Tag Archives: Health care

The Truth About Those High Patient Satisfaction Scores For Doctor-Patient Communication

We have all seen them.  You know…those charts showing us how satisfied patients are with the way their doctors communicate.  Did your doctor listen to you?  Did you doctor explain things in a way you could understand?

Funny thing about these charts, whether they be for hospitals or doctor’s offices,  1) they never seem to change from year to year – 80% – 90% of doctors communicate well with patients and 2) patients consistently rate their doctors’ communication skills as high.

Doctor-Pt Communication GraphThe problem with satisfaction data related to doctor-patient communication is that, at face value, it simply doesn’t correlate with other published data on the subject. There is a “disconnect” between what patients say in satisfaction surveys and what happens in actual practice.

Here’s what I mean.

Recent studies of hospitalized patients have shown that:

  • 68% to 85.3% of patients could not name the physician in charge of their care.
  • 43% to 58% of patients did not know the reason for their hospital admission.
  • 67% of patients received a new medication while hospitalized… yet 25% of these patients were unaware that they were given a new medication.
  • 90% of patients given a new medication reported never being told of adverse effects of the new medication.
  • 38% of patients were not aware of planned tests for the day.

The amazing thing was that majority of these patients (up to 58% in one study) said that their doctors always explained things in ways they could understand!

The same types of “disconnects” show up in satisfaction surveys done in doctor’s offices.   Studies of primary care physicians show that:

  • Patients are interrupted by their physicians within the first 18 seconds of their opening statement during office visits
  • Physicians and patients agree on the reason for the office visit only 50% to 70% of the time
  • Physician underestimate the patient’s desire for health information in 65% of the time
  • 50% of patients walk out of their doctor’s office not understanding what their doctor told them to do
  • Patient are not asked if they have any questions in up to 50% of office visits

Again, I am sure these same patients praised their physicians’ communication skills on one or another satisfaction survey.

So What Explains The “Disconnect” Between How Physicians Actually Talk To Patients…And Patient Satisfaction?

Today’s high patient satisfaction scores are an artifact of the way we (when we become patients) have been “socialized” when it comes to a trip to the doctor’s office. Here’s what I mean.

1) Beginning with childhood, we have all been socialized to assume the “sick role” when seeing the doctor.  From our initial visits to the pediatrician with our Mom we quickly learned that the doctor is in charge and that our Mom’s role (and ours) is to sit passive by while the doctor does most of the talking.  Notwithstanding all the “talk” about how empowered patients are today, most of us still assume the “sick role” when seeing our doctor.

2) Accustomed as most of us today are to the sick role, and accepting the fact that physicians are very busy, we are not surprised when doctors don’t seem to listen to us or interrupt us. We are not surprised that they don’t have time for all our questions or frown on us bringing in lists of things we have researched on the internet. This for most patients is what we are used to…it is what we are satisfied with given that most of us have don’t another or better point of comparison, i.e., a highly patient-centered physician.

3) Consistent with the sick role, we as patients “tend to be overly patient.” We “grant our doctors the benefit of every doubt.” Most of us begrudgingly put up with poor service, inconvenience, and unnecessary discomforts, until we can’t overlook it anymore. Even then we are reluctant to take our busy, overburdened doctor to task for these shortcomings by giving them a low score on a satisfaction survey.

The Take Away?

Hospital, medical group, IPA and ACO executives need to:

  • Be cautious about putting too much credence in patient ratings of physician communication skills. “One can assume that the quality of care is actually worse than surveys of patient satisfaction would seem to show” to quote Avedis Donabedian, MD, an old professor of mine.
  • Recognize that high quality, patient-centered communications (the gold standard for physician-patient communications) is essential to patient engagement, optimal patient outcomes and great patient experiences. If physician communication were as great as patients satisfaction surveys suggest, we wouldn’t be having the problems we are with low levels of patient engagement and non-adherence.
  • Benchmark the patient centered communication skills of the primary care physicians on their staff (employed and otherwise) and compare the findings against established best practices.
  • Take the additional reimbursement you will get from CMS for your patient high satisfaction scores and invest it back into improving the patient-centered communication skills of their physicians and patients. That is, if you don’t have to pay a penalty to CMS for high re-admission rates – which by the way is another by-product of poor physician-patient communication.

Remember that there is perhaps no better, more cost-effective way to differentiate your physicians (and your brand) these days than to have physicians on staff who really know how to listen and relate to patients.

That’s my opinion…what’s your?

Sources:

Makaryus, A. et al. Patients’ Understanding of Their Treatment Plans and Diagnosis at Discharge. Mayo Clinic Proceedings. 2005;80(8):991-994

Boland, B. et al. Patient-Physician Agreement on Reasons for Ambulatory General Medical Examinations. Mayo Clinic Proceedings, 1998;73(1), 109-117.

O’Leary, K. et al. Hospitalized Patients’ Understanding of Their Plan of Care. Mayo Clinic Proceedings 2010;85(1):47-52.

Olson, D. et al. Communication Discrepancies Between Physicians and Hospitalized Patients. Archives of Internal Medicine. 2010;170(15):1302-1307

What Are Your Personal Health Goals? Have You Ever Shared Them With Your Doctor? Has Your Doctor Ever Asked You What Yours Are?

Face it.  We all have personal health goals.  We may not share our personal health goals with family of friends like we do our financial or professional goals, but we all still have them.   I for example aspire to the following personal health goals:

  • To defy the conventional wisdom associated with aging (look younger, feel younger, live like I am younger).
  • To avoid premature aging – vision problems, flexibility and balance issues, aging and appearance, weight gain, skin tone, etc.
  • To not be called old by my grand kids
  • To live a more active life than my parents did
  • Question authority (yes I am a product of the 60’s and 70’s)

OK personal health goalsso I am vain.  I bet I am not the only one.  I am just the one dumb enough to publicly admit it (LOL).

Have I ever share these goals with my doctor?  Are you kidding me?

He can’t deal with the fact that I experience depression from time to time and insist on telling him about it…eeewww.   Besides…he will just tell me that getting old is part of the natural process.   You are supposed to lose your hearing, lose your balance and flexibility, get fat and wrinkly, become senile, and so on.   Let’s face it. It’s hard to have a conversation with someone – including your physician – when you know from experience that they are simply not interested  in what you have to say…or don’t share your point of view…when it comes to certain subjects.

There’s also another reason I have never shared my person health goals with my physician.   I have never been asked.

In their defense, doctors aren’t trained to care about things beyond the realm of strict biomedical conditions – acute conditions in other words.   That’s why it is so hard for physicians and many other provider types to get their heads around patient-centered care.   To become more patient-centered providers need to deal with touchy feely issues like personal health goals, personal health beliefs and motivations, family issues, depression, anxiety and all the other human emotions.   A physician I know referred to patient-centered care as a kind of “rabbit hole” physicians just don’t want to go down.  Getting to know the “person behind the disease” is time consuming and can take you down paths you not sure where they end up!

Health care executives, providers and payers wonder why patients aren’t more engaged in their health…aka do as they are told.  The problem isn’t that patients (people) aren’t engaged in their health…they are…the problem is that so much of what is passed off as patient engagement these days (EHRs, PHRs, team care, care coordinators, web portals, decision support tools) are not inherently engaging to us patients!   Why?  Go back and read my personal health goals and explain to how today’s technology-enabled vision of patient engagement is at all relevant to my (and I suspect many of your) personal health care goals.   

That’s what I think.   What’s your opinion?

Post Script

As I mentioned in my last post, I am heading up a research team that will be auditing 2,500 physician-patient conversations recorded during primary care office visits from across the US.   Among the many questions we will seek to answer will be the frequency with which physicians and/or patients raise the question of the patient’s personal health goals.

Stay tuned.  For more information on the 2012 Physician-Patient Communication Benchmark Report click here.