Patient input in their treatment should be valued by doctors

Thanks all who responded to my recent USA Today piece, Patient-satisfaction surveys have drawbacks.

But in a letter published in the paper yesterday, a reader from Oklahoma City was quite unhappy with my take.

Mark R. Heaton writes, somewhat angrily:

Dr. Kevin Pho’s recent opinion piece was not only arrogant but also grossly naive.

His basic premise was twofold:

• Doctors know best and should therefore ignore patient feedback regarding possible tests and treatments.

• Patient-satisfaction surveys should not affect doctors’ pay.

Frankly, it comes as no surprise that Pho’s arrogance regarding patient feedback (about the patient’s own care) would translate directly to poor patient-satisfaction scores and lower pay for the doctor.

Welcome to the real world, doctor.

No profession is 100% fail-safe (after all, it is called medical “practice” for a reason).

Even the world’s best surgeons should not presume they are qualified to start swinging a scalpel at someone without first considering all the feedback from the patient regarding his care.

The patient will be the only one living with the outcome of a prescribed treatment, so the doctor should at least respectfully consider tests and treatment options that patients would like to discuss.

If the concepts of a free market and customer service are so offensive to Pho, then I recommend he consider changing professions.

Thanks for the response Mark, I appreciate it. I’m going to overlook the ad hominem attacks, chalking it up to your rightful frustration with our health system.

Upon re-reading my column, you’ll find that I indeed support patient feedback, and in fact, wrote that it’s essential to improving physician practice: “Gauging patient sentiment with satisfaction scores is a useful way to point out deficiencies and improve the patient experience,” and, “Satisfaction scores give patients a needed voice to express their concerns, which can help medical professionals improve their patient relations.”

So when you say that I believe “doctors know best and should therefore ignore patient feedback regarding possible tests and treatments,” that’s simply wrong.

I continue to believe, however, that it’s a mistake to tie a doctor’s salary to how well he scores on patient surveys. Multiple studies, which are cited in the piece, show that there is little correlation tying quality care with high satisfaction scores.  Giving a financial motive to “treat to the satisfaction score,” doesn’t necessarily promote the best medical care.

But when you write, “the doctor should at least respectfully consider tests and treatment options that patients would like to discuss,” I absolutely agree with that. Decisions shared between both the doctor and patient form the basis of an ideal relationship. Discussions like these take time, which is in short supply as doctors are pressured to see more patients during the day.

Moving forward, it’s imperative that health reformers recognize that time needs to be better valued, in order to better utilize patients’ input in their own health.

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  • http://glasshospital.com GlassHospital

    Re: “patient input,” i.e. listening to patients.

    My response is about patient comments/satisfaction, but rather about just listening to the patient.

    Upon reflection it feels as if we’re almost taught to discount what the patient says in favor of the “objective data.” I can remember many times when if I or my team had just listened to the patient, actually listened, we’d have come up with a workable plan sooner. And of course, likely saved the health care system lots of time and money.

    So whether for their feedback or for their medical complaints, definitely behooves us to improve our listening skills.

    Dr. John

    • SAM REYES

      I agree with your comment Dr. John. listen and educate. its a two way street. we both learn.

  • DJ

    ‘Satisfaction’ is a nebulous concept, and can mean wildly different things. It has to be taken in context for it to have any meaning. Common sense would tell you won’t always get glowing opinions from a sick person who feels terrible, or who is especially cranky because they feel terrible on top of the fact that they have been made to wait a long time (often just to be hustled in and out in an overburdened health care system.)

    No… this isn’t the same ‘client’ scenario for the ‘Have a nice day!’ fast food or Wal Mart management mentality. That’s the problem with the business model trumping the professional model concerning relationships.

  • paul

    way to take the high road. i can’t imagine this responder wrote what he did to accomplish anything other than to get a rise out of you. simply put:

    1. customer satisfaction and quality care are not one and the same. these two things are sometimes, if not often, at odds with eachother.

    2. if you incentivize physicians with pay based on customer satisfation, some subset of physicians will choose it over quality care when forced to pick one.

    if Mark R. Heaton thinks that is a good thing, then i sincerely hope he is not in a position to be making the rules.

  • Trious

    I have found the exact opposite with several doctors.

    If I input something, I tend to get a look of, “I know what to do as I am the doctor”

    Granted I am VERY HAPPY with my doctors and they have cured me but the few times I have given my input, they listened then went the other way

  • stargirl65

    I think that anything the patient has to say during the encounter is important. Even wrong information has value as it gives me the opportunity to educate the patient. Also I may understand more completely why we cannot agree on a plan. Sometimes you have to agree to meet in the middle. Sometimes you are not going to do well.

    Example: “Doctor I have a cold and need and antibiotic.” This is followed by more information from the patient and a physical exam. Often it does support a cold. The problem is they don’t need antibiotics for this cold. Sometimes they don’t care about the explanation and simply insist that they always get an antibiotic and want one. And they want the strongest and most expensive kind because amoxil never works. I assert again that antibiotics aren’t needed. They sometimes leave angry. One even said “Fine then I’ll to the ER for the antibiotics.” I am sure those patients would give me bad reviews. But,ironically, they got excellent care.

  • j

    The IOM’s Crossing the Quality Chasm defined quality as safe, effective, patient-centered, timely, efficient, equitable. Most HEDIS measures and those used in the articles you cited are essentially measures of appropriateness (effective and safe). Satisfaction is central to patient-centeredness.

    So isn’t your definition of quality too constrictive? Shouldn’t we be redefining quality and P4P around the broader IOM definition? By this standard, pay-for-satisfaction is useful but insufficient.

  • minutemoon

    The only area I disagree with you, doctor, is when it comes to communication. If a doctor consistently gets feedback that indicates in can’t or won’t communicate effectively with his/her patients, that should affect not only his salary but also his ability to perform any other relevant service. A patient most often isn’t qualified to judge the specific technical aspects of an operation, for example. But if his caregivers don’t communicate properly, or maintain a hostile demeanor or attitude — that the patient is very qualified to judge and that is essential.

  • http://www.cedarhillpt.com Paul Weiss

    My favorite model for patient input is based around the “informed decision” model. The health care provider educates the patient regarding their presenting condition, the benefits and draw backs of different treatment approaches (including doing nothing), and is given the professionals opinion about the best choice. The patient is then encouraged to decide for themselves how they want to proceed.

    However, this doesn’t address the issue of a patient requesting a treatment that is inappropriate.

  • Wendi

    I have experienced two major problems. One is from my own care, and the other is through listening to others’ complaints and my time spent as a medical transcriptionist.

    The first major problem is that doctors are held responsible for patient health, which is utterly stupid. Unless the doctor is present 24/7 to control everything the patient does (exercise, diet, medication), the doctor CANNOT be responsible for the patient’s health. Not should not; it’s simply not possible. Both doctors and patients seem to have lost an understanding of this simple reality.

    The other major problem is patient education and expectation. The number of patients who think antibiotics will help their cold, or who refuse to take any responsibility for knowing what they put in their mouths, is utterly appalling. “Doctor give me these pills and I take ‘em” is far, far too common, and unfortunately, repairing that basic attitude of ignorance being acceptable needs to start at the grade school level. The number of people who cannot tell the difference between some hippie with a wholistic health website and, say, information on a particular condition at the Mayo Clinic website, is deeply disturbing.

    Naturally, this has led to a general response from doctors of assuming the patient is a poorly educated, barely functional moron. It’s not even wrong, in many cases, but it does interfere with the care of patients who are educated about their chronic conditions.

    Personally, I foresee both doctors and patients being incredibly frustrated with each other for some time to come.

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