The Skeptic Doctor: Reflections of a Physician Leader

“Patient experience. I’d like you to take over the initiative,” he said. I looked to my left and right.

Shit. He’s talking to me.

 For a moment, I had an overwhelming sense of insecurity. Give me operations. Give me finance. Give me quality. Give me strategy. But don’t give me patient satisfaction. That’s not me. I’m not light and fluffy. I’m not mushy-gushy. Nor am I very good at the touchy-feely leadership stuff. I’m a cynic. A skeptic. A no-nonsense gangbuster.

This whole patient satisfaction, or “patient experience” push just seemed like another ploy to pressure doctors to compromise themselves or take accountability for things that are beyond their control. And what did I care? My practice was bursting at the seams with a six-week wait for a new patient appointment. If patients weren’t happy, they could find somewhere else to go.

Why did he want me to take on an initiative that I didn’t even believe in? And not to mention, I didn’t know the first thing about how to lead this initiative. I’d been flying under the radar. Focusing on the things I was good at. Crap.

Doctors have a hard time buying-in to the whole concept of patient experience. Why? They don’t believe that patient experience scores have any correlation to quality of care. In fact, they feel that one risks making suboptimal patient care decision due to the pressure of appeasing an unhappy patient. In addition, doctors make the argument that they are pushed to see more and more patients each day in shorter appointment times. How can that satisfy a patient?

And let’s face it, we all practice with colleagues with high patient satisfaction scores that do not always utilize the best practices from a clinical perspective. As a matter of collegial respect, doctors don’t always see the correlation.

How was I going to convince the doctors to value patient experience?

So, I started with the “why”. I had to understand “why” this was such an important issue. I took home the work done on the initiative thus far and dissected through the data, trying to understand the importance and urgency.

From an organizational perspective, patient experience will be a key component of our negotiations with payors as we move toward population health agreements. It will be a bargaining chip. If our scores are in the toilet, the entire organization may suffer financially. In this day and age of increased healthcare costs, payors are always searching for a way to muster a bargain. In the end, the potential financial loss could cripple the organization and reduce provider compensation.

Okay, I got it. Some of this was about money.

Next, I looked at the quality data. I evaluated data, data and more data.

What I realized was that while patient experience and quality are two very separate entities, effective communication was a key component to successful implementation of either initiative.

I decided to sign up for an eight-hour provider communications skills workshop. A group of providers from our organization attended the demo together. We spattered out challenging scenarios to the facilitators:

“A patient comes with a laundry list of issues and we only have fifteen minutes to see her”

“The patient is angry and screaming before we even walk in the room”

“The patient wants narcotics for pain and it’s not appropriate to prescribe”

“The patient’s family is at the bedside and they want ‘everything’ done”

The facilitators laughed out loud and then flawlessly role-played how to de-escalate each situation. Good stuff. Stuff we never learned in medical school. The facilitators handed us a wallet-sized card with a bunch of acronyms representing our “pearls” of communication. I brought it back to the clinic and experimented on myself. I started with the “T” in AIDET.

***

“Thanks so much for coming in today,” I said. I wanted to crawl out of my skin. It just felt so unnatural. I kept at it. I thanked every patient that came through the door. It started to feel good to thank my patients. It made them smile. Some even thanked me back. Cool.

My nurse and I reviewed my patient experience scores together. We evaluated the reports, question-by-question, and strategized ways to improve them. We worked together as a care team, a reflection of each other. We took responsibility for the patient experience together. I realized that she was sometimes on the receiving end of unhappy patients and that she often bore the brunt of their dissatisfaction. We decided to own it together.

Next came the social media exploration. Twitter, Instagram, Facebook, Google forums, WordPress, chat rooms. Patients are flocking to these places, connecting with each other and giving advice about where to go, who to see and what to ask for. I realized that patients are often coming to these places because they did not feel they could trust their providers or that their providers failed to explain to them what was happening in a way they could understand. They sought refuge in these social media avenues. They were searching for something they did not experience in the doctor’s office. It was eye opening to read some of the comments people made. If only their doctors knew how they really felt.

Lastly, I Googled myself. There it was. Ratings on Healthgrades, Vitals, Zocdoc, Ucompare and Yelp. The list went on and on. And what were the ratings based on?

Patient Experience.

Patients are becoming more and more savvy. They do their research. They connect via web. They have choices.

***

“I’m not going to compromise my integrity as a physician because a patient is upset…”

The doctor is venting to me. He’s a non-believer. He’s a cynic. He’s a patient experience denier. We are reviewing his patient experience scores.

He’s a good doctor. He’s passionate about his patients. He follows the standard of care. He stays up on the most current guidelines and recommendations. He always shows up on time. He will stay late if needed. He will come in and help on his day off. He is the best kind of doctor.

This conversation is crushing. How do I help him understand while respecting his hard work and dedication? He’s not a bad doctor. He just needs some fine tuning.

But, I got this. I was a non-believer once too. I get it now. I get the urgency. I get the importance. Like it or not, this isn’t going to go away. And admittedly, my nurse and I found work more satisfying since engaging in our patient experience experiment. It felt good to see our scores go up, knowing our tools and pearls of communication made a difference.

I suddenly realized why my boss asked me to take over the initiative. He was right. The touchy-feely mushy-gushy types won’t connect with this doctor…but I will.

***

Lot’s of great commentary on this post when it was posted on KevinMD.

I learned a lot from the comments, most specifically how angry so many providers are about the idea of patient experience and patient satisfaction. But, I also observed that providers truly care about their relationships with their patients and have so many best practices in provider communication to share with their colleagues. We will learn the most by learning from each other.

Patient experience is a piece or component of the care we provide…but it should not define our care. Quality and appropriateness of care should always come first.