TulsaAllergyNews

Today, I had the opportunity to review a patient satisfaction survey from our allergy office. Now that COVID-19 pandemic isn’t at the top of everyone’s agenda (but may be changing soon with delta variant), I expect you’ll be asked to complete more surveys and as doctors, we’ll be asked to review more of your responses. This raises several questions for me and I hope you as well– I’ll share with you some “science” about answering survey questions, and you might just be surprised at the results.

• Do you even answer medical survey questions?
• How honest are you with your responses? Are you confident that changes will be made based on your survey responses?
• Do you think doctors/providers really read their individual surveys?
• Should compensation depend on your survey results?
• Can I sue you if you have good patient satisfaction surveys? Does it matter?

Yes, we have to do something about our medical system, and hopefully, we’ll all do our part. As promised, there is actually information on what patients like or don’t like about their physician interaction that shows up in physician surveys. I’ll see if I can’t relate this to an allergy visit with surveys included.

What Patients Value in Physicians: Analyzing Drivers of Patient Satisfaction Using Physician-Rating Website Background: Customer-oriented health care management and patient satisfaction have become important for physicians to attract patients in an increasingly competitive environment. Satisfaction influences patients‘ choice of physician and leads to higher patient retention and higher willingness to engage in positive word of mouth. In addition, higher satisfaction has positive effects on patients‘ willingness to follow the advice given by the physician. In recent years, physician-rating websites (PRWs) have emerged in the health care sector and are increasingly used by patients. Patients‘ usage includes either posting an evaluation to provide feedback to others about their own experience with a physician or reading evaluations of other patients before choosing a physician.
Methods: We analyzed large-scale survey data from a German PRW containing 84,680 surveys of patients rating a total of 7038 physicians on 24 service attributes and 4 overall evaluation measures.
Results: The proposed approach revealed new insights into what patients value when visiting physicians and what they take for granted. Improvements in the physicians‘ pleasantness and friendliness have increasing returns to the publicly available overall evaluation (b=1.26). The practices’ cleanliness (b=1.05) and the communication behavior of a physician during a visit (b level between .97 and 1.03) have constant returns. Indiscretion in the waiting rooms, extended waiting times, and a lack of modernity of the medical equipment (b level between .46 and .59) have the strongest diminishing returns to overall evaluation.
Conclusions: The categorization of the service attributes supports physicians in identifying potential for improvements and prioritizing resource allocation to improve the publicly available overall evaluation ratings on PRWs. Thus, the study contributes to patient-centered health care management and, furthermore, promotes the utility of PRWs through large-scale data analysis.

J Med Internet Res 2020; 22(2):e13830

How about that? If you like your doctor, you are more willing to follow provider directions on the care prescribed. In allergy & asthma, this means using your inhaler as soon as you feel shortness of breath or wheezing, not just when you’re so sick the ER is the next logical decision. Or how about using a biological that takes care of your asthma by 1-2 shots per month?

Physician-rating websites can be very helpful if you’re choosing a physician. But buyer beware, some patients have used these PRW’s to “vent” their frustration with a medical office visit that reflects more of an emotional dislike for some aspect of the visit, rather than bad medical advice. On a personal note, I try and implement “shared decision making” with every patient that I see, but sometimes, I don’t end up on the same page as what meets patient’s expectation. For instance, I can tell you that you probably have asthma, and some are not ready to hear that. My advice: just let your doctor know about your concerns and 99% of the time, your questions are answered and life is good again. I can tell you from personal experience that doctors go to school for >10+ years to make patients happy and provide the best possible outcome for any medical condition.

• So what will cause a “bad” rating on physician-rating websites? (or diminishing returns to the overall evaluation)
• Indiscretion in the waiting rooms. Unfortunately, I’ve seen this too many times when health care providers or staff talk without discretion outside of the waiting room. Doors are never sound proof and no one wants to be “that guy” that feels embarrassed at what the office staff is saying about HIM. Never once did I think I’d have to say this, but social media doesn’t help with our lack of discretion. You can say what you want and when you want to on your favorite platform, whether it’s Facebook, Twitter, or even LinkedIn. Give some respect to even those that irritate you or you don’t agree with. My favorite sign I saw recently in a medical office: “viewer discretion advised!”
• Extended waiting times will always hurt your P-RW. Nobody likes to wait, but it’s even worse if you don’t think the office or doctor cares about your time as well as theirs. From the outside looking in, it’s a challenge to get patients in when needed and at the same time, keep on schedule. I do try to apologize for making anyone wait > 15 minutes, but even that isn’t good enough at times. I understand your dilemma, and maybe that’s just a good reason to have surveys and pay attention to the results by changing schedule demands.
• Lack of a clean office environment and modern equipment/facility is also a deterrent to favorable reviews according to the above study. This one is almost a “no-brainer” but even old chairs in the waiting room and otoscopes falling off the walls, probably don’t make you feel comfortable with the level of medical expertise in your doctors’ office. Granted, the medical advice you receive may still be correct even if the upholstery is ripped in the waiting room, or the exam tables were possibly used by your grandmother; you still want to hear medical advice in a clean, modern facility. As an example, medical offices are now “open” with large nursing stations rather than the old model of small exam rooms and nursing staff hidden in obscure corners, trying to hide from patients to not be bothered; the change is somewhat like our new kitchens!

So what have I really said so far? First of all, medical surveys are becoming another part of our health care system. Like it or not, patients will be asked for their opinion about medical care they received and doctors will be paid based in part on their performance. As expected, this can create some unintended consequences that I will talk about below. One of the positive benefits from patient interaction, which definitely includes patient satisfaction surveys is better relationships with your doctor and less conflict which has to be resolved by formal intervention such as lawsuits or arbitration. The best way to prevent malpractice claims is not perfection, but rather an improved physician-patient relationship.

A Survey of Sued and Nonsued Physicians and Suing Patients
Authors:	Shapiro, Robyn S. Simpson, Deborah E. Lawrence, Steven L. Talsky, Anne Marie Sobocinski, Kathleen A. Schiedermayer, David L.
Source:	Archives of Internal Medicine; October 1989, Vol. 149 Issue: 10 p2190-2196, 7p
Publication Year:	1989
Abstract:	• To systematically assess the impact of malpractice litigation on the doctor-patient relationship and to collect data that might suggest effective tort reform, we surveyed 642 sued physicians, nonsued physicians, and suing patients in Wisconsin. Parallel forms of survey instruments obtained information regarding changes in physicians’ practices, changes in attitudes toward patients or physicians, and changes in physical and emotional well-being as a result of malpractice litigation or the threat of the same. In addition, opinions regarding causes and deterrents of malpractice litigation were obtained. Results suggested that claims or threats of malpractice suits had a negative impact on physicians’ practices and emotional well-being; that this negative impact was more pronounced when the sued physician had been more personally involved with his patient prior to the malpractice claim; and that suing patients’ and sued physicians’ understanding of their relationship before the malpractice claim significantly differed. All respondents viewed improved physician-patient communication as the most effective method of preventing malpractice claims. Informal, alternative dispute resolution mechanisms in hospitals and clinics and improved peer review may decrease litigation and its deleterious effects.(Arch Intern Med. 1989;149:2190-2196)

“As physicians, we want our patients to have not only better outcomes but also a positive experience of care,” gastroenterologist Shivan J. Mehta, MD, MBA, wrote in the AMA Journal of Medical Ethics® (@JournalofEthics). “If we care about the experience of our patients, why shouldn’t we measure it and strive to improve our performance?”

The answer is a complicated one, wrote Dr. Mehta, assistant professor of medicine at the Perelman School of Medicine at the University of Pennsylvania and director of operations at the Penn Medicine Center for Innovation.

On the one hand, patient-experience scores can help physicians think more broadly about outcomes. They can also carry huge financial stakes, such as through the incentives and public disclosures that are Centers for Medicare & Medicaid Services’ efforts to improve quality through value-based purchasing.

But patient-experience measures aren’t infallible in their collection or their application. Following are three concerns about surveys for physicians, hospital administrators and policymakers to consider. Reference: https://www.ama-assn.org/delivering-care/ethics/3-legitimate-concerns-about-patient-experience-surveys

Patients may seek low-value treatments 

Physicians often spend less time than they would like with their patients, and can feel  pressure to expedite selection and explanation of treatment plans. When confronted with low patient-satisfaction scores—or even the threat of them—some doctors may assent to requests for low-value or unnecessary treatments that patients have come to expect.

One large study even showed that high patient satisfaction was associated with higher utilization, expenditure and mortality—the very opposite of high value.

What could this possibly mean for an allergy practice? Take for instance, a patient who comes in to the office with a chief complaint of headaches and wants to be tested for food allergy. The correct answer is most food allergy (ie, anaphylaxis) doesn’t cause isolated headaches and testing for foods won’t give you any clues about which foods to suspect anyway. A satisfaction survey would “ding” you because you didn’t provide something the patient was looking for, but wasn’t medically necessary.

Gains could concentrate at the top 

It’s typical for safety-net hospitals to score lower on patient satisfaction than hospitals that provide less care to underserved populations—not surprising given the challenges of caring for sicker populations with fewer resources—so it follows that one-size-fits-all financial incentives could produce even wider disparities in care and satisfaction.

https://www.ama-assn.org/delivering-care/ethics/3-legitimate-concerns-about-patient-experience-surveys

In addition, concerns over penalties for low satisfaction scores could cause physicians to avoid caring for more challenging patients, such as poorer people and persons with mental illness.

Responses can be suspect

Patients’ expectations and perceptions may not lend themselves to technical or objective measures of quality.

Also, voluntary surveys can be long and may not be filled out immediately following consultation or recovery, producing selection and recall biases in those with experiences at the extremes, and limited sample sizes can similarly skew results. There may even be a crowding-out effect of surveys on other, more reliable quality metrics.

“Physicians can no longer choose not to participate in, but they can decide how best to engage with, incentive programs,” Dr. Mehta wrote. “Patient experience scores should also be evaluated in the context of other clinician incentives, whether productivity or quality metrics.”

https://www.ama-assn.org/delivering-care/ethics/3-legitimate-concerns-about-patient-experience-surveys

So what can we do together to improve our physician-patient relationships and avoid the dread of patient surveys?

Do unto others as you would have them do unto you–this mantra has worked in the past, and should definitely improve our task of answering those pesky surveys!