Speak the words “patient satisfaction” to any physician these days and stand back. At best you may get an eye roll and/or an expression of disgruntled resignation; at worst you may unleash a full-on rant about patient entitlement and how ludicrous it feels to be rated in the same way as servers at a restaurant. Patient satisfaction survey data drives operational decisions in healthcare organizations across the country, for better or worse. But what do these surveys mean for the patient-physician relationship?
What goes through your mind when you receive a patient satisfaction survey?
What moves you to fill in the dots, write comments, and then submit it?
What result do you expect from your response?
Do you think of it as communicating with the physician him/herself?
Or are you giving feedback to the organization as a whole?
Would you say to the doctor’s or the staff’s face the things you write in the survey comments?
Do you include your name?
Clearly we doctors feel great when someone writes, “She’s fantastic, I love her!” and “She always makes me feel comfortable and I feel like she really cares.” Conversely, it’s very upsetting when we get “He’s a terrible doctor,” and “He doesn’t listen and makes me feel bad about myself.” If someone said the latter about you, what would you think? One of my first questions would be, ‘What do I do to make you feel that way?’ It’s relevant to both positive and negative feedback. What do I do that makes you feel comfortable, and communicates caring? What do I do that causes you to feel shame? Consider this story:
Dr. Kairselott’s patients consistently wrote on their surveys that they felt rushed when seeing her. This baffled her, because she prided herself on taking time with patients, looking them in the eye instead of staring at her notes, and making sure she came to each encounter thoughtfully. Her superiors thought it odd as well, because they knew her to be a compassionate and dedicated physician. But they felt they had to act on the data, and so admonished her to do better—take more time, don’t just hand the patients a prescription. Dr. K felt indignant. Her bosses were not in the room with her, they didn’t see how much she really engaged and attended to her patients’ needs. She felt attacked, demoralized, and invisible. She worried that if her patient satisfaction scores remained low, her income and reputation would suffer, and she felt powerless to change it. What were these patients talking about? Finally, one of them wrote:
“I really like Dr. Kairselott, but I feel rushed during my visits. She’s always tapping her fingers on the desk, and it makes me feel like she wants me to talk faster, get to the point. I end up not saying everything I want to say because I feel like she just wants to get out of the room.”
This patient gave Dr. K the best possible feedback: An objective observation about a behavior, her subjective interpretation of it, and its consequence for their relationship. This is how we communicate evaluations to medical students on their performance in clinical rotations. There is no reason why it should stop at the end of training; it’s just that the evaluators have changed.
Dr. K knew about her finger tapping habit, but had no idea of its effect on her patients. It made sense, and she felt validated—she was, in fact, doing things right, and after gaining this new insight, she could take action to improve her patients’ experiences, and thereby her relationships with them.
Feedback can go both ways, too. If I sense a patient disengaging, I can point out that his posture is turned away from me, he is not looking into my eyes, and his brow is furrowed. I can tell him that I feel he does not trust me. I can invite him to tell me what he’s thinking in the moment, and open the door to clearer communication. Sometimes he will accept the invitation, other times not, and our relationship will proceed according to the path we choose to take together.
Medicine is more than a business; physicians are more than shop owners who want return customers. When patients and physicians alike can approach patient satisfaction surveys as an opportunity to improve our relationships, rather than a forum to simply compliment or complain, then the surveys will truly fulfill their highest purpose.
Healing Through Connection 
Once again, Catherine, a thought-provoking piece. Coming at from strictly the patient side, I’m amazed at how drab many doctor’s offices look. Is there some reason the walls have to be putty/gray/bland beige?! The effect is one of sterility, detachment…in other words: a business transaction is about to take place. Certainly not an intimate, open, honest discussion about a private health issue. So it’s a bit ironic to hear that some docs resent being rated like restaurant servers, since restaurants beat them out handily in creating an inviting space. 🙂
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Hi Nancy! Thanks for your comment, and you are right! I have not looked up the history of outpatient clinic decor, but I suspect its origin is an extension of hospital facilities design, as opposed to business, but you make an interesting observation, as medicine has increasingly become a business… Our waiting rooms resemble bank lobby areas in a lot of ways. But when you think about what really makes or breaks your experience at the doctor’s office, how much does the decor matter, as opposed to the interactions you have with the people there? And which interactions influence your experience the most?
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This is all new to me. Since I rarely visit a doctor, I was going to say I’ve never gotten a survey, but that’s not true. I got one to fill out online after my eye surgery. I filled it out, but perfunctorily. Of course, my experience was so good, it wasn’t difficult.
Otherwise, I never fill out satisfaction surveys: not the one from the Toyota dealership, not the one from the carpet-cleaning company, not the ones from Amazon. I’ve don’t review restaurants or other business establishments on sites like Yelp, either.
Is it generational? Perhaps. Is it a desire to stay off as many databases as possible? That certainly plays a role. But the biggest problem I have with surveys is the forced-choice approach, and the fact that, more often than not, the answer I would give isn’t an option.
Of course, providing options for free-form feedback like that given to Dr. K, above, helps greatly, but it seems to me that conversations still are best. Perhaps part of my problem with surveys is my sense that they’re more for the bean-counters than the staff.
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Hi Linda! Your comments resonate with me very much. Wouldn’t it be great if patients and physicians could have open, heartfelt conversations about our relationship, like you say? What keeps us from doing that? And I think you are at least partially correct about the ‘bean counters’–surveys done on a group of individuals are used to gauge the performance of the whole group, and decisions for the group are made based on aggregate data. Of course, the larger the n, or number of data points, the more valid and useful the data. So there is value to the 5-point Lickert scale for general rating, but the comments are what should guide actual improvement interventions, if they are specific and actionable enough!
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The surveys I have received were made to look as if my doctor was requesting my response directly, though I didn’t believe that was the case. Since I am not sure exactly how the information is used, I have been reluctant to respond very often, especially since the questions and allowed answers don’t always seem to fit. When I have responded, it was only when I was in the mood to give the most favorable ratings possible. But I have been too timid to include my name, even in those situations.
If I should ever have a major problem with my “experience”, I imagine I would rather bypass the middleman and speak directly to those involved (assuming in that instance they would even care). On the other hand, it might be nice if I would bypass the middleman in reflecting gratitude, too, beyond the standard “thank you” at the end of the visit.
I suppose if no one completed the surveys, they would just go away, which could be a good thing. I doubt that will happen and still I remain unsure about the true ramifications in returning a survey. In any case, your example did make me aware of the importance of using clear, helpful detail in the comments sections of the surveys, should I decide to complete another.
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Dear Kathy,
Thank you for visiting my blog, and for sharing your experience. You make a great point about not knowing how the information is used. And it’s telling that you entertain the possibility that a practice may not even care about your negative experience, if you have one. I’m sorry that in our system, a patient could even think that their doctor’s office does not care about them. That is the antithesis of what doctors’ offices are (or should be) about, no? *sigh* Onward… one day, one moment, one breath…one encounter at a time.
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