Wednesday, August 27, 2014

Why is there so much hostility toward the patient experience?

by Dr. Trina E. Dorrah

Whenever I talk about the patient experience, 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.

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?” “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 the patient experience 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 the patient experience, 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.

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 reeducate 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 survey 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?

Dr. Trina E. Dorrah (@drtrinadorrah) is an internal medicine physician/hospitalist and the author of Physician's Guide to Surviving CGCAHPS & HCAHPS. She can be reached through www.drtrinadorrah.com.



Saturday, August 23, 2014

What one of my favorite restaurants taught me about patient satisfaction
by Dr. Trina E. Dorrah

A few weeks ago, my husband and I took my parents to dinner at one of my favorite restaurants. I was excited to go because the food is excellent and the customer service is top notch. In the past, I’d always had a great experience…until then.

That night, the restaurant was packed as they were offering ½ priced desserts. My husband and I arrived first. I noticed when we ordered our appetizer that our waiter seemed to be in a hurry, but I didn’t think much of it. However, when he came back to take my parents’ order, they hesitated. As they took a moment to glance back at the menu, the waiter said, “Are you ready to order or not? I’ve got 4 other tables so I don’t have time to wait.” I was stunned. I remember thinking, “I can’t believe he just said that,” followed by, “He obviously doesn’t care if he gets a good tip.”

Fortunately, his attitude improved throughout the rest of our dinner. He did his job, and although I would never say he was friendly, he was competent. When it came time to pay the bill, my husband and I left an acceptable tip (he worked hard so we did not want to shortchange him). However, it wasn’t the 20+% that we normally give. This got me thinking. What did this experience teach me about patient satisfaction, and what did I learn that I can share with you?

1. Patients come to us expecting to have a great experience

One reason providers distrust patient satisfaction is because they feel their patients are determined to find something to complain about. Although this may be true for a few patients, most patients enter our healthcare system expecting to have a great experience. They have had positive healthcare experiences in the past, so they see no reason why this interaction would be different. This is also how I felt. Based on my past experiences, I arrived at the restaurant expecting to have a great time. Unfortunately, my waiter’s actions changed my perception. Instead of confirming what I felt was true, his attitude forced me to reevaluate my opinion of the restaurant. In this same way, our patients come to us believing that they will have a positive experience. Through our actions, we have the power to either confirm or destroy this belief.

2. We do have control over how our patients view us

Another reason providers distrust patient satisfaction is because they do not feel it is within their control. I have heard many providers express the belief that patients judge them based on preconceived notions that the provider is powerless to change. Again, this may be true for a few patients, but most patients are more open-minded than this. In general, patients formulate their opinions of doctors in that moment, so we definitely have the ability to impact their views. When I walked into the restaurant, I fully expected to tip my waiter my usual amount of 20+%. However, my waiter’s negative attitude immediately changed my opinion of him. Prior to his comments, I had no problem with him. However, his words and attitude directly changed my opinion of him.  When it came time to pay the bill and evaluate his work, his tip was negatively affected.

3. Attitude is as important as competence

One final reason providers distrust patient satisfaction is because it asks us to concentrate on something besides clinical expertise. Patient satisfaction asks us to focus on how our patients feel and what they think. This is burdensome in the midst of a busy day. To be honest, I think that’s how my waiter felt. It was extremely busy and he was simply trying to make it through the day. Providing a pleasant customer experience was not his top priority. It was, however, one of mine. Don’t get me wrong…I definitely appreciate the fact that the restaurant was clean, my food was cooked properly, and that I never developed food poisoning. However, when you think about it, those are basic expectations that every restaurant should meet. That’s how our patients feel about us. They expect all physicians to be knowledgeable and skilled, and they take this as a given. Instead, patients choose doctors based on things such as if we listen to them, spend enough time with them, and communicate in ways they can understand. These are all characteristics that patients care about. They are the fundamental principles of patient satisfaction.

In the end, I still love that restaurant and I would definitely go back again. However, if I end up having the same waiter, I hope he’s having a better day. If not, maybe I’ll slip him my card. I’m always happy to share a few customer service tips.

Dr. Trina E. Dorrah is an internal medicine physician/hospitalist and the author of Physician’s Guide to Surviving CGCAHPS & HCAHPS. She can be reached through www.drtrinadorrah.com. Follow her on Twitter: @drtrinadorrah


Monday, August 4, 2014

“Doc, can I ask you one more thing?”


These words are classic symptoms for those patients suffering from the “One More Thing” syndrome. We’ve all been there. The visit has ended, your hand is on the doorknob, and you’re about to leave the room. Precisely at that moment, your patient stops you and says he has “one more thing” to discuss. You think to yourself, No! I almost made it out of the room on time! You now have a decision to make. Do you tell your patient he is out of time and will have to wait until your next visit? Do you sit down again knowing you are already running late? It feels like a no win situation. If you end the visit without acknowledging the additional concern, your patient will be upset. If you run too late, your next patient will be frustrated by the wait. You begin to wonder if it is truly possible to maintain a good patient experience despite a schedule filled with patients suffering from the “one more thing” syndrome. Absolutely!

We all know the patient experience is a hot topic within healthcare for both inpatient and outpatient providers. Like me, you’ve probably been asked by your employer to create definitive ways to improve your patients’ experience. What can you do? The following tips show you things you can do RIGHT NOW, so the next time your patient says, Doc, can I ask you one more thing?, you can definitively say, Yes.

Tips to maintaining a great patient experience even when patients have
“one more thing” to discuss.

1.    Be proactive
One way to discourage patients from saving important topics until the end is to ask them what they want to discuss before the visit begins. There are several ways to do this. You can ask your nurse or medical assistant to gather this information for you when they register or room the patient. You can ask your staff to give all patients a Patient Agenda Form. This form asks patients to prioritize and record exactly what they want to discuss during the visit. It can be downloaded for free here: www.drtrinadorrah.com. Finally, most patients have a smartphone, so encourage them to use it to keep track of their questions and concerns.

2.    Stand
Throughout our training, we are taught that sitting increases our patients’ perception of time spent with them. I completely agree. However, when trying to combat the “one more thing” syndrome, I advocate for standing. The reality is that doctors simply do not have time to spend another 15-30 minutes in the room. Unless it truly requires extended time, I recommend you address your patient’s additional concern while standing. Your patient is still happy that you addressed their concern, but standing acts as a visual reminder that the visit is over.

3.    Address at least one additional concern
If your patient has several additional concerns, you will have to use your medical judgment to prioritize. Explain why you chose that particular concern as the priority so your patient understands your rationale. Other times, your patient only has one additional complaint, but the differential is huge. Take ‘fatigue’ as an example. Multiple things cause fatigue, but you can quickly order a couple of tests to begin the workup. Ordering a CBC or TSH only takes an extra minute, but your patient will feel like you cared.

4.    Follow the leader
     Signal to your patients that the visit is over by inviting them to follow you out of the room. Offer to walk them to the lab or checkout desk. If your nurse needs to enter the room after you, let your patient know that you need to find your nurse to proceed to the next step of their visit. These strategies still allow you to leave the room, but it sends a message to the patient that you care about them and are still working on their behalf even after you step out.

Dr. Trina Dorrah is an internal medicine physician/hospitalist who is passionate about helping providers improve their patients' experience. She is the author of Physician’s Guide to Surviving CGCAHPS & HCAHPS.