3 pigs and patient satisfaction

A physician who had a side gig as a pig farmer wanted to breed his three female pigs with the boars on a neighboring farm. He loaded them into the back of his pickup truck and took them to visit several boars at the nearby farm. While the pigs were getting acquainted, the farmer of the female pigs asked the second farmer, “How will I know if my pigs are pregnant?”

“That's easy”, said the second farmer. “They wallow in the grass when it takes, and they wallow in the mud when it doesn't take.”

The next morning, the farmer awoke, looked out the window, and found his pigs wallowing in the mud. So, he loaded them into the truck and took them back to the boars. But the following morning, the pigs were still wallowing in the mud. Undaunted, the farmer once again loaded the pigs into the truck and returned them to the boars for a third time, hoping for better results.

On the third morning, the farmer was away from the farm, so he anxiously phoned his wife and asked, “Are the pigs wallowing in the grass or the mud?”

“Neither.” replied the wife. “Two of them are in the back of the pickup truck, and the third one is up front, blowing the horn!”

Moral: You get what you reward!

Most of the medical profession believes that most patients are satisfied and appreciate the care they receive from doctors, nurses, and allied professionals. Patient satisfaction is an elusive concept and is often difficult to measure. However, systems and metrics are in place to provide objective evidence of patient satisfaction beyond patient satisfaction surveys.

The need to improve health care quality is increasing. When patients can go to Amazon.com and order a product with just a few clicks, have it delivered in one to two days, their expectation of that efficiency also occurs with their health care experience. The Centers for Medicare & Medicaid Services (CMS), hospitals, and insurance providers alike are striving to better define and measure the quality of health care. Doctors and staff must understand that patient satisfaction is a major component of health care quality. Furthermore, patient satisfaction is important for patient compliance and patient outcomes, including lower mortality, fewer readmissions, improved adherence to treatments, and greater patient engagement in their own care. Patients who feel satisfied often experience better care quality and communication, and feel more empowered to manage their health, leading to improved clinical outcomes.

Good patient-staff interactions and clear communication are central to satisfaction and better outcomes. When patients trust their doctors and feel heard, they are more likely to engage and participate in their own care.

My take-home message is that patient satisfaction isn't just about "feeling good"; it's a meaningful indicator of the quality, safety, and effectiveness of the services you provide.

The repeal of the Affordable Care Act is going to create millions of patients who don’t have health care insurance. As a result, many of these patients will avoid health care and become sicker than patients who have insurance and access to care. Consequently, these patients will require more of a physician’s time. This is compounded by slow erosion in reimbursements and rising overhead costs. That translates into a decrease in physicians’ incomes. All of this means health care providers will have to see more patients than previously. When doctors see more patients and spend less time with each, there is a greater risk of deterioration in patient satisfaction and an increased risk of litigation. This increase in demand for services results in decreased access to care, longer wait times, and physicians looking at their computers instead of patients. This all leads to greater dissatisfaction in our patients and more stress for doctors and their staff. With this increased demand for services in an already chaotic atmosphere, who has time to worry or even care about patient satisfaction?

Practices\doctors need to show the community that they are interested in quality care, and they need to find ways to improve quality to remain competitive. Patients are our customers, and as customers, they have the right to choose where to go for their medical care. Patients are easier to serve if they feel their needs are being met. This results in happier staff and patients. Conversely, when patients' needs are not met, we often hear about it through angry letters, poor satisfaction scores, or negative reviews on online review sites. In the past, if a patient had a negative experience with a doctor or their practice, they might have told 10-20 others about it. Today, that same patient, with a negative experience, can go online and write a scathing review that can be read by hundreds, if not thousands, of viewers. This does more than affect the doctors’ ratings. A negative review can affect existing patients and potential new patients who may choose to seek medical care elsewhere. This is why patient satisfaction is extremely important to your practice.

Certainly, our challenge as physicians is to continue striving for high RVUs while maintaining high patient satisfaction scores to bolster our reputation, not to mention our own job security and participation in various health care plans. In addition, patient satisfaction will be a scorecard used to determine physicians’ compensation, as those with low patient satisfaction scores won’t receive salary bonuses.

Our patients come to us when they are vulnerable and in pain. They are often scared and anxious and then accept long wait times. Patients wait in the reception area, wait to return to an exam room, wait to be seen by a physician, wait for test and imaging reports, wait for emails to be answered, and wait for their telephone calls to be returned. This all leads to decreased satisfaction.

Satisfaction trends will have peaks and valleys, but the overall trend should always be increasing. Making patients feel unique and keeping them updated during their waits may also help to increase patient satisfaction. How we speak and act influences the healing process of our patients. By helping patients feel more comfortable, their anxiety lessens, and they are better able to understand their treatment plan and the importance of compliance with the physician’s suggestions. We may all come to the same diagnosis for a patient, but satisfaction also depends on how the patient was treated while we formed that diagnosis.

Communication is key to patient satisfaction. We must acknowledge our patients' feelings and concerns and let them know we understand and are actively paying attention to both their verbal and nonverbal language. It is not only what we say, but also how we say it. Our patients must feel that we care and have their best interests at heart. When dealing with angry and upset patients/families, there are multiple techniques that can help diffuse the situation, all based on how we communicate.

Suggestions for improving the patient experience and improving patient satisfaction scores include:

Start with the telephone. Try to answer the phone in three rings; the receptionist should identify themselves; avoid phone trees and placing callers on hold, and finally, use the caller’s name during the phone call.

The doctor or nurse should knock on the door before entering the exam room. Knock and then wait two to three seconds to allow the patient to become physically and psychologically ready for the encounter.

The doctor or medical assistant should introduce themselves not only to the patient but also to the patient's family and friends. I also suggest that staff and the doctor have their names on their white coats or uniforms.

The doctor or the person taking the history, such as a scribe, should sit down, be at eye level, and maintain eye contact. If possible, don’t allow the exam table or other barriers between the health care provider and the patient.

Don’t turn your back on the patient while entering data into the EMR. Configure the rooms so the doctor can view the computer and the patient at the same time, or use a tablet or iPad to enter data, allowing the physician to look at the patient and the computer simultaneously.

Your body language is important. I suggest you lean slightly forward and avoid holding your arms across your chest, as this is a defensive posture.

Make sure the patient is comfortable. If your patient requests a blanket, try to get it yourself rather than rely on someone else. Remember, our behaviors sometimes do speak louder than words.

Bottom Line: Patient satisfaction means putting patients first or adopting a patient-centric philosophy so that every patient has a positive experience with the physician and the practice. And like the three pigs, you will be rewarded with stellar patient satisfaction scores.

Neil Baum, M.D., is a professor of clinical urology at Tulane University in New Orleans. Baum is the author of several books, including the best-selling book “Marketing Your Medical Practice-Ethically, Effectively, and Economically,” which has sold over 225,000 copies and has been translated into Spanish.