The focus on patient satisfaction is enough to make you sick

All patients should be treated with professionalism and respect.  We all want our patients leaving our care happy, healthy and satisfied, if at all possible.  However, sometimes patients don’t leave an emergency department very happy or satisfied.  Sometimes the doctor could have prevented it, but many if not most times, such dissatisfaction has little if anything to do with what the treating physician did, or didn’t, do.

The reasons for a patient being dissatisfied with a particular healthcare encounter can be very complex.  It’s not so simple as to just include a line in a survey such as, “Were you satisfied with your doctor?”

Who should be held responsible for the results of these surveys, is where the crux of this debate lies.

So why are hospitals obsessed with patient satisfaction?

It’s the same reason Walmart puts greeters at the front door (the ED), not the back door (inpatient floors), and the same reason the government collects taxes and not sea shells: money.  The question we really need to be asking is: Why is the obsession with patient satisfaction in the ED so soul-crushing to those that work there?

1. Lack of control

A patient pulls into the ED parking lot.  The lot is full.  He doesn’t feel well, he’s in a hurry and having to search for a parking spot irritates him.  The wait to see a doctor is long, too long.  Once finally in his room, he sees a drop of blood on the floor from the previous patient.  He’s disgusted.  Despite great care by the doctor, it biases his overall view of the experience.  As much as he tries to remain objective, the patient satisfaction score suffers.  The patient gives a “1 star out of 5″ review after discharge, but writes in the comments, “Doctor and nurse were great, though!”  The tabulated score remains 1/5, or “FAIL.”

The doctor gets pulled aside at her next group meeting and is told she’s on watch due to low scores.  She’s never been fired from a job in her life, but now her job is in jeopardy, over something which she has no control.

A patient leaves an ED satisfied.  He gets a patient satisfaction survey and throws it aside.  He has no need for it.  The visit went great.  It’s his preferred hospital for anytime he gets in a bar fight and needs to be sewed up.  He got in, got his knuckles stitched, and got a free Sierra Mist and a meal tray.  On his way out the door, he tweets, “#CityGeneralERrocks!” on his smartphone to the world’s prospective ER “customers.”

Six weeks later, all has healed well, and there’s barely a scar.  Then, the bill comes.

“!&@!?#€!!!,” he thinks.  “$920?  Screw that place!”  He grabs the survey and nukes the hospital, doctor and nurse all with the lowest score possible.  He writes in the comments, “I would have rated you a ‘negative infinity’ if the scale went that low!”

You can save a life, walk out of the trauma bay drained but proud, and be pulled aside and told that on last months survey, you didn’t get a patient a coffee “like they do at the car dealership.”

You are told, “Get those scores up.  Administration is watching.”

It translates into, “You suck.”

It’s not that big of a deal, right?  Maybe you should brush it off, but you are human.  You haven’t “evolved” to the “new way” yet.  You’ve heard of ER doctors losing their group contracts and therefore their jobs over things like this.  It bothers you.

There’s a complete and utter lack of control, and this can be utterly demoralizing to some people, particularly those who thinks of themselves as doctors, not “providers.”  Some may not be bothered.  These are the new generation of ER doctors.  Thick skin. Carbon-fiber reinforced alligator hide. An unembittered new species of ER doctor evolved to thrive in his new and changing environment.  He goes in each room armed with an EMR tablet, a $5 Starbucks gift, and a devastating smile.

I imagine one would feel more in control owning and operating a hot dog stand in the chaos of Times Square.  An angry customer tells you your buns are flat (no pun intended).  His rant doesn’t frustrate you, in fact, you welcome it.  This informal “customer satisfaction survey” has given you a valuable nugget of information to make your hot dogs and buns tastier, and make your business grow.  You cut through his dissatisfaction with a smile and say, “Thank you for telling me, sir.  I’m sorry.  It’ll never happen again,” and you can actually mean it.  Fluff those buns up and 2014 will be a profitable year!

Sometimes a patient voices frustration in a survey despite your best efforts to be nice, helpful, professional and clinically astute.  This may be due to factors out of your control regarding ER wait times, a large hospital bill, dirt on the waiting room floor, or a rude staffer that wasn’t you.  If the results are used against you, it is very difficult to smile and say, “It’ll never happen again.  I’ll do better next time.”

You didn’t make it happen, and you have little if any ability to make it better next time.  You’re already nice to your patients, do your best to help them and treat them with respect.  There’s tremendous cognitive and emotional dissonance there.  Things like this can end careers and fuel burnout in a big way.  Such things are the undercurrents that cause doctors to go work for insurance companies, as non-clinical consultants, or just plain move on.

2. Fundamental unfairness

I think it was said best by commenter Doctor Amy, a hospitalist, in the comments section after a previous post I wrote on the subject,

Hospitalists feel much the same way as you do … The patients are essentially asked if the doctor ‘always’ did everything perfectly — the vagueness of the question should automatically invalidate the response … the hospitalist may well have spent a great deal of time doing just that — making sure all the home meds are correct, arranging rehab, taking care of the fall at 3am, controlling pain meds, actually addressing code status etc. The sat[isfaction] scores are not parceled out in a way to delineate any of that data. We are told we suck. Maybe we do … but this data sure as hell isn’t a valid way to show that.

While only being only one person and only one component of any given patient’s perception of their hospital encounter, Doctor Amy has obviously felt the weight of being held responsible for the dozens, if not hundreds of intangible factors that make up a patient’s overall satisfaction, or lack thereof.  Being held responsible for factors over which one has no control, is fundamentally unfair, and as such only depresses morale among those involved.  Poor physician and staff morale certainly can’t be good for patients, let alone hospital “business.”

3. Bad for patients (Violation of our oath)

This is definitely the biggest and least acceptable reason, and the one that bothers me the most.  This is the one that leaves us no excuse for looking the other way: our patients. You went to school for decades, indebted yourself $166,000, worked 100-hour weeks in residency (even though you only logged 79 so your program wouldn’t get sacked by ACGME) all because at age 16 you decided idealistically you wanted to be a doctor to “help people.”

Then you find out, that according to the Journal of the American Medical Association, the patient “satisfaction” obsession you’re coerced to participate in not only increases health care costs, but is associated with higher death rates with the purpose of increasing corporate profits, not for yourself as an emergency physician, but for “the men in suits.”  There is unwelcome pressure to treat viruses with antibiotics to keep patients happy, irradiate the brains of children with unnecessary CT scans to satisfy anxious parents and prescribe medications to people seeking to fuel dangerous addictions.

Evidence based medicine is good enough for Medicare, private insurers and malpractice lawyers to demand it, yet it’s not good enough to stop the harmful practice of satisfaction-survey obsessed medicine.  If you think this is just opinion without evidence, read: “Conclusion: In a nationally representative sample, higher patient satisfaction was associated with … increased mortality.”

The current system pressures doctors to violate their oath to “do no harm.”  It forces doctors to consciously and regularly make this decision, “Should I do what I think is best for my patient and possibly lose my job, or violate my oath and practice bad medicine to boost survey scores, to avoid being fired?”

Did we sign up for this?

4. Self-preservation

Patient satisfaction-obsessed medicine has been linked to higher mortality rates, and as currently modeled, should be banned.  There should be a moratorium on such policies until the methods can be reformed, with patient heath as their focus, not profits, so they can be applied safely, if at all.  The real questions is: why don’t more physicians have the courage to, as First Lady Nancy Reagan’s anti-drug slogan went,  ”Just Say No?”

Emergency physicians and hospitalists are either employees, or de facto psuedo-employees of hospital corporations.  They are primarily there to serve their effective employers whose goals as non-physicians and MBAs are to increase patient volume to make as much money as possible.  Period.  You can throw out any idealistic nonsense you learned in medical school that says anything else.  If they don’t follow the rules, play the game and keep their bosses happy, the powers that be will find a way not to renew their contract.  “Do what I say or you are fired,” is the message, if not explicitly stated.

Doctors feel they are powerless to change a system larger than themselves and feel they have no choice in the matter.  To preserve their paycheck, they play “the game” to avoid being fired.  The whistle has been blown, but no one’s listening.  There is too much money being made.  The one’s who are being harmed, and who could change it are the patients, but they don’t seem to know they are being harmed.  After all, the system is designed to keep them “satisfied” first, and healthy, second.

But often, what makes a patient most “satisfied” isn’t what is best for their health.  Our current system doesn’t allow this to be reconciled, and doesn’t want to.  The loss of a “customer” isn’t tolerated, for any reason.

“Sick, but satisfied” comes back to the ED.  “Sick, but satisfied” is good for business.  “Healthy and dissatisfied” takes their business elsewhere, and is a lost customer.

Is this what we want our healthcare system to promote?

There is no debate as to the motivation behind the satisfaction-survey obsession.  Administrators and businessmen seeking profits drive it.  Period.  The sky is blue.  The sun sets in the West.  Again, we all want our patients leaving our care happy, healthy and satisfied, if at all possible.

But there is a tremendous sense of a lack of control among those held responsible for these patient satisfaction survey results.  The application of these surveys is fundamentally unfair, and not substantiated scientifically.  Also, those applying these surveys and their principles pressure physicians to violate their oath to “do no harm” and to help people.  As doctors, we place much greater value on our own sense of control, basic fairness, and helping our patients over making our bosses wealthier.

This can make some feel very demoralized, and even cause some to leave the specialty of emergency medicine or medicine in general.  Unfortunately, so far, the system which is linked to higher patient death rates has been perpetuated due to the great power imbalance between hospital-based physicians and their much more powerful corporate employers.  Hopefully for our patients’ sake, there will be much greater opportunity for positive change in the future.

“BirdStrike” is an emergency physician who blogs at Dr. Whitecoat.

email

Comments are moderated before they are published. Please read the comment policy.

  • buzzkillerjsmith

    1. Doctors should not work for hospitals or health systems. They should work only in physician-owned groups, including, if they so desire, groups of one. ER docs and hospitalists should form groups and contract with hospitals. If the business types then try to isolate and sting, then the group can resist much better.

    2. If you do work for a hospital or health system, you are lost. Quit your job. Quit it today.

    3. I realize of course that the above maxims are often impossible to follow. But work towards them.

    • ninguem

      And, at the risk of sounding like a broken record………outlaw noncompetes.

      That affected doc that’s so terrible and is let go, should be able to go right down the street to the competition and work in their ER, or set up across the street in an Urgent Care and refer patients…….you know.

      The administration, realizing they are no longer able to take doctors and just throw them away like trash (you went through medical school and postgraduate training to be treated like this?), will now think twice about discarding a doctor on a malignant whim.

      I’ve yet to meet a hospital administrator with anything BUT a malignant whim.

      I feel strongly about this. A lot of what doctors complain about, will vanish should this ever happen.

      There will, of course, always be new problems.

      • buzzkillerjsmith

        Brilliant idea put exactly right.

      • LeoHolmMD

        You really can’t say that enough since no one is acting on it. We should chant “eliminate noncomepte clauses”.

        • ninguem

          Massachusetts does not not allow noncompetes, by statute.

          Massachusetts has more than its share of problems, but you know, I just don’t hear people in that state going around muttering, “if only we allowed noncompetes, everything would be wonderful here”.

    • Amy Arrant

      We are a physician owned group. But as hospitalists we essentially have to have a contract with the hospital to allow us to function/practice. It effectively makes us de facto employees. We get a stipend….we are owned. The threat always looms that if we make too much noise they will replace us with a national hospitalist group that will be happy to churn unsuspecting new grads through the machine.

    • Amy

      We are a physician owned group. But as hospitalists we essentially have to have a contract with the hospital to allow us to function/practice. It effectively makes us de facto employees. We get a stipend….we are owned. The threat always looms that if we make too much noise they will replace us with a national hospitalist group that will be happy to churn unsuspecting new grads through the machine.

  • southerndoc1

    Another situation where one would expect the medical societies to stand up for what is right for patients and physicians, and they do nothing.
    Killer post.

  • Dr. Drake Ramoray

    Excellent post. You have hit the nail on the head for one of the reasons I will try my hardest to never work for a hospital again.

  • buzzkillerjsmith

    The problem here, JR, is that admin types, those who use the surveys, are basically evil idiots. Evil because they want to keep us under their thumb and to maximize profit with no concern for the health and welfare of sick people. Idiots because they have not the least understanding of the statistics required to use surveys intelligently. They reach their limit by mouthing “six sigma” and suchlike nonsense. Remember these folks were the frat-rats who drank their way through college.

    So these surveys often act as weapons, pure and simple. This will not change by improving the surveys but by improving the people who run things- replacing them with us. We are qualified to say what is good medical care. These other people are usurpers.

    • macbook

      This is really terrible. Doctors need to band together and simply quit when they are bullied like this. At the end of the day, the hospital needs us for their services. If people group together and refuse, there is nothing they can do but go along.

  • jjameson

    I find it extremely annoying that my “grade” is how much someone likes me. As a surgeon, shouldn’t it reflect my surgical complication rate? Put another way if my recurrent hernia rate is 50% but I’m a nice guy, I’ll get good “grades” and be paid more! Crazy!

    • Deceased MD

      Why Dr. Jameson,
      You must be a great surgeon! You have 8 up votes and no down votes.

      • Mika

        I was tempted to give Dr Jameson a “down vote” just now, just to illustrate how easy it is for someone who’s simply having a bad day or is in a grumpy mood to capriciously take it out on their physician and affect their rating for no good reason at all.

        But I didn’t =)

  • guest

    I received one of those surveys after an ER visit. I told them the ER doctor did a good job and deserves a raise.

    I thought it was ludicrous that they asked my opinion about the ER wait. I went to the ER because I had a fever of 105 and woke up on the floor. I suspect the strokes, MI’s, and amputations were seen ahead of me as they should be. I’m not sure what the wait has to do with the price of tea in China. I was always under the impression that if the patient is waiting, it’s because they are not the most critical. Sad, that doctors who are doing the right thing could get penalized because someone, heaven forbid, had to wait while someone more critical is cared for.

    • cnshap

      Guest, are you sure you are an American? Because your perception of self and attitude toward others is more indicative of a citizen of a more developed country with universal healthcare. I have worked in a US critical care setting for almost two decades and I must tell you your perspective is refreshing. Your response lacks a sense of self-entitlement that is pervasive in American culture. Nice. And classy.

      • guest

        I appreciate your comments; I have the utmost respect for what you guys do.

    • Michelle

      I’ve never written a comment before, but I must respond with great appreciation for your attitude. When I was working as a resident in the ER in a county hospital (for indigent patients and always busy), if patient’s complained about the delay I would acknowledge their frustration, but then point out they can be grateful we were not rushing to their bedside first because that usually meant their life was in danger. This usually gave them pause to think that maybe they were not the sickest person in the ER and that we were not delayed just because we were being lazy. They often acknowledged that maybe the ER is not the place you want to be #1.
      I had a fellow resident who got paged and called to the administrators office while on surgery call because she did not immediately go to the bedside of an already admitted stable patient. The patient was mad that the physician did not appear when he wanted and filed a complaint. She refused to go the office because she was busy dealing with 2 potentially life threatening emergencies in the ER at that moment. I believe it was the secretary on the phone, but per my colleague she couldn’t understand why she was not immediately going to the patient’s bedside and now to the office. I thought patient’s dying in the ER was also bad for business? My colleague did the right thing, addressed the emergencies on hand and dealt with politics later. Thankfully this was during a change of residency hour limits and the administration realized the personal shortage and coverage was changed.

  • whoknows

    that’s disgusting.

  • guest

    I don’t agree that the wait time means more staff is needed. It may mean that the patients waiting went to the ER for an issue that wasn’t urgent. I was seen in a reasonable amount of time because I was really ill. I suspect if I had had the sniffles I would have waited a lot longer.

  • Thomas D Guastavino

    Can you imagine what it be like after accountable care ?

  • Rachel Phillips

    An “aha” moment for sure. I was shocked and disgusted when I saw that ACA was going to pull back a percentage of Medicare reimbursements based on satisfactory patient surveys. Are you kidding me?!! What sick person is going to be in a happy state to fill out a survey, let alone a good one?! That’s like asking someone whose had their car towed to fill out a satisfaction survey for the tow company. Who is ever happy their car was towed even if the tow company has affordable rates, good customer service and treated their car like it was a Lamborghini. NO ONE.

    This is actually going to handicap hospitals that serve the “less than endowed with good insurance coverage” because they can’t afford to paint their walls or serve gourmet meals. This is preposterous. This is just another great example of how inept our government is at improving quality of care. Another way to destabilize free enterprise. REALLY…A survey?

    Here is what physicians need to do… set up their own cost-effective models of care, focus on providing transparency of benefit coverage BEFORE providing non-emergent services… believe me consumers will appreciate this more than anything and the tide will turn against government control… if physicians can show the consumer that they are taking strides to control the cost issue.

  • Sherry Gordon

    This problem is symptomatic of a major societal problem, not
    just in medicine. Keep this in mind when you read about the
    problems in higher education.

    I teach Income Taxation. I am a CPA also.

    My students are asked if I made the course fun. Most of
    them have no idea if I know what I am talking about, but it
    seems very important that I have good jokes.

    We were promised that satisfaction surveys would never
    become a major part of our evaluation process. That was
    untrue.

    Physicians beware. Higher ed is filled with poorly paid
    part-time instructors who are subject to the whim of
    students of questionable motivation and ability.

    The money is going to the glad-hander administrators who
    only care about keeping their own jobs and keeping their
    pay high. That is the unsaid goal in the “mission statement.”

    • Deceased MD

      good point. Expand that to consumerism in the general sense. Call up your any service provider and they generally have abysmal service but at the end ask if they can waste your time with a survey and questions like, “Do I get a 10 out of 10 for helping you today? Absurd.

    • azmd

      This is also happening in medicine; the teaching attendings where I work were recently all informed that we need to be sure that we are “keeping the med students entertained.”

      Quite a far cry from my days in medical school I must say. The funny thing to me is that when I mention to the residents that I have added funny slides to my powerpoints because I have been told that they are Millennials and like to be entertained, not just instructed, they get quite huffy.

  • rbthe4th2

    I looked at “tired” and “mengles” posts. May I suggest that we try to split up the surveys?

    1) Has to do with quality of care in terms of communication. Did the provider give you a diagnosis, explained the treatment, give you treatment options, and what you were to do next?

    2) Has to do with quality of care in terms of treatment. Did the provider give you a treatment that would correct or alleviate your symptoms?

    3) What was your wait time in the department?

    4) Did the provider appear interested in what you had to say regarding your symptoms and work with you in regards to treatment?

    Then maybe some open ended questions if someone wants to speak further.

    The last time I went to the ER, the PA in training and PA gave me one plain IV bag. They said all my labs were fine and would give me something for my headache. I got my IV removed. The nurse left soon after, and I didn’t clot, so I started bleeding like I was on blood thinners. I didn’t clean the floor but I got myself cleaned up, found gauze, etc. to patch me up and got the bleeding stopped. No one ever checked on me, so I found a nurse sitting at a station, said I’d like to leave (figuring I was holding up the ER for no reason) and that I had cleaned up my bleeding issue using materials there and would they clean the floor. I got a copy of my labs. I discovered low albumin, protein, high cortisol, and several other values that were borderline low/high. To me, there were 2 service issues: labs that were taken and reported incorrectly as “fine” (albumin especially doesn’t go low unless there is a problem) and that no one checked on me.

    I take that back. The only time the nurse came in was wanting to do a EKG (I asked if they had proof of dehydration, no they didn’t, and I reported no heart problems). I refused that test. I couldn’t do a urine test because, well I had no urine to give them. I was dehydrated and had reported that.

    I had to go out of my room to get a nurse, sitting at her station the whole time, to remove the IV, to check on where any one was, but not to “sell” me on tests.

    Was the PA & PA in training nice? Yes. However, there the history I gave them should have given them a major clue that with the albumin off, protein,

    Quite a difference.

    • guest

      Actually low albumin is a very common and non-specific finding. Unless it was associated with liver failure or nephrotic syndrome, both of which would have caused other, more serious lab abnormalities, it would be considered an incidental finding, would not be treated, and certainly would not have kept you from being discharged from the ED. I would say about 30% of my patients have low albumin levels and I only mention it in cases where there is a concern that the patient is neglecting his or her nutritional status, usually because of drug or alcohol use.

      • rbthe4th2

        They didn’t investigate anything else or tell me to investigate it with a PCP. There would have been a major concern about malnutrition, since I was hospitalized for it in 2012. I also mentioned several times I had problems eating, nausea, vomiting, etc. & the hospitalization. It wasn’t for drug and alcohol abuse, I’ve lost part of my digestive system AND what’s left doesn’t work.
        Speaking of which, my liver values, ALT/AST & ALP are now just a point or so above the low normal values, the cortisol has been up for months. I’ve had GI pain now and then and dark yellow urine that smells strongly at times.
        I’m known Vit. D deficient, the B12 has dropped by 2/3′rds in a few months, calcium & zinc are low …

        • guest

          That sounds rough. Maybe see if there’s a group like this that practices near you…

          http://www.rush.edu/rumc/page-1099611550726.html

          • rbthe4th2

            Thanks guest!! There isn’t. I did go to one, but they said all was fine. I didn’t get all the testing that I was told I would, so I don’t know what happened. The problem is that I show signs LONG before my levels are very low, and NO doctor here can figure it out. They can only judge the paper, not the patient. I’m suspecting I need to do more to get the point across. I have a doc down here who knows what liver failure is, etc. and he’s the only one who gets it. The problem is that he’s not really in a position where he can do anything about it. I’m just glad my will is made out.

  • Tiredoc

    Personally, I would never want my emergency room physician to score above a 2/4 on patient satisfaction. I think the ability to say “no” is a job requirement.

    Perhaps they can make the patient satisfaction surveys like sweeps week for TV. That way, everyone can do what they normally do except for 2 weeks out of the year. For those 2 weeks, hire a “triage plus,” and give all of the retreads 10 Lortabs in 5 minutes and boot them out the door. It’s be a magic 4/4 every time!

  • Jody

    They should do what our local hospital did with my disasters, I never received surveys any time things didn’t go well. The time I was paralyzed before being knocked out, the time I was sent to six different locations because nobody knew where I was supposed to go, The time I had to return for an extra blood draw because they forgot to order platelets along with the other testing…….. Nary a survey. I was armed and ready.

  • http://www.CommunicatingWithPatients.com/ Edward Leigh, MA

    I have two words to describe patient satisfaction, “It’s complicated.” There are so many variables at play and no easy answers. How do we define a “satisfied patient?” Here lies the problem — there are so many definitions. We probably each have a definition. What’s yours? I don’t focus on the word “happy” — I focus on the word “safety.” I focus on communication tools to be sure patients understand their medical situation to avoid adverse events. There are also communication tools to diffuse an angry patient. Yes, there will be issues with parking, wait times, delays in testing, etc. Using the right words to help the patient re-focus changes everything.

  • meyati

    I was contacted by the health system why I didn’t use the in system urgent care or ER, instead of an outside urgent care with a contract. I told whomever that the system urgent cares are about a 30 minute drive, and the contract UC is a 5 minute drive. If I was well enough to drive through traffic for a half hour, I didn’t need UC. They told me to go to their ER that’s too blocks away, if I was too sick to drive for 30 minutes.

    They have patient feedback-I asked them why they didn’t have an Urgent Care on this side of town? I received a letter that they had counseled my doctor on his lack knowledge of the system, and they reprimanded him. On the next visit, I apologized. I told him this is America- asking the system about an urgent care clinic on this side of town should not have had anything to do with him. He told me that nothing happened to him everything was OK. Then at the end of the visit he said that he had to tell me something. He told me where every system Urgent Care clinic was and their hours.

    After I went out, I started crying, because it was obvious they had dumped on him. Then the receptionists wanted to know if he had scared me or abused me. I told them, “No, I was mad at the plan reps that reported him, because I asked why they didn’t have an UC on this side of town?” They probably reported him again.

    Lots of these problems against doctors are obviously caused by petty bureaucrats that are trying to keep themselves employed.

  • guest

    I received one of those patient satisfaction surveys after seeing a dermatologist. I scratch my head at all the wasted money sending patients a 4 page booklet with pre-paid envelope to critique the dermatologist, staff, and ambience of the place. It’s a dermatology appointment for pete’s sake. She was professional and did a good job. It was a routine procedure. What am I supposed to say? The physician had a chipper attitude as she injected lidocaine into my face? I liked that she used blue thread to sew up the little hole left after she cut out the mole, because it matches my sweater? I loved the way the nursing assistant handed gauze to the doctor? What in the world are they doing with these silly surveys? Isn’t the fact that I’ve come back a sign that I’m satisfied with the care I’ve received? If I didn’t like the care, I wouldn’t have returned. Why the need for the survey?

  • Sherry R

    There is a huge demand for physicians willing to work in inner city clinics as well as 1 nation areas. A growing field is also tele-health. It is an amazing time to be in healthcare and the reality is that some places are able to get high scores consistently so it is something both people and systems can learn. Don’t give up or take it personally.

  • DoubtfulGuest

    I filled out a couple of surveys in the early days before I understood how they’re used against doctors and staff. Fortunately, I never ripped anyone, but I made a few constructive suggestions that would’ve been better expressed in private, face to face interaction. It’s hard to do that, but it’s ultimately better for the relationship and much more respectful. These surveys are deceptive to patients who wish to help their doctor and express their concerns in the most efficient way.

  • Suzi Q 38

    I think the score-cards from Press Greaney are useless.
    I mostly write the highest scores possible for the doctors who deserve the high scores. There are doctors who try their best and are positive and helpful.
    I only scored one doctor down. He deserved it. He ignored my complaints about my nerve condition and I worsened irreversibly under his care.

    IMHO, the scorecard means NOTHING. The chief of staff does NOTHING with the doctor who does not do a decent job, so what does it matter?

  • Suzi Q 38

    Another thought.

    Yes, in the past, this did not happen.
    Doctors were not evaluated, they were admired, appreciated, and adored.
    Believe it or not, some still are.

    What has changed is that many times, the doctor does not have the luxury of time in giving the patient the appearance that the or she cares.

    Mistakes are more frequent, and distrust emerges.

    Administrators of hospitals pressuring physicians to order more tests, some unnecessary, time consuming, and costly.

    We as patients realize that yes, they are here to make us well, and we are stuck, if the condition is acute. We allow all the repetitive tests and see the bills hit our lifetime insurance tab and our co pay and non covered service totals soar.

    It took me three months to see a specialist. The receptionist and NP makes this decision. By the time I got into the office, I was acute and worsened. I was still walking, but now I needed a wheelchair to get from the parking lot to the physician’s office.

    I, and many other patients, have a reason to be displeased.
    Do not lump us all into to the same category of “whiney” patients.

  • Herman Munster

    actually it shows JUST THAT. people can’t do a review of something they are not trained in. emergency rooms have nothing to do with customer

    • JR

      If you have one doctor who’s rating is 50% across 1000 reviews, when the average hospital rating is 80% – yes, there is something wrong there. But there is probably also something wrong with the person with a 99% rating across 1000 reviews.

      1 bad review? That isn’t statistically significant. Everyone is going to piss someone off. That’s just it – if someone is getting in trouble for one bad review, or if they are getting in trouble when their reviews are at the same level as the hospitals in general, etc – that’s just plain bad management. It doesn’t mean that the reviews can’t provide valid feedback or be useful if implemented in a helpful and meaningful way.

  • christie

    Wow the same type of behavoir from upper management happened to me. I was fired because a manipulative, abusive, devious pataint told them I was “rude to her”. I had done everything humanly possible to make her stay pleasant. The administration is so concerned with PR of the facility and fails to realize some patiants are liars and manipulators.I havn’t worked for over a year now, time to go back and try again. I hate patiant satisfaction BS and management that lacks the decencey to stand up for thier nurses, docs etc. When are we going to be treated like the professionals we are.

  • macbook

    Very interesting debate!
    Do specialists seem to be under the same pressure or is it just primary care/hospitalists/ED??
    I really believe the only way to fight this is for doctors to join together and put up a fight. Patient satisfaction is extremely complicated and as another poster pointed out, its really important for a doctor to be able to say no. This isn’t a typical service industry where we are here to give the patient everything we want. We should only do things that are medically indicated and that make sense. Therefore, if we oppose and anger someone, depending on the clinical situation, that may be perfectly appropriate.

  • cjb

    I can’t help but see the parallels between test scores and being told “you SUCK!” as a teacher due to factors beyond my control in the classroom.

  • Sapphire Munford

    I am a nurse tech at a big hospital and am on a commitee looking at pt satisfaction scores. We literally had a meeting this week to discuss how to implant positive thoughts into our pts minds during their stay so they answer their surveys “correctly”. Using key words over and over…some of the same wordings used on the survey. We sound like drones. It makes me sick. We have also been forced to catalog every encounter we have with our pts during shift to prove we are taking care of them…this requires us to physically go into their room and answer a few questions every single hour about how they are doing. If we do not we could be penalized. All for pt satisfaction. This is on top of everything else that nurses do for the doctors and pts. I assure you that the pressure of these scores is felt by all…except perhaps by those sitting on top counting their money.

  • deb

    same thing is happening in education–even 1st graders are supposed to “evaluate” their teachers. If you are a special ed teacher and have just referred a student for behavior problems, know that that student will be evaluating you. Kids who don’t do the work, still get to do the evaluation. Ridiculous. Just like it is in medicine.