Is the goal of patient satisfaction to make patients happy?

The link to a recent article in Forbes magazine entitled, “Why Rating Your Doctor is Bad for Your Health” keeps showing up in my inbox with the subject, “thought you would find this interesting.” The reason is because I’m responsible for overseeing education and training related to physician communication and patient satisfaction for a large national hospitalist practice.

The article isn’t so much interesting as it is unfortunate.  Its premise, based on comments from physicians, is that, “many doctors, in order to get high ratings (and a higher salary), overprescribe and overtest, just to ‘satisfy’ patients who probably aren’t qualified to judge their care.” And physicians report that this is taking place in an effort to meet patient satisfaction goals.

While it’s true that patients may be unable to judge certain aspects of clinical quality, there’s one thing they are quite capable of noticing (apparently a lot better than us physicians): a bad attitude.

The patient satisfaction mission is a critical one and our understanding and support of it is essential to the care of our patients and the credibility of our profession.

Before expanding on that point, let me try to establish some “street cred” by sharing that I’m a working hospitalist in addition to my administrative responsibilities and personal interest in patient satisfaction (which, for the purposes of this commentary is best referred to as the “patient experience” – I’ll explain below).

Much of what I hear from physicians about patient satisfaction is negative. And I do understand why. The government’s HCAHPS survey methodology and the Value Based Purchasing program are imperfect systems leaving obvious room for improvement. Additionally, hospital administrators sometimes have unrealistic expectations or misunderstand the limitations of these surveys. However, I believe these evaluation tools and their results can foster improved patient care. And with greater clarity regarding the goal of the patient experience mission and physicians’ role in it, I hope to convince my colleagues of the same.

What’s the goal?

One thing it isn’t, is making everyone satisfied (or happy). And that’s the reason why the term “patient satisfaction” misses the mark. For one thing, trying to make everyone happy is a losing battle.  The reality is that our recommendations sometimes collide with patients’ expectations. And this is where our expertise must show.  We physicians are charged with synthesizing many variables to determine what the correct care is for our patients. Effectively communicating the rationale for such care to patients so they can understand our recommendations is a responsibility we all signed up for and must abide by.

The goal of the patient experience mission is to ensure that all our patient interactions culminate in decreased patient anxiety, increased patient understanding and hopefully improved patient compliance and outcomes. And we shouldn’t lose sight of the fact that each of these outcomes is a valid end-point in its own right.

Yes, there are patients and families that are demanding and the final risk/benefit analysis may dictate that we provide something that isn’t absolutely necessary but not overtly harmful. I have ordered an MRI for an inpatient with back pain and at best a marginal indication for it. It was an unnecessary expense (to the hospital and the health care system), but a necessary maneuver to avoid further inefficiency in the patient’s care and the potential utilization of other costly resources within the hospital. But these are the vast minority of situations and to focus on them misses the point.

If we’re preemptively over-ordering, over-prescribing or simply taking orders from patients solely to improve survey scores or to generate a chunk of bonus money, we have only ourselves to blame. And again, we are missing the point.

The vast majority of patients are appreciative of our explanations and expertise when we take the time to listen carefully and make the effort to explain things clearly. This leads to better patient experiences and it can only help patients’ survey ratings of care. Care that accomplishes these goals is achieved through superior communication, which informs our role in improving the patient experience.

What’s our role?

It goes without saying that physicians are responsible for providing the most effective and evidence-based medical care at all times. But accurate clinical decision making must be accompanied by communication that addresses what I refer to as the patient’s “core concerns”:

What is happening to me?

Will you listen/talk to me?

Will you look out for me?

By offering clear explanations, listening compassionately and acknowledging patients’ predicaments with empathy and caring statements, we can restore a degree of autonomy that will allow patients to trust that we have their best interests in mind at all times. This is our role in improving the patient experience.

Patients surely have the ability to judge whether we’ve addressed the “core concerns.” And we should keep asking them how good a job we’re doing of it. After all, we’re healing people, not fixing computers.

The public will forgive us the occasional disgruntled patient who cannot be convinced of our best intentions, but they will never forgive us for misunderstanding the patient experience mission and failing to do the right things while under our care.

Mark A. Rudolph is Vice President, Patient Experience & Physician Development, Sound Physicians. He blogs at The (in)Patient Experience.

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