When Efforts to Boost Patient Satisfaction Hinder Great Patient Care

The increasing emphasis on patient satisfaction has some physicians walking a tightrope when it comes to discussing serious health issues.

Physicians face a difficult balancing act when it comes to patient communication.  One common concern among physicians is that some of the popular patient satisfaction quality surveys and physician ranking sources appear to be more about whether the patient "liked" the physician than whether the physician provided quality care.

On one hand, the patient satisfaction survey has become the elephant in the room. However, it is the patient in the room who sometimes needs his physician to hold serious conversations, present difficult news, and give tough advice. Addressing a serious diagnosis or a high-risk lifestyle issue, such as weight gain or smoking, will not necessarily help the physician win the popularity contest. It’s understandable that physicians are becoming frustrated.

While in some ways it may seem that patient satisfaction improvement programs are just meant to give patients an extra smile and pat on the back, keep in mind that the data consistently shows that 70 percent to 80 percent of all malpractice cases involve poor doctor-patient communication or relationships, which is of course, will be indicated by poor patient satisfaction survey results. 

Physicians will be pleased to know that there is support building at the legislative level. The AMA is so concerned about the implications of such measurements that it has written model legislation. Georgia has actually passed legislation based on the AMA recommendations. It prevents malpractice claimants from using federal or state practice guidelines, quality measures, reimbursement criteria and the like to establish or define the standard of care without expert testimony.

State-specific initiatives like this are positive steps. But until more laws are passed in other states and nationally, physicians are generally still not sure how to proceed. Here are a few points to consider:

Know the quality survey criteria used by your organization. There is no need to be surprised by low quality marks merely because you were unaware of the questions being asked patients. Knowing the criteria used to measure your performance will help you focus your conversations with patients.

Maintain clinical perspective and thoroughness. Good patient communication is crucial, but should never overshadow providing appropriate patient care and clinical advice. Withholding “bad news” or tough advice out of fear of offending a patient could very well lead to problems in the courtroom.  Although this may seem obvious, surveys indicate that physicians are often hesitant to discuss potentially sensitive issues with patients. For example, a physician may not want to say anything to a patient who shows signs of alcoholism, but who is also high functioning and successful at home and work.

Request a consult. If you have found it difficult to discuss sensitive issues with patients (e.g., alcohol use or weight gain) or you are unsure of the best phrases to use/avoid in today’s malpractice climate, consider speaking with outside experts who can give you advice.

Physicians today must be comfortable discussing serious health issues that involve personal behaviors or actions with their patients. They must balance those discussions against the reality of patient satisfaction performance standards and the reality that unhappy patients are more likely to initiate legal action.

By understanding optimal patient communication strategies and by knowing and understanding the goals of surveys, physicians will be better equipped for today’s physician-patient communications tightrope.