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Patients Set to Unleash Feedback on Doctors

 |  By cclark@healthleadersmedia.com  
   March 15, 2012

A friend's bad patient experience during the doctor's office visit got a tongue lashing on Facebook this week with comments that followed this status update:

"Why do doctors think their time is more valuable than yours?" she asked.

"I spent 90 minutes, essentially, to [see the doctor to] get a refill for my Rx. I waited a full hour before she came in, which to me is simply inexcusable," she said. "The only good thing was that she was very patient and thorough, although she seemed to have no recollection of my previous visits...If they don't know how much we resent being treated like this, they should."

She might as well have poked a tiger in the remarks that followed from others with humiliating experiences.

"I waited half an hour this morning while my doctor was schmoozed by some pharmaceutic[al] floozie. Very irritating," one person wrote.  They think they get to act that way because of "what we pay them," answered another.

The angry, "We-shouldn't-have-to-take-this-anymore" thread, which was much longer than I can display here, got me thinking. It reminded me that we soon will enter an era of formalized surveys that finally give patients a chance to talk back to their doctors en masse, to say how they really feel about the quality of their office visit experience

Doctors should brace for an earful about scheduling difficulties, hour-long waits, perceived disrespectful attitudes, and unreturned phone calls.

I know doctors think these aspects of the care process are, in the big scheme of things, minor annoyances that have nothing to do with their skills in diagnosis and treatment.

But perceived mistreatment by physicians and their staffs may have an enormous indirect, much more subtle, impact on patient compliance, and ultimately on quality and outcomes.

And that's why value-based purchasing "satisfaction" scorecards for primary care docs as well as specialists are just around the corner. Soon they'll be posted on some state health department websites, or on Physician Compare.

Patients across the country will get a formal chance to tell their doctors what they think about their patient experience, and some already do for physician care in hospital settings, through a patient survey modeled after HCAHPS (Medicare's Hospital Consumer Assessment of Healthcare Providers and Systems).  It's called the Clinician and Group Consumer Assessment of Health Providers and Systems, or CGCAHPS, questionnaire.

And I don't think doctors are at all prepared for this. They'll no longer be able to brush away a bad review as just another outlier on Yelp. In time, there will be a real cost associated with bad reviews. "Many physicians have no idea what CGCAHPS is, and that value-based purchasing is coming soon for them," says Patricia Riskind, senior vice president of medical services for Press Ganey, which administers these surveys for its medical group clients, and soon for health departments in at least two states. "And it probably will be a little shocking, at least initially."

Versions of the survey are now being sent to patients of about 100,000 "early starter" physicians nationally, whose medical groups, such as one regional Kaiser Permanente Medical Group, apparently are eager to know what patients think, Riskind says.

Under Medicaid waivers, such surveys will go out first in California beginning April 1 to patients who receive care from doctors affiliated with 27 public hospitals. Minnesota is poised to follow starting September 1, with surveys for patients seen at clinics with at least 715 patients in a three-month period. California intends to post doctor scores by name on a public web page. Minnesota will publicly post scores by clinic only.

The survey poses such questions as:

"During your most recent visit, did this provider listen carefully to you?"

"In the last 12 months, when you phoned this provider's office to get an appointment for care you needed right away, how often did you get an appointment as soon as you needed?"   

"During your most recent visit, were clerks and receptionists at this provider's office as helpful as you thought they should be?

Certainly this is will be a wake-up call for many practitioners who didn't think they had to care about such issues, as long as their diagnoses, prescriptions, and referrals were medically justified.

"There is a deep sickness in the way care is delivered in many practices, and the source of this sickness is that consumers are not just free to change merchants because of crappy service," says e-Patient Dave deBronkart, a patient advocate, who after surviving stage 4 cancer decided to work toward improving care from the patient's perspective.

"Supposedly, as the reform legislation roles out, it will get easier, especially if it's easier to take records with you," deBronkart says. Some healthcare systems like the Cleveland Clinic are now offering same-day consults in any specialty, an expanding trend that will allow patients more opportunities to "vote with their feet."

The angry Facebook thread also made me wonder whether the satisfaction or frustration these patients will relate, in larger patient populations, might somehow translate to their outcomes of care.  Does a good patient experience encompassing engagement with the physician, courtesy by the receptionist and maybe even parking validation, mean the patient will get better faster, avoid hospitalization?

And conversely, might a long wait or perceived slight signal disrespect that the patient absorbs and perhaps in some subtle, indirect way translates to a poorer health outcome?

"Your instincts are on target," says Gordon Moore, MD, a family practitioner and fellow with the Institute for Healthcare Improvement who specializes in care measurement, patient experience, staff satisfaction, and their relationships to outcomes and cost.

"It's not overwhelming, as in lots and lots of evidence that's been repeated, but there's enough that I can say with confidence there's a good correlation between experience in the practice and outcomes," he says.

Research into the reasons why patients failed to follow up with appointments shows one negative impact of a patient's poor experience with a doctor. One response that came out was the physician's failure to show the patient respect.

"When you parse out 'respect,' with these individuals, it turned out that it masked things like, 'You kept me waiting around,' 'You didn't listen to me,' 'You treated me rudely,' " Moore says.

Likewise, Moore says there is a lot more scientific evidence that points to the inverse, that patients who have good experiences with their visits and perceive that their doctors treat them with respect are more likely to stick to recommended treatment plans.

A colleague conveyed a comment made by a physician at last week’s American Medical Group Association National Conference in San Diego, “If your patients are non-compliant, then it’s your fault [as the doctor]. You didn’t convince them.” And how can you ‘convince’ your patients if they don’t feel you respect them?

So to patients who think they deserve faster responses, shorter waits and yes, more respect from their doctors and practice staff, I say just wait a bit longer. You'll soon have your chance to tell them in a format that will command them to pay attention.

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