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Doctor’s Day is March 30. Here’s our latest press release for DrScore.com in recognition of the important role that doctors play in patients’ lives.

 

Patient Satisfaction: DrScore’s Three Simple Solutions for Improving Customer Service

Online physician rating website shares latest research for Doctor’s Day on March 30

WINSTON-SALEM, N.C.–(BUSINESS WIRE)–In recognition of Doctor’s Day on March 30 and the important role that physicians play in patients’ lives, DrScore.com is sharing three simple solutions to improving patient satisfaction. The tips are the result of an analysis of data from 180,000 patient satisfaction surveys on the DrScore.com online doctor rating website.

“It’s a fact: A patient’s health care experience does matter. Patient satisfaction is important in its own right, but it also improves the outcomes of a patient’s care,” said patient satisfaction expert Steve Feldman, M.D., founder of DrScore. “And at DrScore, the online ratings of patient experiences strongly suggest that there are three very important factors that contribute to patient satisfaction.”

1. Keep wait times short. DrScore’s data analysis found that 44 percent of wait times were less than 15 minutes, 34 percent were 15 to 30 minutes, 13 percent were 30 to 60 minutes, and 9 percent were greater than one hour. “There is a strong, statistically significant correlation between wait times and overall patient satisfaction,” Dr. Feldman said. He suggested the following to improve patient satisfaction in this area:

  • If wait times are consistently running longer than 30 minutes, doctors should look into their operations and find out if patients are being scheduled too close together or if there is another operational reason this is happening. “Making the goal 15 minutes or less is even better, particularly for primary care providers,” Dr. Feldman said.
  • Make the waiting room pleasant with plenty of good reading materials, coffee, etc. “Time goes by very slowly in an unpleasant waiting room,” Dr. Feldman said. “The best doctors don’t even call it a waiting room — they call it a reception area and do their best not to keep patients waiting.”

2. Spend enough time with each patient. “Patients tend to feel like 10 minutes or longer is adequate time to spend with the doctor, and the DrScore data shows that two-thirds of visits last this amount of time,” Dr. Feldman said. “We found that 23 percent of visits run five to 10 minutes, and 11 percent run less than five minutes. The statistics are clear: The longer a doctor spends with a patient, the more satisfied the patient tends to be with the visit.”

3. Make sure your demeanor is perceived as being friendly and caring. Patients need to have a sense of feeling cared for. “A caring and friendly attitude is far and away the most important variable that contributes to patient satisfaction,” Dr. Feldman said.

The DrScore researchers performed an analysis to determine the independent contributions of different variables such as age, gender, first or return visit, routine or emergent care, wait time, time with doctor and the doctor’s friendly/caring attitude. Wait time and time with doctor were statistically significant, but their contribution to overall satisfaction was small, each accounting for only about 10 percent of the variance in patient satisfaction. In contrast, the doctor’s friendly/caring attitude was the strongest contributor to patient satisfaction, accounting for more than three-fourths of the variance in patient satisfaction/doctor rating scores.

“Tips 1 and 2 don’t matter nearly as much as Tip 3,” Dr. Feldman said. “Every time, before a doctor walks into the exam room, he or she should pause and think: ‘How am I going to make this patient feel cared for today?’ And ‘how can I make sure they realize I am a friendly, caring doctor?”

About DrScore.com

Founded by Steve Feldman, M.D., DrScore.com is an interactive online survey site where patients can rate their physicians, as well as find a physician based on their service level preference. DrScore’s mission is to improve medical care by giving patients a forum for rating their physicians, and by giving doctors an affordable, objective, non-intrusive means of documenting the quality of care that they provide. For more information, visit www.drscore.com.

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While I was in Japan recently, my credit card didn’t work — most likely because I didn’t warn my credit card company that I was going to be in Japan.

When I got back to the States, I called the company to make sure the hold on my card was taken off. I spent FOREVER on the phone waiting for assistance (it must have been 30 to 40 minutes).  Then the line went dead. I called and waited again only to get  connected to a service representative who said that because their systems were down,  she couldn’t help me.

I felt like they made me waste my time. I got mad. I’m sure I didn’t sound particularly nice.

Generally, I’m a nice guy, but I’m sure this person could hear how angry I was and thought I was just  chronically unhappy.

I just wanted to get off the phone, so I didn’t give this representative who couldn’t help me much time to argue with me.  It would have been easy for her to be surly in response to my being surly, but that would have just escalated my anger.  A better approach would have been for her to  remember that the angry customer may be an entirely reasonable —  just temporarily unhappy — person.

In our doctors’ offices, it may also be hard to see that the patient who comes in unhappy — possibly because of us keeping them waiting — may not always be unhappy or angry. We should treat every patient with respect and give them the benefit of the doubt.

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I received an e-mail invitation to attend a medical-legal seminar on reducing risks. I’m not sure what they are going to cover, but clearly, the No. 1 way to reduce medical legal risks is for doctors to give patients great quality medical care. Patients also need to perceive the quality of care is great. That is why obtaining feedback from a patient satisfaction survey service like DrScore is a necessary component to assessing and assuring patient satisfaction.

Great medical care is really a partnership. Patients can reduce their risk of being in the kind of situation that results in medico-legal liability by taking more responsibility for their own care. Patients should get a copy of their medical records, particularly the results of laboratory work that is done. That will help make certain nothing falls through the cracks in a system that has shown itself to have too many cracks.

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Doctor patient communication

The Archives of Internal Medicine reports that communication between doctors and patients isn’t always what it should be.  The study of 89 hospitalized patients found:

  • Of the 73% of patients who thought there was 1 main physician, only 18% could name the physician
  • Only 67% of the physicians thought patients knew their names
  • Only 57% of patients knew their diagnosis
  • Only 21% of physicians said they always provided explanations of some kind
  • 90% of patients getting a new medication said they were never told about any side effects

The researchers concluded that steps to improve patient-physician communication should be identified and implemented.  Boy, is that an understatement!

To start, perhaps doctors could leave each patient a business card with the doctor’s name on the card.  That would help patients know their doctors’ names.  Even better, have a line on the card where the diagnosis could be written.  I’d include the doctor’s cell phone and e-mail address to help enhance communication between the doctor and the patient and their family.  And perhaps the doctor ought to have a checklist of things to do so that whenever a new prescription is given, the patient is given a written explanation about the medication, including the potential side effects to look out for.

Of course it would help for every patient to be given the opportunity to give their doctor feedback through a system like www.DrScore.com to identify these kinds of problems and solutions to them ASAP.  A “Please give me feedback at http://www.DrScore.com” would be a nice addition to that business card.

We are so invested in improving medical care, with billions and billions of dollars going to the development of new treatments that may someday help someone.  Just a little common sense and some inexpensive solutions could be done right now to enhance the care that most patients receive.

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The AMA and 47 state medical societies authored a letter to insurers about the unreliability of “claims-based” doctor ratings. Claims-based studies use the billing information doctors send to insurers to assess the quality of the care that is delivered. The AMA letter cited studies by the RAND Corporation showing the limitations of these studies.

The AMA hasn’t offered a better way to assess the quality of care doctors provide. Measuring the quality of medical services that doctors provide is extremely complicated, especially because we want doctors to tailor treatments to each patients’ specific needs, preferences and desires.

One aspect of medical care that may be most easily measured is patient satisfaction. This is what we measure and report at DrScore.com.

Patients always know how satisfied they were with their experiences, and there’s growing recognition of the value of patient satisfaction measurement. Government reimbursement programs covering health care may soon require patient satisfaction measurement. The medical boards that certify physicians may require doctors to document and report results of patient satisfaction surveys, too.

This is good news for doctors. Doctors give patients great medical care, and open reporting of that quality is bound to help the public see what a good job physicians are doing.

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Avandia, a medicine used to treat diabetes, has been the subject of news and controversy. Concerns have been raised about the drug potentially causing an increased risk of heart attacks compared to other treatment options. An FDA panel reviewed the evidence and voted 20-12 to keep Avandia on the market.

The controversy around Avandia is complicated. Concerns were expressed that the manufacturer may have downplayed or hidden evidence of problems with the drug. But so far, a detailed examination of the evidence didn’t lead the FDA panel to call for sales of the drug to stop.

In some of the latest news about the controversy, a couple of members of the FDA panel that reviewed the drug were found to have been paid in the past for services to the company that makes Avandia or by the company that makes the competing product (Wall Street Journal). I doubt this affected the panel deliberations or decision in any substantive way.

The bottom line is that understanding the safety of drug products is really quite difficult. In the case of Avandia, it’s easy (well, at least relatively easy) to show that the drug helps patients control their sugar level. It’s much harder to know if there’s a small increased risk of heart attacks or how big that small increased risk is. If you are taking Avandia, the best course is probably to speak to your doctor about it.

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On June 29, 2010, the New York Times published an article by Jennifer Schultz entitled Punishing Doctors Who Make You Wait, an article which begins by claiming: “There’s nothing worse than showing up on time for a doctor’s appointment and then having to wait because the physician is running late.”  According to our research at DrScore, that simply isn’t true.

Data from the patient satisfaction surveys collected at DrScore.com tell a different story.  While it is true that keeping patients waiting lowers patient satisfaction, it is only by a very modest degree.  Much more important in determining satisfaction  is whether the patient saw a friendly, caring doctor. When it comes to patient satisfaction, there’s nothing worse than seeing a doctor who you don’t think is friendly and caring.

Of course it is a bad idea to keep patients waiting.  But if patients are kept waiting because a doctor cares so much that he is giving each and every patient all the attention those patients need and deserve, patients are generally very understanding.

Schultz’s article goes on to suggest asking the doctor for a discount if the patient has had a long wait.  I’m not so sure that’s a good idea.  I’m willing to wait for my doctor if she’s busy with another patient who unexpectedly needed more time, because I know my doctor would spend more time with me if I were the one who needed more time.  That’s all the compensation I need.


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Analyses of the patient satisfaction ratings on DrScore.com shows an extraordinary relationship between how caring the patient thinks the doctor is and how satisfied the patient is with the visit. How caring the patient thinks the doctor is accounts for nearly all the variation in doctors’ patient satisfactions scores far more often than other factors such as how long the patient waits in the waiting room or even how much time the doctor spends with the patient.

Notice I didn’t say there was an extraordinary relationship between how caring the doctor is and how satisfied the patient is. What matters is how caring the patient thinks the doctor is. That doesn’t mean the doctor doesn’t have to be caring. But in addition to being caring, doctors need to make sure patients know the doctor is caring.

I’ve yet to personally know a doctor who wasn’t caring. But doctors don’t always appear caring. I’m a test tube scientist, a nerd who isn’t naturally touchy feely, comfortable with hugging or interpersonally warm. While I care deeply about my patients, it might not always be obvious. Many doctors are probably like this, working incredibly hard to make sure they give patients great care, but not automatically appearing caring to all their patients.

Leaving just a few patients unsure about whether the doctor cares or not can ruin a doctor’s overall patient satisfaction score (at least compared to other doctors). As I mentioned in a recent blog, getting just a few 0s or 1s from patients can lower a doctor from having a score among the highest doctors (say a 9.8 or 9.9) to a score among the bottom half of doctors (say a 9.1 or 9.0).

Giving every patient the right diagnosis and the best treatment isn’t enough. It is absolutely critical that patients know the doctor is caring. Great medical care isn’t just about the right diagnosis and the right treatment. Touching patients, eye contact, body language — it’s all important.

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In my last blog, I pointed out that doctors’ overall patient satisfaction scores are very dependent on how often patients are completely dissatisfied. Even if there are only a few highly dissatisfied patients, it can lower a doctor’s patient satisfaction score considerably. And that’s the least of the problems with unhappy patients.

Leaving patients feeling uncared for and dissatisfied increases doctors’ risk of being sued for malpractice. These unhappy patients may also share their poor experiences with their friends, hurting the doctor’s (and all doctors’) reputation.

Worse yet, these dissatisfied patients are at risk for having poor outcomes. Poor outcomes leave patients angry and disappointed, and leaving patients angry and disappointed results in patients having poor outcomes. I think this is probably because these patients are less likely to use their medications. Since our goal as physicians is to get patients well, we also need to make sure our patients are satisfied with their care.

But the biggest problem of all with having unhappy patients is: having unhappy patients. We didn’t spend all those years in training because we don’t care about our patients. We care deeply about them. If they aren’t happy, neither are we.

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While the media or the general public may not recognize it, doctors tend to have very high patient satisfaction scores. Sure, there is variation among physicians, but isn’t that some doctors get ones and twos and other doctors get 8 and 10s. Nearly all doctors get very high scores from their patients, most getting an average of nine out of 10 or higher.

When you look at the data on DrScore or other reputable patient satisfaction surveys, you see that most patients who rate their visit with their physician give the physician a 10, and the next most likely score is a 9. But doctors’ overall scores are not determined by the number of 9s vs. 10s.

What generally determines a doctor’s overall score is how many patients give the doctor a really low score, a 0, 1 or 2. A doctor who gets a 10 from 9 patients and a 0 from 1 patient will have an overall score of 9.0. If the doctor gets a 10 from 19 patients and a 0 from 1 patient, the doctor’s overall score will be a 9.5. If a doctor manages to get 10s from 49 patients and a 0 from 1 patient, the overall score is 9.8.

The key to having extraordinarily high scores is to not have any very unhappy patients. Some people think there will always be unhappy patients. I’m not so sure. If we doctors do our jobs right, we’ll make sure patients know we care about them, and we won’t have patients leave our offices totally dissatisfied with us.

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