Whenever I talk about patient satisfaction, I notice a general hostility from my colleagues toward the subject. Recently, since I’ve started blogging about the patient experience, the angry opinions have become even more noticeable.

The other day, I was discussing the different comments I’ve received from my blog posts with my friend, who is also a physician. He noted that he understood the hostility because that is also how he feels. He asked me why he should have to change his practice to pander to the ridiculous whims of patients?

That got me thinking. I asked him if he thought it was OK for doctors to explain a diagnosis or treatment plan to a patient without using medical lingo? After all, how many patients can be expected to know what metabolic acidosis is? I then asked him if he thought it was fine for doctors to give patients the results of their procedure in the recovery room while they are still altered from the drugs used for sedation? I chose these two examples because they are both things I have seen providers do throughout my career as a doctor. In both instances, my friend answered no. He said, “Of course, doctors should explain things in ways patients can understand, and of course, doctors should treat patients with courtesy and respect by discussing test results when their patients are coherent.”

 

Thoughtful care vs. catering to unreasonable demands

Interesting. I didn’t tell him this, but guess what? He just advocated for providing a good patient experience. Given that most physicians feel as he does, why have we turned the conversation about the patient experience from providing thoughtful care for our patients to catering to their unreasonable demands? When I hear this, I always ask, “What is so unreasonable about wanting to understand what your doctor is saying?” and “What is so unreasonable about wanting to know your test results?” In fact, when we all eventually become patients, we will all want to know these same things.

I think the issue is that instead of focusing on what it truly means to have a good patient experience, we’ve allowed ourselves to be swayed by people who equate patient satisfaction with patient dictatorship. In reality, the two were never meant to be the same thing. I agree that we should advocate against any movement whose goal is to create a culture where the patient is always right. As physicians, we know that simply is not in the best interest of our patients. In fact, if patients truly understood how dangerous the patient is always right mantra is to their health, they would abandon it. Thus, instead of trying to discredit patient satisfaction, I would challenge us as health care professionals to return the patient experience movement back to what it was intended to be. It was never supposed to be about patients threatening doctors or making unreasonable demands. Nor was it ever intended to be about doctors prescribing unnecessary medications, tests, or treatments.

 

Patient experience is about doing what is right for patients

The patient experience movement was and still should be about showing kindness, empathy, respect, listening, explaining, and doing what’s in the best interest of our patients. As health care providers, we need to re-educate our patients, administrators, and the general public on what providing a good patient experience is truly about. The public needs to know it is not about the patient always being right. It is not about making doctors feel as if their jobs or salaries are on the line unless their satisfaction scores are always high, regardless of the possible unintended consequences. Both of these positions take away from what focusing on the patient experience is truly about—empowering doctors to work collaboratively with their patients to do what is right for the patient each and every time.

We all went into medicine to help our patients, and focusing on the patient experience does exactly that. In the end, it’s not the patient experience that’s the problem…it’s the way in which it’s often interpreted and implemented. The next time you hear your colleague mention the patient experience, instead of showering him or her with cynicism, remember what it’s truly about. When doctors are able to collaborate with patients to do what’s right for the patient, the patient experience flourishes. Who can argue with that?


First posted on Dr. Dorrah’s Corner on 08/27/2014.

68 COMMENTS

  1. Thanks a lot for this, Dr. D. It’s not so much that there aren’t patients who have “ridiculous whims”, it’s the reaction of docs like your friend who use loaded words like “pandering” to describe communication with such patients that concerns me. This is also less about “equatIng patient satisfaction with patient dictatorship” than it is about the shifting hierarchy of traditional doctor-patient relationships. Some may indeed be feeling threatened and hostile about this shift – that is, until the physician becomes the patient themselves one day. I wrote more about this in “When Patients Are Seen As The Enemy” – http://myheartsisters.org/2013/10/30/patients-as-the-enemy/

    We are not the enemy. But here’s a small example of how some doctors see patient engagement as a threat: like many women, I was misdiagnosed with GERD in mid-heart attack despite textbook MI symptoms. But before I was sent home from the ER that morning (feeling so embarrassed for having made such a fuss over nothing), the ER nurse said to me: “You’ll have to stop asking questions of the doctor. He is a very good doctor, and he does NOT like to be questioned!”

    The question I’d just asked this doc: “But what about this pain down my left arm?” I’m just guessing, but my assumption was that this ER physician had grumbled something to this nurse about that pain in the neck woman in Bed 8 who had dared to question him.

  2. I sent you a tweet but wanted to post here. The situation with 5 year old Ashya King in the UK and the challenges the parents faced illuminates the issue in your article. Here, parents were unsatisfied with doctor’s recommendations and sought different treatment. They removed their child from the care of the hospital and were met not just with hostility but an arrest! They sought Proton Beam Radiation Therapy for their child’s brain tumor, something actually completely reasonable and used in the states. Im finding this story not only fascinating and heartbreaking but to be the exact chasm where the inability of a physician’s ego to consider alternatives suggested by patients results in a patient “held hostage” by the physician and/or hospital institution.

  3. As a patient, I rage against the [Press Ganey/HCAHPS] machine, since WTF good is a survey delivered to the patient as long as 90 days post-discharge? Who even remembers?

    Plus, 99.999% of the chronic-condition folks I know who have a revolving-door relationship with hospitals have never themselves gotten surveyed.

    Experience surveys should be conducted in real-time, via mobile tech if possible. At most within 7 days post-discharge. The problem is that PG and HCAHPS have major revenue models tied to their surveys, and will fight like dogs to keep the status quo, status quo.

    Hospitals & practices can roll their own. However, that will require a bit of work on their part. They could ask some savvy patients to help ’em build it. We are legion.

  4. Working with the public in any capacity will wear you down. I know because I was flight crew for 42 years. People who mingle with other sick people become different, too. That is what I saw. Without our fine medical care in this country, we would not live as long. It’s not perfect, but it is good. I’m alive because of it.a big thank you to the doctors who put up with me,during my ordeal.

    • You’re right. Working with the public is difficult. That’s why I’m so appreciate of my colleagues who focus on physician burnout. It’s a real issue, and one that has to be addressed, because it’s impossible for burned out providers to care about improving the patient experience.

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