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Posts Tagged ‘Steve Feldman’

American Medical News reports that patients would pay their medical bills more quickly using the Internet (Dolan PL, Patients say they would pay more quickly with online access).  This isn’t surprising to us at DrScore.  Facility with the Internet is rapidly becoming ubiquitous.  Patients recognize the potential of the Internet to facilitate all kinds of transactions.

At DrScore, we’ve recognized for years that the Internet can also be used to facilitate getting feedback from patients.  By sending patients a link to DrScore with the bill, physicians can seek feedback from every patient, letting each patient know their opinions are respected, getting the kind of detailed feedback doctors need in order to know how well they are doing and what they can do even better.

Just as online access can ease billing issues, the hassles, costs and limitations of paper-based or telephone-based patient satisfaction surveys can now be avoided.

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What’s right and what’s wrong with the U.S. health care system? Does it need a major overhaul or a few tweaks?

In a two part episode, I discuss the cost of the U.S. health care system with Dr. Robert Berenson, a health care policy expert who has served as a practicing physician, the manager of a large health plan and in senior government positions, including being in charge of Medicare payment policy and private health plan contracting in the Centers for Medicare and Medicaid Services.

Dr. Berenson describes how incentives need to change to get control of our medical costs.  You can hear both of these episodes and others on my online podcast radio program, Getting Better Health Care.

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A title like “Computer bests humans in skin infection diagnosis,” is sure to get my attention.

Can computers beat doctors in actually providing medical care?  A recent study was reported as showing that “a computer program diagnosed a serious skin infection more accurately based on symptoms than emergency room physicians.”

Cellulitis is a deep skin infection that may be erroneously diagnosed in patients who have allergic or irritation reactions in their skin.  Investigators from Rochester, N.Y., and Los Angeles, Calif., evaluated  patients who were hospitalized for cellulitis by emergency room physicians. Dermatologists and infectious disease specialists found that 28 percent of the patients had been misdiagnosed and did not have cellulitis.  The admitting senior residents were asked to make a list of the possible diagnoses of these patients and to input characteristics of the patients’ conditions into a computer program that provided a computer generated list of possible diagnoses.  The investigators found that the computer listed the true diagnosis more often than did the resident physician.

The study does provide some evidence that a computer program may help some non-specialist physicians come up with a more comprehensive list of possible diagnoses than they would on their own.  The authors of the study concluded that the technology “has the potential to direct providers to more accurate diagnoses.”  They didn’t mention that having longer lists of possible diagnoses means that the technology also has the potential to direct providers to more inaccurate diagnoses, too, and that doing so could result in needless testing.

This study relied upon the expert skills of human physicians to make the gold standard judgments about whether patients had cellulitis or not.  While the computer program could help clue some doctors in to possible diagnoses they may not have considered (both accurate and inaccurate possible diagnoses), patients ultimately still depend on the good judgment of their physicians.

At DrScore, we’re excited about using digital technologies to improve medical care.  Giving doctors feedback from patients and making medical care quality more transparent are surefire ways to enhance care. But computers are not beating, besting or replacing doctors just yet.

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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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We are living in the Internet Age.

A 2011 report from the Sesame Workshop and the Joan Ganz Cooney Center, entitled Always Connected: The new digital media habits of young children, examined the media that are available to and used by children.  The report finds that 60 to 80 percent of households with children have Internet access.  Moreover, even among young children ages 5 to 9 years old, some 50 to 60 percent of children are using the Internet!

It wasn’t that long ago that the idea that patients could rate their medical experiences and publicly share those ratings  seemed to be impossibly difficult and impractical. That idea seems antiquated today.  The ability of a doctor rating website to provide greater transparency of medical quality, to provide representative sampling, and to empower patients to give their doctors feedback depends on patients having Internet access. And that access continues to grow.

Use of the Internet is rapidly becoming ubiquitous.  DrScore.com is proud to be one of the many organizations to take advantage of this opportunity to improve communication and make the previously unimaginable a normal part of our lives.

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One of the benefits of online doctor rating — a benefit to patients and doctors — is a transparency of medical care quality that will help people identify the bad doctors, the uncaring ones, the ones who, according to some patients, you wouldn’t send your dog to. Patients aren’t the only ones who know about these doctors.  Doctors know about them too. They have seen patients who were seen by these colleagues, and all of those patients were unhappy with the care they received.

I know that online doctor rating isn’t going to find many such doctors.  In fact, quite the opposite, online rating of physicians is going to show there aren’t nearly so many “bad doctors” out there as people think there are. Let me explain.

I’m a practicing dermatologist.  I see patients who have seen another dermatologist in town, maybe a dozen or so of that doctor’s patients.  Every one of those patients was unhappy with the care they received, and none of those patients received treatment that cured their condition.

Now that’s clear evidence the other dermatologist didn’t know what they were doing, right?

No, not right.  You see, every time that other dermatologist clears up his or her patient’s rash and gives his or her patient a medical care experience the patient is happy with, that patient continues seeing the other dermatologist and doesn’t come see me.  I  see that doctor’s outliers, the occasional patient who, for whatever reason, didn’t get better or who was unhappy.  I’m sure that the other dermatologist sees a few of my former patients too, only the ones whom I didn’t cure, only the ones who were unhappy with me.  Our observations give us a misleading picture of other people.

Well what about those doctors whose patients post comments like, “I wouldn’t send my dog to that doctor?”  That kind of comment does happen, and, sadly, I’m sure that’s the true opinion of the patient who makes that comment.  But those comments are generally not anywhere close to representative of what the vast majority of that doctor’s patients think.  I get comments like that at times (thankfully less often than I used to, having learned from patient satisfaction feedback what I was doing wrong).  I’ve been rated over 500 times on DrScore.com.  The average of those scores is 9.1 out of 10 (not bad, according to my mom).  Still, occasional patients give me a 0 or a 1 for their experience.  I know they may think everyone gives me a 0 or 1, that I’m a “bad doctor,” but the great majority of my patients think I’m a 9 or 10.  So far, that’s true for all the doctors with just 10 or more ratings on DrScore.

There may be “bad doctors” out there, but I suspect they are incredibly rare.  There weren’t any in my medical school class, and I have yet to meet one in person.  If there are any, I hope we do smoke them out with online ratings.  If they exist, maybe the online scrutiny will wake them up to the need to improve the quality of care they offer.

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Researchers from the Dartmouth Institute for Health Policy and Clinical Practice and the Centers for Medicare and Medicaid Services have found that beneficiaries of Medicare who live in areas with a “larger supply of doctors” are not any more likely to be satisfied with the physician care they receive or the time they spend with their doctors than Medicare recipients who live in regions with smaller pools of physicians. Additionally, the study “found no significant differences in access to specialists or availability of tests.

This isn’t surprising.  At DrScore, we’ve found that seeing a caring, friendly doctor is the critical factor in patient satisfaction.  Having more doctors won’t make patients happier, but having more empathetic doctors who show how much they care about their patients does.

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Joe and Terry Graedon interviewed me about my book Compartments on the People’s Pharmacy: Compartments and Communication.

Our interview was about how misperceptions can lead to communication difficulties that interfere with good health care. When people are operating within their own area of expertise, they may find it hard to understand what the big picture looks like from another person’s perspective. Whether the differences lie between doctor and patient or between different health care providers, the results can be unfair judgments and missed opportunities.

This  attitude can affect the way doctors interpret the results of placebo-controlled trials and how they feel about home remedies. We also discussed the pros and cons of e-mail communication between doctors and patients, and how to choose a good doctor.

Listen here and let me know what you think.

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One of the big efforts to improve the quality of medical care in the United States is the implementation of electronic health records. By putting our medical charts into electronic media, doctors will have more uniform access to our health histories, can be given ticklers for important screening tests, and can be told of potential drug interactions with medicines that were prescribed by other doctors, along with many other potential benefits. You can learn more about the advantages [and disadvantages] of electronic health records on my Getting Better Health Care radio program: “Will the electronic medical record revolutionize health care?.

These benefits may help improve patient satisfaction, too.

However, electronic health records have the potential to negatively impact patients’ medical experiences.  DrScore.com research has shown that the No. 1 factor that drives patients’ satisfaction with their doctors is the patient knowing he or she is seeing a friendly, caring doctor.  If patients find their doctors buried in a computer screen, punching buttons and typing, it could take away from the sense that the doctor is providing the patient personal attention.

There are some things doctors can do to manage the situation.

  • First, don’t put the computer on one side of the doctor’s chair and the patient on the other.  If you do place things that way, the doctor has to  turn their back to the patient to see the chart, and that is simply not good for patients’ impressions of their doctor.  I know, because that’s how things are arranged in my new office!
  • The other thing that doctors can do, especially if their office is like mine, is to acknowledge the problem to the patient. Tell the patient, “These new electronic health records are helpful in so many ways, but one thing I don’t like about them is that I have to turn my back to you to look at your chart.  I hope you will understand and don’t mind.”  Comments like these let patients clearly know that they are being seen by a physician that cares about them and about their feelings.  Letting patients in on one of these little secrets about medical office functioning also lets them feel like they are a part of the process. And they are part of the process — they are the very center of it.

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A very nice blog post described the difficulty in getting some doctors to recognize the importance of measuring patients’ satisfaction.  The blog post differentiated patient satisfaction from “clinical quality.”

While the blog post was right on the mark in many ways, differentiating patient satisfaction from quality of care may be a mistake.  Patient satisfaction is a critical dimension of the quality of medical care.  Sure, making the right diagnosis and prescribing the right treatment are essential elements of good medical care, but patient satisfaction is an essential element as well.  To achieve great medical care, patients must feel cared for.  The way to find out if that’s being achieved is to ask them.

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