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

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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 Graph

The 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

6 Comments

  1. Judith A Bond says:

    This is a fascinating article. I could not agree more with it. Based on my personal experience and my family’s experience I am CERTAIN that current patient satisfaction surveys are not measuring the right things if they are to improve communication or quality of care and experience.

  2. I agree the HCAHPS scores for CMS don’t jive with other evaluations. But, this is a moving target. And there is hope for improvement. Most surgeries are now done as an outpatient. The hospitalist movement is sweeping the country. And, hospitals seem to have taken some interest since there are financial penalities associated with the CMS survey. There is a lot of survey bias since the hospitals actually send out the HCAHPS surveys (they are not looking for bad results!). Anybody out there been in the hospital recently? How was the communication? Did you get a survey?

  3. Betsey Shapiro says:

    I must be one of the few patients who refuses to “begrudingly put up with poor service.” I spent this afternoon waiting for a pre-op appointment with a surgeon who finally saw me an HOUR late. I was flat-out lied to by the front desk staff at check-in, when I asked how late he was running. They told me ten minutes, it was 58. When I asked when I would be seen, I was told “you’re next.” Eight more patients were called in before I was seen. The staff and the doctor were surprised that I called them out on their lying. I know have NO confidence in this doctor’s skill as a surgeon because of the fact that his staff lied to me, and am contemplating cancelling the surgery. If they’ll lie to me about the doctor’s schedule, they’ll have not problem lying to me about other things.

    • Hopefully, you told the surgeon of your problem with the patient flow in the office. It is unlikely the surgeon gets reports on waiting times for his paitents. Sometimes surgeons operate just fine but leave the office operation to someone with little knowledge of real-world scheduling. Suggest looking at http://www.healthgrades.com to find out about surgical quality. Ask your friends about the office efficiency! Larger surgical offices seem to do a better job than the one or two doctor offices.

      • Betsey Shapiro says:

        Thanks for the response. This is a very large practice, and I did let him know how unhappy I was.. Unfortunately, the surgery wait time was longer – 3 1/2 hours waiting in a shower cap, gown and booties till it was my turn. To top it all off, I had a life threatening reaction to the anesthesia/opiates/anti-nausea meds, and a few days later ended up in the ER not once, but twice before the problem was found. Lucky to be alive, At my post-op appointment yesterday, he said “Jeez, you can’t catch a break, can you?” and refused to put a copy of my ER discharge summary in my file. He just gave me one more reason to despise doctors.

  4. Grant Taylor says:

    Great article, Stephen. Satisfaction surveying is IMO one of the more unhelpful pieces of business/managerialism/marketing to enter healthcare. I am no fan of satisfaction surveying in most contexts, given the lack of clarity around the construct of ‘satisfaction’ and the many challenges to measurement validity. But in healthcare these surveys are potentially very destructive to the relationship between patients and healthcare workers and between healthcare workers and their funders (where these are not the patients themselves). I’m all for measurement when we know how and what to measure but we need to be constantly mindful that bad data can be worse than no data at all and that numbers can be easy to produce but don’t necessarily mean anything.

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