A simple solution — greater transparency for all

An e-mail arrived from a marketer offering to help market my medical practice.  The message talked about how the Internet can be good or bad, how doctor rating websites can negatively affect a practice, and how this marketer has solutions for how to put the Internet to better use.

I have a solution, and it’s really quite simple.  Doctors should be encouraging their patients to do online ratings.  Doctors are doing a great job for their patients.  What doctors need is transparency: We ought to encourage patients to do online ratings so that the public sees the great quality of care that doctors are providing.

On the DrScore.com rating site, the average score of a doctor with 20 or more ratings is 9.3 out of 10!  There’s no reason to want to hide that.

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If you have a disease or condition, join a patient advocacy group like the National Psoriasis Foundation

I received an email from the National Psoriasis Foundation about some of their recent accomplishments.

• $1.5 million allocated by Congress for a patient registry at the Centers for Disease Control and Prevention (CDC) — the first-ever funding approved by Congress for psoriasis.
• More than 130 senators and representatives signed on to co-sponsor the Psoriasis and Psoriatic Arthritis Research, Cure and Care Act (PPARCCA).
• Thousands of advocates came together to work for a cure through the Psoriasis Action Network.

If you or a family member have a chronic illness, consider joining a patient advocacy group.  You can learn about diseases, find out about new treatments or even help support research toward a cure.  You can find a comprehensive  list of patient advocacy groups on DrScore.com.

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Medical librarians offer reliable source of information to physicians, patients

Doctors sometimes worry about the sources of information patients use.  There’s probably one best source of medical information: your physician.  But there are other good sources, too.

I’ve touted the value of patient advocacy groups over and over again. You can find a list of them on the DrScore Web site here.

Medical librarians are another terrific source for medical information.  They have access to a world of references and could be very helpful if you are seeking an answer to a general medical question.

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The key is making sure patients know the doctor is caring

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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Leaving patients unhappy is bad medicine

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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What determines doctors’ patient satisfaction scores?

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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Here’s a Jewel

As a dermatologist, I see many patients who have psoriasis. One of the most valuable resources I can offer my psoriasis patients is the National Psoriasis Foundation, an organization of people devoted to improving the lives of people with psoriasis through education, advocacy and research.  

A National Psoriasis Foundation volunteer, 17-year old Lauren Henschel, was named one of Florida’s top youth volunteers for her work with the foundation’s Walk to Cure Psoriasis in Miami. Way to go, Lauren! This is an event that she and her family spearheaded to raise money for research and to dispel common misconceptions about psoriasis. Their local walk has helped generate more than $750,000 to support psoriasis research and education in the past four years. With young leaders like Lauren, the future is looking bright. 

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Patient Advocates

On April 28, 2010, the non-profit Patient Advocate Foundation (PAF) released their annual report documenting problems routinely confronted by patients. Some 55,000 patients contacted the PAF for information and assistance in 2009. These data are important for understanding the problems faced by people who contact a patient advocacy group. In interpreting the data, we have to be critically aware that the data may not be representative of all the many, many patients who don’t contact a patient advocacy group. 

At DrScore, we are acutely attentive to the need to get representative data on patients’ experiences. We strongly believe that open transparency helps patients and doctors, letting the public see the strong work of physicians and letting physicians learn what they most want to know: how to make medical care even better.  

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Join a Patient Advocacy Group

Patient advocacy groups are a huge help to patients. As a dermatologist who specializes in treating patients with psoriasis, I have had the opportunity to work extensively with the National Psoriasis Foundation over the past 20 years. Like so many other patient advocacy groups, the Psoriasis Foundation is a wonderful group of people dedicated to finding a cure, to educating patients, doctors and the public, and to advocating on behalf of patients.

The Foundation is creating a nationwide network of psoriasis activists. They will be organized through the National Psoriasis Foundation’s new community divisions. If you have psoriasis, I encourage you to check this out. It may be just what you are looking for. If you have some other chronic disease, there is likely to be a patient advocacy group for you, too. You can get a list of many of these at the DrScore.com website, http://www.drscore.com/advocacy/list.cfm.

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