Recently, I spent some time answering the questions on one of those CAHPS surveys for doctors. CAHPS stands for Consumer Assessment of Healthcare Providers and Systems, and these days hospitals ask patients to use them to review not only their hospital experience but their experience with their doctors as well.
Many public hospital ratings use data collected from CAHPS hospital experience surveys, but patients rarely have much access to credible reviews for their doctors. What would those data tell them if they did? Would they be more useful than some of the ratings schemes for hospitals alone?
First, to answer these questions, we have to start from the premise that most Americans trust and respect their doctors. We often tolerate, and may even like, the medicine man or woman who may be incompetent but genial, but we don’t accord the same favor to, say, bad car mechanics. Reasons for this love affair are historical and run deep. So it seems to me a survey question that asks if patients liked their doctor or would recommend him or her to someone else might not mean very much.
I wasn’t too impressed with the survey questions that dwelled on how quickly I could see the provider and how long I had to sit in the waiting room. One question asked whether patients saw the doctor within 15 minutes of a scheduled appointment. Let’s face it, no one likes to wait too long, but then I evaluated this question in light of others on the survey. There were several better questions that probed into a patient’s direct interactions with their doctor.
For example: did the patient talk about their health concerns; did the doctor give easy-to-understand answers and information; did the doctor listen; and did the doctor spend enough time with you? Good communication takes time, and we want providers to do it well and help us when we are sick. If we want to be engaged in our care – that is, we are open to learning about drugs, side effects, surgical recovery times, and what’s going to happen during a procedure and after we get home – we need and want our doctor to take time with us.
If they rush through our office visits because they are monitoring some sort of waiting room time clock, or are pressured to see so many patients per hour as doctors at a chain of Florida walk-in clinics reportedly are, where does that leave the patient?
I would rather wait 25 minutes or even 30 in the waiting room for doctors who take more time with their patients. Then, too, some kinds of doctors, particularly specialists treating complicated illnesses, need more time. Some of the CAHPS survey questions seemed to contradict themselves.
I wasn’t surprised to see questions about using electronic medical records given the government’s push to get doctors to use them. It didn’t seem to me, though, patients could actually answer the questions with any accuracy. One asked me to rate the degree to which the computer system in the room made my interactions with the doctor easier. Another asked me to judge if my care improved because of the electronic medical record. I couldn’t make a judgment on either.
Still, there were items on the survey that are worth promoting in ratings schemes for doctors. The most important concern for me was patient safety, and the survey asked a question about whether providers washed their hands, wore gloves and took other precautions. I commented on this a few weeks ago after my recent eye surgery. More than anything else, I want to know that those who touch me wash their hands and follow other good hygienic practices.
The second thing dealt with access. How easy was it to get through on the phone, schedule an appointment, reach the doctor with questions or if an emergency arises. The survey could also have asked how well the practice performed when it came to notifying patients when it had to cancel. Two days before Hurricane Sandy hit New York City, my doctor’s office called to say they would be closed when the hurricane arrived. That showed they were thinking of their patients and their employees. High marks in my book.
Its small things, like that pre-Sandy phone call, that add up to a big picture of a good doctor. The CAHPS physician survey still has a ways to go before it creates one.
Trudy Lieberman is a journalist and an adjunct associate professor of public health at Hunter College in New York City. She blogs regularly on the Prepared Patient Forum.