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mgak47

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I am an ED doc in the community, and they have recently been giving us copy's of our press-ganey surveys that patients fill out. The number of surveys per doctor that is returned is so low that I am unsure of how these are used at all in determining pay or have any meaning whatsoever (maybe 1% or less of all patients seen return them?). I was just wondering what are some of the funniest (or most ridiculous) comments that were put?

Besides the usual "I had to wait to long to see the doctor, and he only saw me for 5 minutes", what other good ones have people seen?

Ive had "He refused to give me a work excuse for what I wanted off".

One lady called to complain because I wouldnt give antibiotics for her obvious viral URI (I usually only fight one of these patients a shift on giving antibiotics). And after calling, also filled out a surey.

Ive had a patient fill in the doctor's comments (there are comment areas for nursing, registration, triage, etc..) "The triage nurse was rude to me", yet the triage comment area was empty.
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We get Press-Ganey's in residency training.

The best comment I got was, "I saw two ER doctors (resident & attending), I didn't appreciate being billed for two doctors."
 
At my old job in the DC area, we would get Press Ganey scores, but, our hospital had to incentivize the patients to fill them out. usually they would get a $10 grocery card or something to even just return them.

The VAST majority of the write in comments were:
"I want the grocery card not the starbucks card this time." Like, where it says comments for the doctors.

Ugh.

Q
 
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At least they were honest!!!

DrQuinn said:
The VAST majority of the write in comments were:
"I want the grocery card not the starbucks card this time." Like, where it says comments for the doctors.
Q
Click to expand...
 
My best: "Doctor did not diagnose me properly. Could not diagnose strep throat."

When I looked through the chart, the final diagnosis: "Strep pharyngitis." Treatment: IM Bicillin, dexamethasone, and morphine.

When I looked through the record in more detail, I found out that the patient had a history of paranoid schizophrenia. Perhaps we shouldn't send Press-Ganeys to everyone.
 
southerndoc said:
My best: "Doctor did not diagnose me properly. Could not diagnose strep throat."

When I looked through the chart, the final diagnosis: "Strep pharyngitis." Treatment: IM Bicillin, dexamethasone, and morphine.

When I looked through the record in more detail, I found out that the patient had a history of paranoid schizophrenia. Perhaps we shouldn't send Press-Ganeys to everyone.
Click to expand...

At our monthly meeting we just voted to exclude all drug-seekers from getting surveys. If they receive a diagnosis of "Chronic Pain - with Pain Contract" then the coders know to flag that, and it will be reviewed by administration to see if it can legitimately be thrown out.
 
Good thread.
Few favorites I have received.
I waited two hours and didn't see a doctor so I left. Credited me with all low scores. Don't know how my name got linked. Have had a few of these.

ER doctor told me my child had a virus went to pediatrician next day and got antibiotics and a couple of days later he was better. Nice!

I told my doctor I had food poisoning all he did was give me fluids and phenergan but didn't test me for why. All lowest scores.

The worst is that part of our raise is tied to this junk. One bad review a month drops you from 90thpercentile when only 20 people send them back.
Got a few more I need to remember.
 
macdaddy23 said:
ER doctor told me my child had a virus went to pediatrician next day and got antibiotics and a couple of days later he was better. Nice!
Click to expand...
I have said for a long time that there is no way that good medicine or EBM can peacefully coexist with "patient satisfaction" measures such as PG or HCAHPS.
 
I definately do not understand how compensation is tied to these scores. Might as well flip a coin or pick random numbers, with the very small percentage of surveys that are returned.

And since most of the "emergencies" we deal with usually get admitted, those surveys dont count.
 
this was the best one.

" I didn't even see a doctor, just nurses." (the doctor was female)
 
docB said:
I have said for a long time that there is no way that good medicine or EBM can peacefully coexist with "patient satisfaction" measures such as PG or HCAHPS.
Click to expand...
We all need to band together and resist them. Tonight I realized why we get dinged so badly for the time it takes us to see a patient once they are brought back to a treatment area. I sat around for nearly 45 minutes doing absolutely nothing watching patients pile up in the waiting room. Finally I went to find the charge nurse but couldn't find her... nowhere to be found. I went to triage and spoke to the nurses and told them to bring the patient's back to rooms. I had plenty of rooms open in my area.

It took another 45 minutes before they started bringing them back, and when they did, they brought back 7 patients in 10 minutes.

So even as quick as I am, it still took me more than an hour to see patient #7. So for any of the patients that waited >30 minutes for me to see them, they will rate me a 1 for the length of time it took me to see them once they got back to a treatment room. Of course rate me a 1 in that area, and they'll probably rate you poorly in all other areas too.

I normally see patients the minute they are brought back if we're not busy. I could have done that tonight -- seen each patient <10 minutes after being placed in a treatment area. However, because the patients were "batched," there's no way you can see them that quickly.

It's not only the docs not seeing patients quickly when they are batched, but everybody else is affected. The tech now has 4 EKG's to do/labs to draw, the nurses now have 5 IV's to do at once, the lab now has 5 sets of labs to do at one time, etc. The nurse could have started IV's and drawn labs on patients more quickly had they not been batched. The last patient that I evaluated and wrote orders for probably waited an extra 30 minutes to have their labs sent.

People fail to realize how things outside a doctor's control affects their scores. It doesn't matter if you are the nicest doc in the world, if a patient waits more than 30 minutes to see you, he or she is going to rate you poorly.

As a profession, we really need to stand together to resist PG and other satisfaction measures. AAEM and ACEP need to take policies on this. It leads many physicians to being fired for poor scores (even excellent clinicians) and increases healthcare spending not only by paying the surveyors, but also because hospitals spend tons of money hiring consulting firms to help them keep their scores up.
 
southerndoc said:
We all need to band together and resist them. Tonight I realized why we get dinged so badly for the time it takes us to see a patient once they are brought back to a treatment area. I sat around for nearly 45 minutes doing absolutely nothing watching patients pile up in the waiting room. Finally I went to find the charge nurse but couldn't find her... nowhere to be found. I went to triage and spoke to the nurses and told them to bring the patient's back to rooms. I had plenty of rooms open in my area.
Click to expand...

To combat this we've implemented a doc-in-triage policy. Once the patient is sitting down getting triaged by the nurse, the nurse HAS TO CALL the doctor. We go out look at the vitals, ask a couple of questions and start the workup. Many patients now get their whole workup while sitting in the waiting room and are discharged before ever seeing a bed. It has essentially eliminated the door-to-doc time.
 
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southerndoc said:
We all need to band together and resist them. Tonight I realized why we get dinged so badly for the time it takes us to see a patient once they are brought back to a treatment area. I sat around for nearly 45 minutes doing absolutely nothing watching patients pile up in the waiting room. Finally I went to find the charge nurse but couldn't find her... nowhere to be found. I went to triage and spoke to the nurses and told them to bring the patient's back to rooms. I had plenty of rooms open in my area.

It took another 45 minutes before they started bringing them back, and when they did, they brought back 7 patients in 10 minutes.

So even as quick as I am, it still took me more than an hour to see patient #7. So for any of the patients that waited >30 minutes for me to see them, they will rate me a 1 for the length of time it took me to see them once they got back to a treatment room. Of course rate me a 1 in that area, and they'll probably rate you poorly in all other areas too.

I normally see patients the minute they are brought back if we're not busy. I could have done that tonight -- seen each patient <10 minutes after being placed in a treatment area. However, because the patients were "batched," there's no way you can see them that quickly.

It's not only the docs not seeing patients quickly when they are batched, but everybody else is affected. The tech now has 4 EKG's to do/labs to draw, the nurses now have 5 IV's to do at once, the lab now has 5 sets of labs to do at one time, etc. The nurse could have started IV's and drawn labs on patients more quickly had they not been batched. The last patient that I evaluated and wrote orders for probably waited an extra 30 minutes to have their labs sent.

People fail to realize how things outside a doctor's control affects their scores. It doesn't matter if you are the nicest doc in the world, if a patient waits more than 30 minutes to see you, he or she is going to rate you poorly.

As a profession, we really need to stand together to resist PG and other satisfaction measures. AAEM and ACEP need to take policies on this. It leads many physicians to being fired for poor scores (even excellent clinicians) and increases healthcare spending not only by paying the surveyors, but also because hospitals spend tons of money hiring consulting firms to help them keep their scores up.
Click to expand...

I hate batching as well. I think the amount of batching is directly related to how far the triage area is from the main ED, as people can be lazy and want to bring back multiple people at the same time.
 
Are raises tied to Press-Ganey something that we as Job Seekers can negotiate out of new contracts or at least express our displeasure at? If its universally hated we should be able to push back at this time.

It really does seem silly if the sample size of people that fill these out is so low, that they be used as performance indicators.
 
Speed Racer said:
Are raises tied to Press-Ganey something that we as Job Seekers can negotiate out of new contracts or at least express our displeasure at? If its universally hated we should be able to push back at this time.

It really does seem silly if the sample size of people that fill these out is so low, that they be used as performance indicators.
Click to expand...
Good questions.

No, this will not be something you can negotiate when job seeking. The use, importance of PG and the like are terms of the contract between the EM group and the hosptial. You will not be able to opt out of whatever your group has negotiated.

It isn't universally hated. It's universally hated by docs but the hospital admins love these things because they really don't know much about the nuts and bolts of EM. As far as they're concerned high patient satisfaction scores = more insured patients coming back. They get kind of fuzzy when you point out that the uninsured will come back too and that poor patient satisfaction is sometime better medicine (such as with narcotic seeking and antibiotics for viruses). But they think what they think.

Yes the N is too low to be statistically significant. Have you ever tried explaining the concept of "statistical significance" to an administrator? Give it a shot and you'll see why it doesn't matter.
 
It's not possible for EM physicians to have "solidarity" on this issue. While the majority of us think that Press-Ganey is FOS, there will always be Corporate-run EM groups like EmCare who will ***** themselves out to get any contract they can.
 
Today I got a copy of a PG where a patient gave me all 5's and wrote "best ER doctor I've ever seen. Will definitely come back to this hospital."

As soon as I read that, I looked at the nurses standing next to me, read the comment, and said "I must have given her a script for 100 OC's with 99 refills."
 
GeneralVeers said:
It's not possible for EM physicians to have "solidarity" on this issue. While the majority of us think that Press-Ganey is FOS, there will always be Corporate-run EM groups like EmCare who will ***** themselves out to get any contract they can.
Click to expand...
Touche. But I'm sure you meant EmCare and EPMG:D.
 
I certainly agree that PG is terribly flawed. But given its prevalence and the growing feeling that we need to assess the quality of healthcare provided in some manner, I think the sensible approach would be for us to offer an alternative method of evaluation to try and supplant PG. Simply rising up against it is not enough, even if we could get all EPs to do so.

To answer your next question, no I don't have the answer, but that is a worthwhile project to tackle as a specialty (e.g through ACEP).
 
Koko said:
I certainly agree that PG is terribly flawed. But given its prevalence and the growing feeling that we need to assess the quality of healthcare provided in some manner, I think the sensible approach would be for us to offer an alternative method of evaluation to try and supplant PG. Simply rising up against it is not enough, even if we could get all EPs to do so.

To answer your next question, no I don't have the answer, but that is a worthwhile project to tackle as a specialty (e.g through ACEP).
Click to expand...


I think most of us really only have problems giving surveys to two types of patients:

1. Drug seekers
2. Antibiotic seekers.

I think if we pointed this out to the hospital administration, and offered a way to screen these out, they would be receptive to it. As I said, we've already started this process at my institution with drug-seekers.
 
GeneralVeers said:
I think most of us really only have problems giving surveys to two types of patients:

1. Drug seekers
2. Antibiotic seekers.

I think if we pointed this out to the hospital administration, and offered a way to screen these out, they would be receptive to it. As I said, we've already started this process at my institution with drug-seekers.
Click to expand...

It seems as though it also may be useful to establish a mechanism for allowing the other 20-odd% of our patients to evaluate the ED: the hospital admissions.
 
xaelia said:
It seems as though it also may be useful to establish a mechanism for allowing the other 20-odd% of our patients to evaluate the ED: the hospital admissions.
Click to expand...

They do evaluate the ED, but they can't evaluate the doctor. The problem lies in the fact that many people who are admitted will be seen by 3, 4 or more doctors. Do you really want them rating you a month later, when they may not remember which doctor did what?
 
docB said:
:laugh:

EmCare would spring for the implanted chips. We have electronic collars. You used to work for EmCare. Do the chip and the collar interfere with each other?:p
Click to expand...
is
I still technically do....as the chip remains active under contract

When I get partnership in EPMG they've promised to remove the EmCare one and place in the EPMG one.
 
Koko said:
I certainly agree that PG is terribly flawed. But given its prevalence and the growing feeling that we need to assess the quality of healthcare provided in some manner, I think the sensible approach would be for us to offer an alternative method of evaluation to try and supplant PG. Simply rising up against it is not enough, even if we could get all EPs to do so.

To answer your next question, no I don't have the answer, but that is a worthwhile project to tackle as a specialty (e.g through ACEP).
Click to expand...

One thing that ACEP is pushing (trying again, it's failed before) is to create a rating system for EDs based on capability. The idea is that hospitals would apply to ACEP for certification of their EDs and that they would strive to achieve a higher level. This would be similar to the way trauma center apply to the American College of Surgeons. ACEP has never really been able to get this off the ground but something like this could supplant a lot of this other silliness and at the same time put us more in control of our own specialty.
 
Koko said:
I certainly agree that PG is terribly flawed. But given its prevalence and the growing feeling that we need to assess the quality of healthcare provided in some manner, I think the sensible approach would be for us to offer an alternative method of evaluation to try and supplant PG. Simply rising up against it is not enough, even if we could get all EPs to do so.

To answer your next question, no I don't have the answer, but that is a worthwhile project to tackle as a specialty (e.g through ACEP).
Click to expand...

I'm going to stand on my tiny soap box for a second and try and avoid :bang:'ing my head for a moment.

I agree that there are many practical doctor centered reasons to destroy PG.

A more subtle and insidious reason is the commodification of medicine. Medicine is not a customer service business. While I think there are very few black and white issues, I think this is one. How happy are you, how did you like your doctor, were you happy with your wait time? These are corporatized, for profit measures of success. They have NOTHING to do with the health care provided patients.

As health care providers, our obligation is to provide quality health care, not succumb to a 'customer is right' mentality. Patients are not customers. Yes, they might want antibiotics, however, this is not in thier best interst. Yes, thier sore throat might need to be seen, but the MI, stroke, and septic patietns come first.

/end rant. I can't go on. :(
 
"He made me feel like a crack ***** on the street" when he asked why I brought my 4 year old to the ER for his runny nose instead of my pediatrician's office.

Submitted before I gave up asking this pointless question.

As for the angst about PG expressed above (which, of course, I share).... any wonder why physician job satisfaction is plummeting?

Take care,
Jeff <- feeling like the vicodin-filler on the health care assembly line
 
She knew what that felt like? Really? That's pretty specific, although it does negate the range of experiences and emotions that crack ****** (specifically, "on the street") must feel.
 
dchristismi said:
She knew what that felt like? Really? That's pretty specific, although it does negate the range of experiences and emotions that crack ****** (specifically, "on the street") must feel.
Click to expand...

My thoughts exactly.

The lady doth protest too much, methinks....

Take care,
Jeff
 
In the span of one month I have gone from scoring in the mid low 80's to the mid 90's with an N of around 16. I'm sure next month I'll be back in the 80's or even worse. There is no rhyme or reason to it.

The thing that you can't seem to get administrators to understand is that there is a segment of the patient population you don't want to satisfy and you don't want to come back.

For as much hand wringing the suits do over the PG scores, they sure haven't seemed to effect our volume. They keep coming back, each year more than the last.

I've always thought it would be a fun experiement to audit the ED pyxis each month for total doses of narcotics given divided by patient visits and then compare to the corresponding PG scores. I wonder if there is a correlation. Same could hold true for scripts of narcs written.

Maybe I'm just a cynic.
 
mgak47 said:
I hate batching as well. I think the amount of batching is directly related to how far the triage area is from the main ED, as people can be lazy and want to bring back multiple people at the same time.
Click to expand...

You left out "and then bitch about having lots of orders to do at once".
 
Non-outcomes based patient surveys tell you very little about a doctor's perfomance, particularly in the ED. I could raise my PG score 20% next month by stapling scripts for zithromax, percocet, and a "one week off" work note to every set of discharge papers. Why not cut out the middleman and have a vending machine in the waiting room? Your copay gets you vicodin. An extra $20 upgrades you to percs. $50 moves you up to dilaudid.

Saying "no" isn't popular with patients. They don't want to hear that their 1 cm hand lac doesn't warrant a week's worth of narcotics or that you are not under any circumstances going to fill out their disability paperwork in the ED. And no, you can't admit them to the hospital because they'd be "more comfortable staying here". They also don't want to hear that you haven't been back to see them for an hour because you were in the room next store struggling to get a line in some septic kid with cerebral palsy. They want what they want how they think it should be given to them. Welcome to the "Have it Your Way" society. Thanks, Burger King.

As the very wise Mick Jagger once sang (should be on a sign in the waiting room):

You can't always get what you want
but when you try sometimes
you just might find
you get what you need
 
bartleby said:
You can't always get what you want
but when you try sometimes
you just might find
you get what you need
Click to expand...

:smuggrin: That would be perfect.

I had two patients yesterday with simple lacerations both ask for narcotics prescriptions. I wrote each of them a script for motrin.
 
Every letter of complaint that comes in to the ED nurse manager is required by policy to have a "full" investigation. I'm the assistant director so I've been dealing with some of these stup... er... highly important tasks while the director is skiing. We got a letter where the patient stated they were very unhappy because they had been in the ER for 12 hours and were never fed. It was true. Diagnosis: Bowel Obstruction :rolleyes:.
 
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mgak47 said:
I definately do not understand how compensation is tied to these scores. Might as well flip a coin or pick random numbers, with the very small percentage of surveys that are returned.

And since most of the "emergencies" we deal with usually get admitted, those surveys dont count.
Click to expand...

Probably for the same reason that we accept $110-$175/hr for doing a job that generates our group leaders somewhere on the order of 27% - 48% (payor mix) of $900-$1200 (what we generate per hour).
 
GeneralVeers said:
To combat this we've implemented a doc-in-triage policy. Once the patient is sitting down getting triaged by the nurse, the nurse HAS TO CALL the doctor. We go out look at the vitals, ask a couple of questions and start the workup. Many patients now get their whole workup while sitting in the waiting room and are discharged before ever seeing a bed. It has essentially eliminated the door-to-doc time.
Click to expand...

Good idea in theory, and in practice in many places, but not in all practices. This model breaks down as you get into sicker (ie. tertiary care centers). We tried this for awhile, but lots of our docs got disgruntled at the constant interruptions to go to triage, too. It cut down on the time they were seeing the patients already under their care, and it disrupted flow in the department. We use this now as a "last resort" when grid luck is so drastic we don't have choices.
 
roja said:
I'm going to stand on my tiny soap box for a second and try and avoid :bang:'ing my head for a moment.

I agree that there are many practical doctor centered reasons to destroy PG.

A more subtle and insidious reason is the commodification of medicine. Medicine is not a customer service business. While I think there are very few black and white issues, I think this is one. How happy are you, how did you like your doctor, were you happy with your wait time? These are corporatized, for profit measures of success. They have NOTHING to do with the health care provided patients.

As health care providers, our obligation is to provide quality health care, not succumb to a 'customer is right' mentality. Patients are not customers. Yes, they might want antibiotics, however, this is not in thier best interst. Yes, thier sore throat might need to be seen, but the MI, stroke, and septic patietns come first.

/end rant. I can't go on. :(
Click to expand...

.
 
Last edited:
One of the biggest problems I have with PG is that admitted patients don't fill them out for the ED. The STEMI that goes to the cath lab in 20 minutes or the patient in septic shock that you bring back from the brink of death will never show up on a PG report. And that seems wrong somehow.
 
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