Closing the Satisfaction Gap

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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.

Help Me, Help You

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When I am at my best, it’s a win-win.  I am present, attentive, and actively listening.  I am patient, cheerful, relaxed.  I am less judgmental, and more likely to acknowledge the things you already do to help yourself.  Not only do I hear what you say; I see and hear how you feel, and you know it.

When I am at my best, we feel connected.  You feel safe to reveal things to me that you might not if I were less than my best.  Then I get to know you—what you value, what you fear, and what you need from me.  I know better what questions to ask, and you can answer honestly.  My diagnosis is more accurate, my treatment plan more relevant.  You feel more comfortable asking questions.  We both leave the visit satisfied and fulfilled.

So what do I need to be at my best?  I need to take care of myself first: eat healthy, exercise, get enough sleep, manage my stress, and nurture my relationships.  If we consider each of these a bucket, then the ideal is to keep each bucket mostly full all the time.  How is that possible?  That is up to me.  I need to practice what I preach—a tall order!  It can lead to perfectionism, self-judgment, disappointment, and burnout.  It’s my responsibility to manage myself.

How could you help me be my best?  After all, you have a stake (and a hand) in how I show up.  Have you thought about this already?

What assumptions do you make about me?

How do those assumptions affect your body language, what information you give me, and how you perceive my words and recommendations?

What assumptions can you make about me that would maximize your chances of getting what you need?

I respectfully request that you consider the following about me, your physician:

  • I try my best to walk the talk. I know how hard it is.
  • Every day I bring all that I have to work, to do my best for you.
  • Some days (weeks, months, years) I have more than others, depending on what else is going on in my life.
  • I will make mistakes, and it’s not because I don’t care.
  • I know it’s my job to help you.
  • I need your help to do it.

When you feel that disconnect, like I have left Best Me somewhere else and you’re not getting what you need, what will you do?  Will you yell and storm away? Smile to my face and then write a scathing, anonymous Yelp review? What would you do if I were your spouse, colleague, friend, or child? You and I are in a relationship, not unlike these. Could you patiently, lovingly, ask me to slow down, take a deep breath, and be with you now? I think I would respond very well to that.