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Posts Tagged ‘patient complaints’

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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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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One of my patients gave me a great gift today, a complaint. So I got to put some of my own advice about handling patient complaints into effect.

According to my patient, he 1) expected to spend time with me, not with the resident I supervise; 2) didn’t like the way I spoke to the resident and student, rather than to the him; and 3) didn’t like the way our staff looked at the computer rather than the patients during the check in process. 

Obviously, even at my age, I still have a lot to learn.

Did the comments strike a nerve? Of course! But the fact is, I appreciate that this patient took the time to provide me with that kind of feedback. It will help me do a better job in the future. 

Will I still talk to residents and students? Yes, but I will get the patient’s permission first.  Will our staff still need to look at the computer while entering patient data? Yes, but they can offer an explanation to the patient before they do so. Will I send a personal apology/thank you note to the patient?

Absolutely, because good customer service is just as important in health care as it is in any service industry.

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Even though the direct consumer purchase transaction is not typical in a physician-patient relationship, that does not mean that service should go by the wayside. Physicians need to listen to patients’ needs and be responsive to patients’ complaints.

As a physician, I know that providing great medical care is a constant challenge. It involves long work hours, being on call, continuing medical education, and too many business and regulatory issues. Many doctors hang by a thin thread, and a patient complaint pulls hard on that thread. Unfortunately, we don’t have a service desk like Best Buy where we can direct all complaints, concerns and returns that don’t work out!  Maybe we should.

There is some wonderful advice for doctors on how to manage patient complaints in an article by a dermatologist, Joseph Eastern, M.D. I’ve adapted here: 

  • Put systems into place to prevent patients from having something to complain about. Give patients prompt, attentive, thorough care in a pleasant, friendly environment.
  • When patients do complain, don’t take it personally (even if it is). Consider the complaint a gift, something that will help you to give better care in the future.
  • Before doing anything else, contact the patient personally and ask him or her to describe what happened. Listen carefully. As you listen, remember, the patient is helping you.
  • Ask the patient how the issue could be rectified to their satisfaction. Often, it will be very easy. In fact, more often than not, by showing how much you care about the patient and listening to his or her complaint, you will have already solved much of the problem.

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