Posts Tagged ‘DrScore research’

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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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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An AP story from January — “California to set time limit to see doctors” (http://www.newsradioword.com/pages/6151887.php?) — described how California’s Department of Managed Health Care is introducing regulations requiring HMOs to give patients appointments with family doctors within 10 business days of the request and appointments with specialists within 15 days.

This will probably introduce some staffing issues for some HMOs. And there are issues that could be discussed about whether these regulations are an appropriate role of government or if it would just be better for the market to determine the standards to which medical care providers adhere.

But what really interests me about this is how the regulators are codifying what doctors should be trying to do anyway in the name of patient satisfaction. Keeping patients waiting a long time for an appointment isn’t conducive to high levels of patient satisfaction.

The DrScore.com survey collects information on how long patients had to wait for an appointment. The longer patients have to wait for an appointment, the less happy they are. We found that patient satisfaction drops off differently for primary care doctors vs. specialists. A 10-day wait was tolerated pretty well by patients seeking specialists. Waiting that long for the primary care doctor wasn’t so well accepted by patients.

California’s regulations that set different goals for primary care doctors and specialists may make some sense. But I hope California’s regulations don’t end up being a standard that doctors strive to achieve. Based on our data, doctors — especially primary care doctors — should strive to get their patients into the office even quicker than these regulations call for.

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I created DrScore to help doctors enhance the quality of medical care. The primary way DrScore helps doctors is by giving individual doctors detailed feedback from their patients. But DrScore works to enhance care in another way, too. By aggregating patient satisfaction across all doctors, DrScore identifies trends in patient satisfaction and specific areas that are generally in need of greater attention.

The results of these studies are published in the medical literature. We’re very proud of our research team and their accomplishments. Our aggregated data also serve as a basis for our annual report card on the state of patient satisfaction in the United States. You can see the 2009 Report Card at the following link:


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