on our experience of the rest of the staff.  If we had been asked to fill out a satisfaction survey, we would have had the option of degrading our opinion of the hotel based on the response of one individual (we didn’t).

Now, say a patient (i.e, hotel guest) comes to the hospital and everyone is super nice and helpful and the whole experience is great, but as she’s leaving the unit secretary is rude to her, or the guard at the entrance won’t let her husband idle at the curb, or she gets home and can’t find her cell phone charger and the lost-and-found guy is dismissive.  In most cases people are able to perceive that the good overall experience overrides the one negative moment, but the negative moment is there.  Now say the patient gets a short email from the hospital asking her to rate her experience.  She rates a 4 instead of a 5 because of that lingering unpleasantness at the end.  A month later her doctor gets a call, saying his satisfaction numbers are down, and he’s getting penalized.  This is the problem with patient satisfaction surveys.

Add in now the patient who wants something specific from the system or doctor, something the system or doctor knows she can’t or shouldn’t have, or that the system cannot provide.  Narcotics abusers, for instance. Or people looking for antibiotics for a cold.  Or people looking for an MRI for their back pain.  A doctor who refuses these requests, based on good evidence, fiscal responsibility, and clinical expertise, will have terrible patient satisfaction scores.  The customer is not getting what he or she wants.  The dissatisfaction of the patient has nothing to do with the level of attentiveness provided by the doctor.  This is the problem with patient satisfaction surveys.

In the world of hotels, guest satisfaction surveys make sense because the whole point of the industry is service, especially at luxury hotels.  In the world of medicine, the point of the industry is to make people better, keep them well, or help them die well.  It is not a service.  Patients cannot just demand whatever they want.  This is the problem with patient satisfaction surveys.

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From → Healthcare

3 Comments
  1. Hi Sherie:

    You know, after reading this interesting post, I have to share with you something I heard from an anonymous ER doc’s blog. As you well know, sometimes docs cannot say stuff on the internet, or at least have to be cautious, sometimes overly so.

    Anyways, this doc said something which had a ring of truth to it:

    He or she said that letting patients grade their doctors is like letting children grade their parents.

    And you know what, I have to agree. Doctors are in a position where they are supposed to know what is best. Same with parents.

    And the patient and child are supposed to listen and trust.

    Are there exceptions?

    Of course. Both doctors and patients make mistakes.

    But society has rules, which, for the sake of mankind, should be followed.

    And that is why children cannot fire parents!

    john bennett md
    InternetMedicine.com

  2. Nice article comparing medicine to industry . As a young graduate in medicine ,in India of sixties, I practiced medicine in a small rural area . I had to cater to all type of ailments. Obstetric services were pathetic and I took upon myself to educate the people and encourage them to undergo regular antenatal clinics and institutional deliveries and postnatal check ups at their residences. Though the federal government paid a pittance as salary, I worked because I had chosen a profession to be of service to humanity. Medicine then was not an industry. Nowadays in my oun country doctors and hospitals are so much commercialized , I am ashamed to call myself a medical man. Respect we had amongst population has taken a nose dive . Profession is no more service minded; it is money spinning industry.
    Gopalan

  3. Actually I think there are 2 types of grades: 1 for personality. Docs need to have listening ears, etc. if they don’t listen to the patient: you have a greater chance of wrong diagnoses or missed diagnoses. Then in terms of what they know can be another grade. I’ve had some doctors not be able to give me a correlation on blood work tests. I could. I knew some were not up to date on treatments, etc. That depends on the person. You can look at a review and figure out who knows what they’re talking about.

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