Page 6 - Mecklenburg_Medicine_May-2018

President’s Letter
Patient Satisfaction:
Is the ‘Customer’ Always Right?
ABy Scott L. Furney, MD
few days ago, a patient angrily expressed his
dissatisfaction with the coordination of his care. His angry
words still linger in my ears. The issue was that it took
too long to complete a referral and have him seen by a
specialist. There is some truth in what he was saying, of course. We have
a responsibility to ensure the processes and outcomes of referrals are
successful, even when we do not have them in our direct view and control.
With my training in quality improvement, I can see the steps that need
to be examined and the improvements to be made — but that is not the
point of this letter.
Patient satisfaction now is a fact of life for most physicians due to
insurer mandates, and it is not without significant risk. When patients rate giving in to the unnecessary antibiotic, tests and other demands they
their medical care — directly impacting compensation— physicians and
ACP’s will pay close attention. In theory, that is a good thing. It also can are on board with us, and engaged by our communication skills and
induce the risk of perverse incentive, in which patients’ desires for their
care outweigh the best judgment of the physician.
About a year ago, I saw one of my partner’s patients with a simple
upper respiratory infection. I concluded it likely was viral and that
symptomatic treatment, not antibiotics, was the best pathway. The patient
clearly disagreed! “Do you mean to say I came in here for nothing?!” she
exclaimed. I calmly replied that she came in for my expert assessment
and advice on how to feel better quickly. She begrudgingly agreed, and I
proceeded to take time to write out the over-the-counter medications she
should find and instructions on how to use them for her symptoms. In
these few minutes, I found something that could mitigate the risks of our
worries about patient ratings of our care.
If you are not convinced that patient satisfaction is a potentially risky
thing to measure high-quality medical care, consider this. A national
study of patient satisfaction published in the Archives of Internal
Medicine in 2012 noted higher patient satisfaction was associated with:
• 8 percent lower risk of ER visits.
• 12 percent higher risk of inpatient admission.
• 9 percent increased prescription drug and overall expenditures.
• 26 percent increased mortality.
While correlation does not prove causation, these results should give
us pause on how we make our patients satisfied with their care. More is
not always better, which is my interpretation of this study.
Of the domains rated by patients in surveys, the one I choose to
focus on for this letter is communication skills. We may be excellent
diagnosticians and have elegant treatment plans, but if patients do not
understand, they are unlikely to follow our advice. Of the many factors
proven to improve communication ratings, the most successful are
addressing patient agendas and basic communication techniques. The
simple things often are overlooked. Introductions occur 50 percent of
the time, eye contact 75 percent, and sitting down for discussion (not at
the computer to document with your back to the patient!) is as low as 10
percent. One author commented, “When I sit down, patients sometimes
get alarmed, thinking something is seriously wrong with them.” If the
6 | May 2018 • Mecklenburg Medicine
basics are uncommon in practice, they are a good place to start.
Back to my current conundrum. I am trying to take what I learned
from the good recovery of patient satisfaction with the URI patient
and similarly recover some of the momentum with the patient who is
concerned about the referral process. Without blaming him, I reminded
him I do care about his symptoms and the rapidity of the evaluation, but
I cannot act on information I am not aware of. I asked him to notify me
when there are delays, so I can act on them in a timely fashion. Engaging
him in partnership and reminding him that we are a team seemed to
mitigate some of the frustration.
The fine line we walk is how to keep our patients satisfied while not
might believe are needed. Walking the fine line is easier if patients
empathy. We do not have to compromise our principles to have happy
patients, but it will take time and skill to communicate.
In humble service,
CHARLOTTE AHEC COURSE OFFERINGS
Charlotte AHEC is part of the N.C. Area Health Education Centers
(AHEC) Program and Carolinas HealthCare System.
MAY 2018
Continuing Medical Education (CME)
5/3 Francis Robicsek Symposium
5/15 Hello: Making Tough Conversations Easier
Online Protecting Your Patients From Air Pollution
Online Risk Management: Patient Identification
Online Social Media: Risks and Benefits for Physicians
Online Prevention and Management of Concussion/Mild Traumatic Brain Injury
Online Motor Vehicle Crash Victims
Online MTAC Trauma Modules
Online Get the 4-1-1: Everything Primary Care Providers Should Know About
Parent Training in Behavior Therapy While Working With Families With
Online Young Children With ADHD
Electronic Medical Record on Trial (Risk Management)
For more information or to register for these courses, call 704-512-6523
or visit www.charlotteahec.org.