Well it’s that season again when contracts come up for renewal. Administrators are working hard to glean data from patient satisfaction reports and emergency physicians are working just as hard to dismiss them as worthless. It’s amazing how quickly we come to be at each other’s throats. When did we get to the point where we were no longer on the same team? When did we get to the point when it was one against the other? The Romans had a great phrase that the medical community would be wise to embrace: “Non mihi, non tibi, sed nobis.” Not me, not you, but us.
It is amazing the extreme positions which people take with regard to patient satisfaction surveys. Let me just begin by saying that I think they tend to be weak science representing small amounts of data. They neglect to ask certain key questions and they tend to lump or split doctors from the group. Having said that, do I think they’re important? In short, when your job depends on it, it becomes important. The hospital administration, who is in many ways our ultimate boss, believes in these surveys and will use them at will. So the smart doctor will pay attention and take them seriously, learning how to interact with the nursing staff such that the patient care is seamless.
When it comes down to it, you might as well “teach to the test.” Take advantage of the fact that the questions are known in advance. Words and phrases can be used in your patient interactions which directly reflect the questions which are going to be asked on the survey. It’s going to be a part of the program, so use the program to your advantage. Virtually all of the surveys try to ascertain whether the physician cared about the patient as a person. They try to find out whether or not the doctor was solicitous of the patient’s pain. They seek to find out if the doctor put the program together for discharge. Is there anything wrong with these things? I think these are important factors. It seems as though we have fallen into a defensive posture, where anything that comes out of the patient surveys has to be wrong and cannot relate to the actual quality of care which the patient has been given. To read some of the columns, it would seem that to get a great Press Ganey score you would need to be an inferior doctor intellectually. Nothing could be further from the truth. In my 34 years of emergency medicine experience, there have been very few physicians who have been fired for lack of medical knowledge. This isn’t rocket science. The two most important elements in an emergency physician are a dedication to getting the work done and the ability to make the patient feel that they’ve been cared for. The physicians who complain that the patient satisfaction surveys unfairly discriminate against them better put this into some kind of perspective. It is not a badge of honor or a sign of brilliance to have bad patient satisfaction scores. The best physicians I’ve worked with, from a scientific standpoint, also had great patient sat scores. They were able to marry the two together.
To be fair, satisfaction surveys judge physicians – and nurses -- by a set of criteria which were never taught in medical or nursing school. In the health care professions, getting the right answer was always the way to go. In the actual practice of medicine, it is much more important to find an answer which is able to accommodate the needs of the patient sitting in front of us. This does not mean that we should do things which are inappropriate. We should not give out medications which are unnecessary and we shouldn’t do testing that isn’t scientifically needed. But we ought to take the time to explain to people why we are doing certain things. And if this is communicated with empathy, it will almost always be a success. For instance, it is inappropriate for the physician to ever mention that the expense of a test or medication is the reason we aren’t getting it. Everybody believes in cost savings…on somebody else. Nobody believes in cost savings on them or their loved ones. The best phrase to use to help you take complete control of the doctor-patient situation is merely to say, “This is what I would do with my own family member.” That will do more to reassure a patient than all the studies, all the graphs, all the protestations which we use to try and discourage unnecessary care.
Many intelligent emergency physicians protest that administrations rely too heavily on patient satisfaction scores. This is indeed a major problem, one that needs to be addressed. What we need is to come together and ask for the quid pro quo. If emergency physicians are always to ask about the pain, then administration needs to do whatever it can to get patients upstairs quickly. If EPs are going to be careful to protect a patient’s privacy and treat them decently, then the hospital needs to do whatever it can to get them into a bed, registered and ready for care in a expeditious manner. If EPs are going to put together the discharge package in such a way that the patient can understand it, then the hospital must provide specialists who are going to take care of cases in a timely manner. This is a joint undertaking. I realize that frustration levels are often high in emergency departments, but the great emergency doctor is able to separate out his anger and frustration at the system and is able to care gently for the patient who presents in front of him.
Most people know the attitude of the doctor or nurse taking care of them. It’s not your words, it’s your attitude. The patient immediately senses if you are working in their best interest or not. Let’s stop the name calling. Let’s stop the war. Let’s start using patient sat surveys for what they’re really good for: looking at both the system and physician interpersonal actions. They are both represented in the patient satisfaction numbers. Emergency physicians need to not be so defensive that we cannot learn from these studies. By the same token, the hospital has to understand that it is equally complicit in patient satisfaction by the very systems it sets up and puts into action.
Greg Henry, MD, is the founder and CEO of Medical Practice Risk Assessment, Inc. Dr. Henry is a past president of ACEP and directed an ED for 21 years.