Memo From The Editor

Satisfaction

Marianne Dekker Mattera

In the days of my youth, Satisfaction was a Rolling Stones song. It wasn't a concept I thought seriously about. It certainly wasn't a measuring stick against which to judge a physician's performance or the quality of the care a physician delivers.

For at least a decade, though, patient satisfaction has been a buzzword in the managed care scene. Books have been written showing the "health care industry" how successful companies in other "segments of the economy" have profited by taking customer satisfaction to new heights. Every doctor and hospital had something to learn—it was alleged—from Nordstrom's. Even the vernacular was supposed to change. Patients were no longer to be referred to as patients. They were customers or clients. And their satisfaction was to be measured as often as possible—just like hotels and car companies survey their customers and the "experience" they've had during their overnight stay or while buying their car.

It wasn't enough for doctors to measure their own patients' (I've always refused to call them clients) satisfaction. HMOs wanted to measure it too, and they developed wonderful "incentive" plans to reward doctors who scored well. Those measurements and plans continue, undergoing minor and not-so-minor changes every few years. In fact, in this issue, in "Better quality care, bigger paycheck," we explore the latest California version.

Whether the bottom-line thinking evidenced by the take-a-page-from-industry urgings or linking bonuses to good patient satisfaction scores is the right way to think about health care or not, patient satisfaction has always been an important part of every physician's practice. Even if it didn't always go by that name. From the time there was more than one doctor in town, physicians have had to make it a point to be sure their patients were happy with the care they provided.

But there's always been more than an economic reason to worry about whether patients were happy, whether they were satisfied. That reason is contained in the phrase "physician-patient relationship." A relationship implies an ongoing interaction between two parties who respect each other. It implies a bond, a trust. Without that bond, without that trust, healing doesn't take place.

Relationships must be tended, though. Many doctors needed the reminder that Nordstrom's pays attention to what the customer wants. That service with a smile breeds loyalty and trust. Some still need a reminder. A colleague told me not long ago that her doctor refused to take her complaint seriously enough, passing it off with a remark akin to "Oh, that's nothing, when I had . . . ." This wasn't a bridge game, she said. She wanted him to treat her, not trump her. Another colleague told me that his physician's office thinks nothing of calling and cancelling his appointment at the drop of a hat, but when he needs to cancel, they get huffy. Still another wonders if it would kill his physician to get some chairs in his waiting room that you can get out of without needing a crane.

So, yes, you need to pay attention to the little things that can be easily overlooked in the hustle and bustle of the typical day, and you need to survey patients—both formally through written instruments and informally in conversation—to be sure the "business" side of your medical practice leaves patients satisfied.

What you don't need are HMOs telling you that satisfaction is important and penalizing you if you don't measure up to their definition of what satisfaction is. If you're attuned to your patients, as a physician should be, you know how important satisfaction is. If you went into medicine for the right reasons, you know the patient must be satisfied in order to have a therapeutic physician-patient relationship. And, as in any good relationship, if one party is satisfied, so is the other.

Need to know if your patients are satisfied? The answer may lie in the answer to this question: In each encounter with a patient, are you satisfied?

 

Marianne Mattera. Memo from the Editor: Satisfaction. Medical Economics 2002;17:6.