Current healthcare reform efforts promote the related ideas that patients ought to be involved in their own care, and that patient satisfaction is a key measure of healthcare quality. U.S. primary care practices have clearly gotten the message: A recent survey by the New Medical Group Management Association found that 85% of practices conduct patient satisfaction surveys.
Further reading: Top 10 challenges facing physicians in 2017
Today, primary care providers are increasingly taking what’s been called a “negotiated approach” to practice where patient and doctor work cooperatively, discussing the patient’s expectations during an office visit.
Andrew Duda, MD, reports patients arriving with specific expectations for their care at least once daily, if not more often. He says that many patients search the internet for advice from “Dr. Google” before seeing him and that their discoveries make such requests inevitable. Duda practices with Henry Ford Allegiance Family Medicine in Leslie, Michigan.
As of now, though, the connection between high levels of patient satisfaction and the highest levels of quality care has not been proven. Patients may explicitly request tests, referrals, and medication that they do not need and that will not help them or be cost effective, and be disappointed if they don’t get them.
Yet sometimes physicians are tempted to oblige, and systems that rate providers using satisfaction metrics may encourage this. In some studies, the most satisfied patients have actually had higher mortality rates than less satisfied ones. Meanwhile, another strong emphasis in healthcare reform efforts is for physicians to use resources wisely, in alignment with evidence-based guidelines.
Using verbal judo
Duda negotiates with patients whose preconceptions about their care may not jibe with his clinical opinion. He takes an approach he calls “verbal judo” that he learned in medical school. “You try to get the patient to understand your point by making it their point…and by getting them to answer their own questions.” This way, he says, he and the patient usually reach a happy medium. They may settle on a test or treatment that costs somewhat less than what the patient had requested, and that will still provide real benefit.