After 37 years of practice in multiple specialties as a physician assistant over tens of thousands of patient encounters, I feel I have a pretty good handle on sensing the status of the patient-provider relationship, sometimes from the moment I enter the room. I look at body English, the patient's chart, family members who are in the room, and a multitude of other clues that gives me a sense of the wants, needs and preferences of the patient.
Patients who are known to me in the practice are much easier to gauge as we have a history together. One of the most difficult things to learn as a healthcare provider is making sure you deal with the primary reason as to why the patient has presented to you for care. This is not always evident and not always found in a "chief complaint."
It's also never ceased to amaze me how many times a patient's satisfaction and quality of care have nothing to do with each other. As clinicians, we can all provide examples of where the quality of care was horrible, but the patient satisfaction was high. The inverse is also true. I can give numerous examples, both from personal experience as well as observed behavior where the quality of care was excellent, but the patients and/or their families perceived it to be sub-par.
This is maddening for any clinician, especially for folks that are in the early stages of their career, and are not yet confident in their approaches to patient care. In reading a recent article in Medical Economics on patient satisfaction, the five most important areas (to patients) were:
1. Shorter wait times (50 percent)
2. Advance knowledge of treatment costs (49 percent)
3. Not feeling rushed during an appointment (47 percent)
4. Providers having a high level of expertise treating a specific illness (44 percent)
5. Easy-to-schedule appointments (41 percent).
It was reported that providers are only working on shorter wait times and appointment scheduling. It is interesting to note the other three. In this day of higher co-pays and out of network penalties, patients have a lot of angst about what their care costs. It would surprise me if a patient delayed getting care for the simple reason of economics. This is not really a failing of the provider, except that they do have access to insurance information that could be more freely shared with the patient on the front end.
The third one I have learned to gauge by careful observation and by my body language. I always completely enter the room and sit down. I am fortunate to have a scribe, so I can take a history and focus all my attention on the patient. It is important to let the patient talk as much as they need to. In my experience, this has been the single most important thing to do to make the patient feel like you are listening to them. This works against wait times, but I also have a sixth sense for patient in a hurry, who don’t want a lot of "hand holding. It balances out most days. Other days are bad, and you get behind no matter your best intentions. Apologize to the patients and let them know that you value their time.
Number four has not been a problem for me except for those who don’t know me (I’m a PA) and expect to see the physician. They don’t know that I have worked with surgeons hand-in-hand for 10 years, and have developed a significant level of expertise in our specialty. The way in which I handle this always put the patient’s needs ahead of my own, and work to involve the surgeon in their care early on in the new patient encounter to reassure them and to put them at ease. I have never failed to win over a patient, and carry a full consult, pre- and post-op case load comprised of satisfied patients.
While there are a lot of definitions around "quality," we have a long way to go in understanding what constitutes patient satisfaction in medicine. The goal is to listen to the patients who give purpose to our lives and strive for both “quality” and “patient satisfaction” in our daily rounds. Understanding what is important to patients is a good first step.