the answer is patient volume. Nurses that see patient often see half or even less of what a Primary care Physician sees during one day, therefore more time to spend with each patient. Instead of having 20-25 minutes per pt this nurses have at least 30-45 minutes with each patient. Believe me that makes a huge difference.
When I was a first year resident I had 35 minutes to each patient on my outpatient clinic, now as a second year I only have 20-25 minutes. And I have had to adapt to this and be more in control of the appointment and only address 1-2 issues per visit instead of 3-4 issues in chronic sick patient.
Is not that nurses are better at conducting interviews, do physical and address problems and treat them, because they are not. WE went to school for that. The thing is more time, and even if they were saying the samething over and over again in those 35-40 minutes pt would be happy because at the end the only thing that would stand out was "WOW, they spend 35-40 minutes with me, they really care"
Give nurses the same amount of patients a PCP see's in one day and you are going to see very different results in this studies. I guarantee it!!
That may be part of it, but a chiropractor (Dr.Al Reach of Reach Chiropractic) I met in and around 1989 had tremendous customer satisfaction. He had a formula based on some scientology principles - I am not a scientologist at all, but they used certain "control" techniques from Scientology (such as the ARC triangle, checking "indicators" and entering one emotional tone above the patient etc) - I learned a tremendous amount from this guy in 4 or 5 brief conversations about dealing with people. He taught his management/control techniques, really you could say borderline brainwashing techniques to other chiropractors he hired and placed in his 8 offices. They were all trained to do things EXACTLY the same : the control techniques I mentioned above he gleaned from scientology , the way they adjusted patients, down to even the type of ballpoint pen they used. Each doctor saw 200-300 (and sometimes more) patients a day. This was in the late 1980's when insurance companies demanded very little from chiropractors, once insurance companies demanded better documentation in the late-1990's their numbers went down.
But anyway, the time drain of documentation aside - all his robot like doctors saw 200+ patients a day, and the patients loved them. They literally spent 1 to 2 minutes with a patient and in that time established this eerie rapport, embraced the patient figuratively on several levels , brought the patient up one or two emotional tone levels (making them feel better emotionally), and the actual physical treatment was almost an afterthought. I literally heard a patient say something like "You know in the 20 minutes the doctor spends with me..." - and I remember thinking "20 minutes ?!?!?! more like 2 minutes" But it seemed longer since this weird intimacy was established.
If I role played what an adjustment was like you would get a quick idea of what I mean, its hard to convey in writing. But the doctor would enter the room and check the patients emotional tone (by the look of their face especially the eyes, and the tone of their voice - its really a weird "science" of Scientologists - I do believe many of them can nail your emotional state accurately in seconds with practice), adopt an emotional state one level or so above them (you don't want to be too emotionally above them - when someone is in emotional "death" it is terrible for you to be in the tone of "exhuberance", its too much of an emotional dissonance - its like
Hey look on the bright side and whistle a happy tune when they are emotionally dead - not good) and then within a few minutes they would raise the patients emotional tone by mirroring and matching bringing the patients emotional tone up, all while establishing "common ground" strengthening the "R" ( reality) and "C" (communication) of the ARC triangle - and anytime you strengthen one side of the ARC triangle you necessarily strengthen the others - in this case the "A" (affinity).
The emotional tone is set up and raised through mostly non-verbal methods such as facial expressions and posture - but also tone of voice (emotionally "dead" people have a very monotone voice compared with "angst" or "exhuberance" or "anger" etc - you may think Tom Cruise etc are nuts and to an extent they are, but there is some whacky control techniques that really do work that is taught outside of the religious beliefs of scientology - and I do think they are spot on with how the voice conveys and influences emotional tone). Rapport was set up largely with common ground conversation - very simple really - if they are Miami Heat sports fans and so are you, this is an area of common ground.
I classify all this under the title of SCHMOOZING. And someone who is really trained in scientology can sell ice to eskimos.
These guys use to see hundreds of patients a day - each doctor would. They were billing $70 a pop to insurance in the late 80's before insurance wised up, and used a "cooperative fee structure" for patients without insurance. They did not physical therapy or exercise prescriptions just "above down/ inside out" chiropractic - and patients loved them
So while you may be right - on the other hand, I have seen the simple power of schmoozing when it comes to establishing patient rapport and obtaining satisfaction - and if someone is a good schmoozer it can be done in seconds, and if you are a bad schmoozer you can't do it in hours.
Althought I think all of the mind control things the high level scientologists (such as Dr.Al Reach) did work - in my own practice the only thing I used from him is establishing common ground. I did that the first visit. Other than that I just tried to demonstrate a higher level of service than my competitors - including alot of touchy feeley crap like calling each and every new patient just to ask how they were doing (not a control techique, just letting them think I care). Pretty much all new patients were feeling about the sameafter the first visit - but the vast majority commented to me that they had NEVER had a doctor call them before to check on them. That one thing alone I think established a strong first impression of me as a caring doctor - appearances are everything and you do not have a second chance to establish a first impression. I never left for home in the evening until I had reached every new patient.
So you might be right - but it is an assumption, I want to go read the entire study and see if there is something to glean from the way the nurses do things that makes a patient more satisfied.
If I am convinced of anything in private practice healthcare its the importance financially of patient satisfaction - including the fact that if patients like you they won't sue you when you do something wrong like break their ribs adjusting them. I know that for a fact (Oh thats ok dear, you didn't mean to do it).
You might be right but this is certainly something worthy of real study and not assumption. Satisfaction is sometimes related to rapport, and rapport is a science one can learn quickly and perform in seconds
I guess you would rather have someone who speaks nicely to you versus someone who actually knows what they're doing. I agree that some MD's need better bedside manners or English speakers, but you can find the same issues with NP's and PA's. If you went to a hospital that wasn't in the ghetto, you would find physicians who both had excellent bedside manners and could speak English fluently.
