ACC NEWS
President’s page: patient satisfaction: a personal perspective
George A. Beller, MD, FACC
Reprint requests and correspondence: George Beller, MD, FACC, Cardiovascular Division, Department of Internal Medicine, Health System, University of Virginia, P.O. Box 800158, Health Science Center, Charlottesville, Virginia 22908-0158
Health care researchers have institutionalized patient satisfaction as a mechanism for assessing quality of care. They have developed measuring instruments to quantify patients’ satisfaction with their medical care (1–5). Unmet expectations of patients, and their perceptions of omissions, are elicited in these surveys as an assessment of patient–caregiver interactions. In some hospitals, individual service lines and departments are rated with respect to patient satisfaction scores, and such scores are made public in an effort to influence continuous quality improvement. Health plans use member satisfaction surveys to rate both hospitals and the specific service centers that patients in these plans use. Many health maintenance organizations (HMOs) use patient satisfaction data as one of the variables to evaluate physician performance. Patient satisfaction data serve as an acceptable measure of a health plan’s overall accountability to employers, purchasers, and members (1). In these surveys, four main factors have been shown to be associated with overall member satisfaction, and they include access to care, quality of care, physician choice, and the way the health plan is administered (1). A patient’s perception of the nonmedical aspects of health care services is deemed to be very important in such surveys.
In recent months, I have personally come to understand what constitutes patient satisfaction from my perspective as a spouse whose wife was diagnosed with metastatic pancreatic cancer in July 2000. By experience, I have learned that high satisfaction with all aspects of medical care is vital to both the physical and the psychological welfare of the patient. Listed below are some of the behaviors and practices I observed that constituted high satisfaction as my wife underwent a very intense regimen characterized by many initial and subsequent diagnostic procedures and a very aggressive outpatient chemotherapy regimen. So far, during the first six months of her illness, she has been hospitalized once for four days and has made several visits to the emergency room. She goes to the outpatient facility frequently for blood draws and for Neupogen and Epogen injections. She frequently sees her oncologist or another oncologist who fills in when her physician is away. I often accompany her when she gets her medical care. We receive and make many phone calls to physicians and nurses who care for her. She and I also have made numerous trips to the pharmacy to pick up prescriptions.
Patient satisfaction is: - Having prompt and easy access to a specialist (e.g., oncologist) of your choice and having that specialist accept you as a patient and see you in consultation without a lengthy delay;
- Having a caring and empathetic physician who takes the time to explain to you what was found in the medical evaluation, describes the disease process in lay terms, does not hurry when answering questions, shows sensitivity and compassion when having to relate bad news, displays a realistic but positive attitude about treatment plans, and fully explains why certain tests are being ordered and specific drugs or procedures are being recommended;
- Being able to be seen by other consultants promptly and having them send comprehensive reports to your physician in a timely manner; often a phone call by the consultant to your physician is essential;
- Having your physician or a consultant spend the appropriate amount of time with you to perform the required history and physical examination and relate the subsequent recommended plan for further diagnostic testing and/or treatment. This entails physicians being good listeners and not interrupting your description of symptoms because they are in a hurry;
- Having a physician who does not talk down to you and includes you in the decision-making process with respect to determining the best course of medical care;
- Having your physician promptly return your phone calls, give you timely reports of laboratory tests, and be more than willing to get consultations from other specialists when needed;
- Being able to gain timely access to physicians for urgent or emergency care after hours and on weekends;
- Being secure that your physician is, or will become, current with medical knowledge and accepted guidelines regarding your disease process;
- Being met at the front door of the hospital or clinic by a cheerful and caring greeter when you are let out of a car and being able to drive your car to an available, nearby parking spot. (Having someone park your car—valet parking—is a service that should be offered to elderly patients or those who have significant disability.);
- Having appropriate directions and strategically placed signs to guide you to the laboratory or office of your destination;
- Having a courteous and pleasant person registering you at the front desk for an office visit or diagnostic test and not having to wait long in the waiting room before being seen;
- Having your fears allayed by nurses or technologists who conduct or assist in diagnostic testing or therapeutic procedures that carry real risk or that just appear to be formidable.
- Having nurses and allied health personnel be upbeat, exhibit a sense of humor, and work with a friendly demeanor when providing medical care;
- Having an intravenous line successfully placed into your vein with the first stick; having those individuals starting intravenous lines be pleasant and show confidence in conducting their tasks;
- Meeting the needs of the patient’s family members and providing support services to them, if needed;
- Having professional counseling services available, having access to patient support groups, and being provided with educational materials written in lay language about specific disease entities;
- Not experiencing hassles with your health care plan with respect to approval for diagnostic and therapeutic procedures as well as drugs that, despite being costly, are the most appropriate for the disease being treated;
- Not having the insurance company refuse to pay for medical care deemed necessary;
- Understanding your hospital and physician bills;
- Not having to wait long periods of time in a pharmacy to pick up prescriptions and having the prescriptions ready when you arrive to pick them up; and
- Having your privacy respected and your medical condition kept confidential by medical and clerical personnel.
This list is not necessarily to be construed as a compilation of all the factors that contribute to patient satisfaction and quality medical care. These are observations relevant to patient satisfaction that I have made in my own experience as a practicing cardiologist and as the spouse of a patient with a very serious disease requiring many medical services. I must emphasize that no matter how sophisticated and reputable a medical facility may be, and no matter how brilliant and knowledgeable the physicians practicing there, patients will not perceive their care as being excellent unless they are satisfied with respect to many of the behaviors cited above. Paramount to high patient satisfaction is having physicians and other caregivers who are truly concerned about their patients and communicate with them effectively. Medical facilities must understand the expectations patients have about their care. Fortunately, my wife has had superb care rendered by an outstanding team of physicians, nurses, and allied health professionals. For them, the patient comes first. We all must do our part to ensure that no matter how busy we are and how difficult our jobs sometimes seem with all the daily hassles we deal with in our current health care system, the welfare of our patients remains our highest priority.
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References
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1. Buchner DA, Probst LY. The member satisfaction survey as a measure of health plan accountability. Qual Manag Health Care. 1999;7:41–49[Medline]
2. Williams S, Weinman J, Dale J. Doctor–patient communication and patient satisfaction: a review. Fam Pract. 1998;15:480–492[Free Full Text]
3. Jackson JL, Kroenke K. Patient satisfaction and quality of care. Mil Med. 1997;162:273–277[Medline]
4. Cleary PD, McNeil BJ. Patient satisfaction as an indicator of quality care. Inquiry. 1988;25:25–36[Medline]
5. Scott A, Smith RD. Keeping the customer satisfied: issues in the interpretation and use of patient satisfaction surveys. Int J Qual Health Care. 1994;6:353–359[Abstract/Free Full Text]
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