What really gets me...

[TrumpetDoc]

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Maybe I shouldn’t be as concerned with this as I am but this burns me and I just have to vent it a bit. Now, give me a dirty work place (ED), give me obnoxious patients, rude/flat out belligerent patients, give me a douche-bag consultant who could really give a damn about patient care, or give me any of our day-to-day battles and I’m fine. In fact, these make the job what it is in a way. What I am having a really hard time swallowing is of all things, patient satisfaction.
Now I have ALWAYS considered this a strong point of mine. Personal interactions in general are a real strong point of mine. I genially love to interact with my colleagues, nurses, staff, and yes…my patients. I spend a lot of extra time with them and I get a lot of personal accolades directly from them and/or their companions. Too bad NONE of these patients evidently fill out surveys! This is NOT an aspect of my practice that I try to beef up on, or simply try to tolerate and treat patients like politicians treat constituents (as I see SO MANY do on a daily basis). I feel I really connect with patients and that’s just a part of who I am.
Needless to say, I have been looking at my scores and percentile within the group and I am NEAR THE BOTTOM! I felt like the character in those movies who just found out their whole life was a lie. OK, not to that extent, but this really pisses me off! I look over my surveys and NO BAD COMMENTS. Simply a whole heck of a lot of middle of the road, (straight lines down the middle sort of thing) apathetic responses. The ones that did comment, commented really positively on me. I took patient satisfaction as a constant in my practice. I felt…”well, if I am not the most productive, at least I will rock the PS”.
This just doesn’t make any sense!
Funny thing is, I have studied the docs that get 99%ile and I really don’t se any magic there. I am truly vexed.
I really don’t give any thought to what effect this has on pay (no bonus), it’s really a personal thing. It’s a damn shame that all I hear for the first year out is how “good I am with the patients” etc… and then this perverted epiphany

Perhaps what trouble me the most is the way this has changed how I look at the job, how I “see” patients. I don’t have the same fervor for coming to work. In fact, I manifest, almost instantly, almost all the signs of career burnout. I refuse to believe that one could be burned out so fast. And over something that I just know should mean less than I am making it out to be. I guess I would be fine with this if someone would just have let me know there was a problem.
So I go through the day, knowing I obviously need to “*****” myself out to these people, and I find myself almost disgusted. Now, a landslide of personal issues are compounding this I must say and I apologize for the vent. But as it stands… PS surveys can %$ %* @#&&

 

[wook]

Maybe I shouldn’t be as concerned with this as I am but this burns me and I just have to vent it a bit. Now, give me a dirty work place (ED), give me obnoxious patients, rude/flat out belligerent patients, give me a douche-bag consultant who could really give a damn about patient care, or give me any of our day-to-day battles and I’m fine. In fact, these make the job what it is in a way. What I am having a really hard time swallowing is of all things, patient satisfaction.
Now I have ALWAYS considered this a strong point of mine. Personal interactions in general are a real strong point of mine. I genially love to interact with my colleagues, nurses, staff, and yes…my patients. I spend a lot of extra time with them and I get a lot of personal accolades directly from them and/or their companions. Too bad NONE of these patients evidently fill out surveys! This is NOT an aspect of my practice that I try to beef up on, or simply try to tolerate and treat patients like politicians treat constituents (as I see SO MANY do on a daily basis). I feel I really connect with patients and that’s just a part of who I am.
Needless to say, I have been looking at my scores and percentile within the group and I am NEAR THE BOTTOM! I felt like the character in those movies who just found out their whole life was a lie. OK, not to that extent, but this really pisses me off! I look over my surveys and NO BAD COMMENTS. Simply a whole heck of a lot of middle of the road, (straight lines down the middle sort of thing) apathetic responses. The ones that did comment, commented really positively on me. I took patient satisfaction as a constant in my practice. I felt…”well, if I am not the most productive, at least I will rock the PS”.
This just doesn’t make any sense!
Funny thing is, I have studied the docs that get 99%ile and I really don’t se any magic there. I am truly vexed.
I really don’t give any thought to what effect this has on pay (no bonus), it’s really a personal thing. It’s a damn shame that all I hear for the first year out is how “good I am with the patients” etc… and then this perverted epiphany

Perhaps what trouble me the most is the way this has changed how I look at the job, how I “see” patients. I don’t have the same fervor for coming to work. In fact, I manifest, almost instantly, almost all the signs of career burnout. I refuse to believe that one could be burned out so fast. And over something that I just know should mean less than I am making it out to be. I guess I would be fine with this if someone would just have let me know there was a problem.
So I go through the day, knowing I obviously need to “*****” myself out to these people, and I find myself almost disgusted. Now, a landslide of personal issues are compounding this I must say and I apologize for the vent. But as it stands… PS surveys can %$ %* @#&&

TDoc:

Sorry that you're getting kicked in the nuggets. I hope things start to look better soon.




Wook

 

[WilcoWorld]

Garbage tests yield garbage results.

 

[BJJVP]

TrumpetDoc, you should not change how you do things. If you care about your pts, & always try to do what you feel is best, then these surveys mean nothing.

I don't believe the surveys are valid for anything. Not valid markers for good care & not even for accessing pt satisfaction.

I am against pt satisfaction surveys for the very reason you state. It alters the pt-doctor relationship adversely and only hurts guys like you...doctors that care. A doctor that doesn't care about his pt couldn't care less about his scores either, even when it's in his financial interest. Btw, I generally do well on surveys....but still hate them.

I understand why administration looks at them. I can't stand it however when physicians embrace it. Its one thing when doctors say, "This is the world we live in and so we have to deal with it and address it because our contractual stability depends on it." It's another thing to say, "You need to do something because these surveys say pts don't like you and this is equivalent to being a bad doctor."

I would think that a reasonable EM group would not go crazy over a set of low pt satisfaction scores. Receiving significantly more complaints than your partners from other medical staff, however, is a bigger concern and maybe a better marker for bad medicine.

 

[Venko]

I'm sorry Trumpet that you're not in a good place right now. I hope things get better for you.

I was reading your post and its funny, I am personally not okay with the turf battles, the not caring consulting services. I find the punting system, the delay tactics employed sometimes, the consistent shotgunning of tests by the off-services, the systems failures for our patients are all unacceptable and need active measures to be changed. I am, however, okay with trying to make my patients as comfortable as possible. I think its not a singular criterion for who is a good doctor but I think part of being a good and complete physician is delivering medicine in a palatable way.

I dont have any experience with the Press-Ganey scores and satisfaction surveys in our departments, but I really think that patient satisfaction / comfort is not an unbelievably separate concept from good patient care.

I think if you ask most people going into medical school, they "want to help people," and often people travel abroad to "help people," and yet sometimes we don't realize how much help it is to the patient to see their doctor sit down when possible, offer them a blanket, and a glass of water (if they are not NPO). I have heard some of my residents explaining things to patients without using common diction, and so many other things. In the end, my personal belief is that we should practice the best science, but deliver it to the patient as if we were seeing our friend sick on the sofa.

I do strive to provide the best evidenced care, AND have patients who are as satisfied by the experience as possible. I think its just being a complete doctor. Survey assessments have their limitations, but until we have something better its the Chest Xray if you will of the satisfaction assessment tools (it may not be perfect but it does give some useful information if it fits with the total picture). We do what we can at the bedside and hope it makes a difference

Regardless, I don't know the details of what you're going through and I hope it gets better. Patient satisfaction is always getting a bad rap, but I think it shouldn't be the concept of satisfying the patient that is the problem, maybe just the assessment tool.

 

[Apollyon]

I dont have any experience with the Press-Ganey scores and satisfaction surveys in our departments, but I really think that patient satisfaction / comfort is not an unbelievably separate concept from good patient care.

A colleague at my last job reminded me of a phrase from the past: "I'm here to save your ass, not to kiss it." Satisfaction for patients discharged from the ED is not nearly as high as that for those admitted, sicker, and do indeed have their lives saved.

Appeasing the patients to be discharged, especially among the group dynamic we see in the ED, is frequently at odds with good patient care. Getting dinged by a patient with a lac that got repaired very well, both functionally and cosmetically, but who had to wait due to other, more ill patients, is between "not fun" and "almost totally bogus".

 

[BJJVP]

I agree with thymeless in that pt satisfaction should not be thrown out the window.

However, it is not the ultimate goal. A pt with back pain that can walk, talk, text on his phone does not need IM opiates or an MRI. He will not be satisfied that I cannot fix his back pain but as a responsible physician, I shouldn't just satisfy him with whatever he requests for. I am all for keeping pts updated, blankets, water, clear explanations without excessive use of medical terminology. I am apalled as well by many residents lack of empathy and inability to communicate effectively.

Having said that, I just don't think press ganey effectively fixes the problem. And it does not motivate anyone to correct their bedside manners effectively either. I do not think it is the CXR of patient satisfaction. It's more like the WBC...not sensitive enough, not specific enough, rarely provides useful information, & misused by everyone.

 

[dotcb]

it's unfortunate that we have to care about metrics such as these. that said, if you want to do better...

I'm sure you're already doing most of the following, but if not...

there is a lot of theatrics in medicine, especially in the ER. here are some:

things like:
"i'm sorry for your wait, I'm Dr. X, how can I help you today?"
always sitting down when seeing the patient the first time
wearing a white coat
shaking hands with everyone in the room
telling everyone the plan before you begin it - if your rooms have whiteboards, write down your name, the nurse's name, the plan, estimated time, and overestimate it.
before you begin the plan, " are there any questions you have, or is there anything I can get for you before I order these things? Would you like pain medicine? How about nausea medicine? Let me know if you change your mind...
if someone expects abdominal imaging, and they totally don't need it, do a bedside US and explain/demonstrate al the structures and how normal they look. patients like technology.
tell them some results as they trickle in
compliment the other staff and consultants on shift with you
explain results
for consultants "the surgeon is operating right now, but as soon as he/she is done, they'll be here to see you."
consider printing out results
when saying goodbye "are there any questions you have, or is there anything else I can get for you? Would you like some pain medicine? How about a note for school or work?

once you make some of these things automatic in your practice, they become second nature, and when the patients like you, it makes you feel better, it makes your shift more enjoyable.

the thing to keep in mind is - it's not about you. it's about the patient.

if you treat every patient like they're a senator's wife, it ends up being good care, and that's pretty satisfying to provide.

it's a tough job we have - when you have 8-16 patients at once and you're practicing like this - it ends up being a lot of work. but having some of the catch-phrases roll off you tongue - it helps.

in the end, we have good jobs, make a nice salary, and it helps you feel like more than a glorified waiter.

 

[GeneralVeers]

I agree with some of the things said above, but a huge percentage of the discharged patients will NOT be satisfied if you provide them with good care. IN fact they are in the ED specifically to obtain shoddy care. Some examples:

-Migraine headache who wants narcotics.
-Back pain who wants an MRI
-MVA victim who wants c-spine x-rays that are not indicated.
-Abdominal pain x 1 year who "just wants an answer"
-Viral URI who won't leave without antibiotics
-Kid with "earache" for whom parents demand antibiotics
-Chronic pain patient who wants a refill of dilaudid pills
-Head injury patient with concussion who wants CT

All of these patients present for a singular reason. Sometimes no amount of reassurance will make them satisfied unless they get the test/drugs that they want.

 

[shopsteward]

It may not feel like it at the moment, but "no bad comments", especially given the nature of your workplace, is a major win. (If you are getting on well with your colleagues and co-workers, that is another major win.)

Negative comments in a customer satisfaction survey are fairly likely (ie more often than not, but not always, given that the malicious and bullying are always with us) to be down to some aspect of the individual being commented on. Positive comments/ratings are more likely than not to be down to the attitude of the individual doing the commenting, and tend to be less under the control of the person being commented on. (And no, I can't point to research which demonstrates these two points, it's just an extrapolation from personal and professional experience).

Also, a single customer satisfaction survey tend not to be very useful, as there is no baseline. Surveys to the same methodology over a period of time can show a trend, which is more useful.

The other thing wrong with nearly all surveys and work evaluations is that they focus on very short term issues, and ignore/are unable to evaluate long-term outcomes. So the glad-handing instant resulters look better than they should. (Often, these are the people who move on before their longer-term results become apparent.)

Carrying on behaving as a professional (whoring yourself not required) is the only way to go until you get your mojo back. I hope that happens for you soon.

 

[Birdstrike]

Maybe I shouldn’t be as concerned with this as I am but this burns me and I just have to vent it a bit. Now, give me a dirty work place (ED), give me obnoxious patients, rude/flat out belligerent patients, give me a douche-bag consultant who could really give a damn about patient care, or give me any of our day-to-day battles and I’m fine. In fact, these make the job what it is in a way. What I am having a really hard time swallowing is of all things, patient satisfaction.
Now I have ALWAYS considered this a strong point of mine. Personal interactions in general are a real strong point of mine. I genially love to interact with my colleagues, nurses, staff, and yes…my patients. I spend a lot of extra time with them and I get a lot of personal accolades directly from them and/or their companions. Too bad NONE of these patients evidently fill out surveys! This is NOT an aspect of my practice that I try to beef up on, or simply try to tolerate and treat patients like politicians treat constituents (as I see SO MANY do on a daily basis). I feel I really connect with patients and that’s just a part of who I am.
Needless to say, I have been looking at my scores and percentile within the group and I am NEAR THE BOTTOM! I felt like the character in those movies who just found out their whole life was a lie. OK, not to that extent, but this really pisses me off! I look over my surveys and NO BAD COMMENTS. Simply a whole heck of a lot of middle of the road, (straight lines down the middle sort of thing) apathetic responses. The ones that did comment, commented really positively on me. I took patient satisfaction as a constant in my practice. I felt…”well, if I am not the most productive, at least I will rock the PS”.
This just doesn’t make any sense!
Funny thing is, I have studied the docs that get 99%ile and I really don’t se any magic there. I am truly vexed.
I really don’t give any thought to what effect this has on pay (no bonus), it’s really a personal thing. It’s a damn shame that all I hear for the first year out is how “good I am with the patients” etc… and then this perverted epiphany

Perhaps what trouble me the most is the way this has changed how I look at the job, how I “see” patients. I don’t have the same fervor for coming to work. In fact, I manifest, almost instantly, almost all the signs of career burnout. I refuse to believe that one could be burned out so fast. And over something that I just know should mean less than I am making it out to be. I guess I would be fine with this if someone would just have let me know there was a problem.
So I go through the day, knowing I obviously need to “*****” myself out to these people, and I find myself almost disgusted. Now, a landslide of personal issues are compounding this I must say and I apologize for the vent. But as it stands… PS surveys can %$ %* @#&&

There's nothing I can say to make you feel better other than to say, "I've been there.". Read my posts, and you can tell, I've been there. EM is the one of the, if not the, hardest and most thankless job in medicine and you should get paid three times what you do for the BS you put up with and the insane chaotic hours you work.

Also, don't make too much out of one survey, and just don't be the one or two worst. Those are the guys they're going to focus on.

Despite what you're CEO and ED director will tell you, you're not a highly paid hourly burger flipper. You're a doctor. Screw 'em!

 

[GeneralVeers]

Despite what you're CEO and ED director will tell you, you're not a highly paid hourly burger flipper. You're a doctor. Screw 'em!

Well actually this is not good advice. As I've mentioned in similar threads, the hospital CEOs are paid large bonuses for Press-Ganey scores that hit a certain mark. If you are hurting their chance of getting a bonus, they will pressure y our group director to fire you. Ignore them at your own peril.

 

[xaelia]

Always entertaining, but the "most likely to kill someone" resident won the award for best patient satisfaction scores at our residency graduation.

He freetexts into their discharge instructions that he will pray for them.

If he has a good encounter, he brings them a form to fill out.

It's worthless clinically, but, well, apparently, our priorities have changed....

 

[WilcoWorld]

Well actually this is not good advice. As I've mentioned in similar threads, the hospital CEOs are paid large bonuses for Press-Ganey scores that hit a certain mark. If you are hurting their chance of getting a bonus, they will pressure y our group director to fire you. Ignore them at your own peril.

He didn't say ignore them, he said screw 'em. There's a difference.

 

[Birdstrike]

Well actually this is not good advice. As I've mentioned in similar threads, the hospital CEOs are paid large bonuses for Press-Ganey scores that hit a certain mark. If you are hurting their chance of getting a bonus, they will pressure y our group director to fire you. Ignore them at your own peril.

TrumpetDoc,

Unfortunately, he's right. It just feels better to say "screw em", but you do have to play the game. It sucks, it's wrong, but he's right.

What is also right, is that in most states it's illegal for a non-physician to own a doctors office but it's okay for non-physician businessmen who know nothing about medicine to run a hospital, and this is the kind of crap they force on you. It should be illegal.

 

[TrumpetDoc]

Thanks for the replies.
I should clarify a couple of points. This ubfortunatly is a trend as I am ableto get monthly reports of our PS results. The scores come back and we can get hard copies of the surveys. However, never a single "bad" score or any negative comment. I am just floored as to what I apparently need to do to get a good score. And what burns is I see people who are the "top performers" in this area and I am just completely vexed.
in fact, already do incorporate most of what was suggested above normally.
I really put some heart and soul into this and I really don't have any more to give.
I know there is not much to be made of these trona "medicine" or real life perspective and with my score not being really "_bad"I am likely not in too much danger...but it is really the hit to my self confidence and pride in this area. I mean, since I felt I was doing so great...I wonder if clinically I am mediocre as well 🙂

 

[michigator04]

...
If he has a good encounter, he brings them a form to fill out.

It's worthless clinically, but, well, apparently, our priorities have changed....

Is this allowed? It seems like a quick way to up your scores would be to encourage the happy patients to fill it out. Kind of an intentional sampling bias to counteract the unintentional bias that seems to exist already.

 

[TrumpetDoc]

Isn't it funny how nurses will @@&& a brick and relentlessly torment a doc for STUPID blood pressures like 170 systolic without symptoms and NEVER tell you your pt's or their pts (admitted pts) pulse rate jumps to 125 and oh, that's ok... It's just stress

 

[shopsteward]

It can happen that someone is so good at their job that they make it look routine, and other people just don't realise how good they are. Other people make the easy look difficult and then milk the applause - the circus performer approach.

Long-term, my view is that it is madness to try to be anyone but yourself. You are doing fine being yourself: if you weren't you would have something other than your survey scores telling you so.

If you want to massage your scores, you don't need to go as far as producing a survey form. For instance, where there has been an encounter that you are sure has gone well, you get the patient to echo back to you that it has gone well by asking "are you happy with X". They are likely to agree, and are then more likely to put "happy" on any survey.

 

[anonymousEM]

The lengths our hospital has gone to in order to insert "Excellent" (ie the only acceptable response for surveys) into our patients' vocabulary so that one might utter it in a "random phone survey" is getting ridiculous.

 

[Birdstrike]

Thanks for the replies.
I should clarify a couple of points. This ubfortunatly is a trend as I am ableto get monthly reports of our PS results. The scores come back and we can get hard copies of the surveys. However, never a single "bad" score or any negative comment. I am just floored as to what I apparently need to do to get a good score. And what burns is I see people who are the "top performers" in this area and I am just completely vexed.
in fact, already do incorporate most of what was suggested above normally.
I really put some heart and soul into this and I really don't have any more to give.
I know there is not much to be made of these trona "medicine" or real life perspective and with my score not being really "_bad"I am likely not in too much danger...but it is really the hit to my self confidence and pride in this area. I mean, since I felt I was doing so great...I wonder if clinically I am mediocre as well 🙂

No, no, no, no, no.

Think of all the horrendous docs you know who's patients love them! Do yo want to be that person? Some of the most incredible physicians are not necessarily loved by their patients every time. Yes, you do have to play the game but you cannot let it affect your "mojo". Yes, administration looks at it, but it is not the measure of you as a physician, any more than a frivolous lawsuit is.

There are some things you can do to easily get these number up. In these surveys, patients will say that these are the things they liked, "he sat down on a chair...he brought me a blanket...he smiled and shook my hand....he answered all my questions...he didn't seem in a hurry...he gave me what I wanted."

EM can be brutal, it really can.

 

[shopsteward]

The lengths our hospital has gone to in order to insert "Excellent" (ie the only acceptable response for surveys) into our patients' vocabulary so that one might utter it in a "random phone survey" is getting ridiculous.

I sense an SDN competition coming on for planting the most random word into a patient survey.

Anyone up for "discombobulating"?

 

[deleted6669]

it's bs but this is what 1 of our docs did to prove a point to go from worst to first in 1 yr.
he changed nothing about his practice except becoming the candy man. everyone with pain gets percocet. best scores in the group. he didn't change his bedside manner, didn't kiss any butts, just became a percocet dispensing machine.

 

[deleted6669]

I sense an SDN competition coming on for planting the most random word into a patient survey.

Anyone up for "discombobulating"?

or phantasmagoric.
"Dr smith was really excellent, in fact he was phantasmagoric."

 

[Daiphon]

or phantasmagoric.
"Dr smith was really excellent, in fact he was phantasmagoric."

I think someone should get a pt to drop in the F-McFP on a survey... that would be, leg-en-(wait for it)-dary! d=)


As an aside, to the OP, keep in mind that the PG surveys targeted to EM docs are only on the *discharged* patients - e.g. the ones described above, who wanted something else than what was indicated, and are thusly unhappy with the fact that their stubbed toe didn't get an MRI, nerve block, and methadone for pain. Personally, I think this is related to the "insurance" mentality that dictates most people will never have any true idea of the costs related to their ED visit & care.

Our happiest patients, IMHO, are the *admits* that we pull back from the brink, get into the hospital, and survive. Unfortunately, those get targeted to the last service to touch them - like a game of hot potato. Would be nice if there was a way to attribute PG scores from an admission to their point of entry... since EDs make up > 50% in most places, this would be some *very* interesting data.

Don't get discouraged; it's just another hoop to jump through. To paraphrase PT Barnum, you can make some of the people happy some of the time, but not all of the people all of the time.

Just my $0.02,
-t

 

[southerndoc]

Another thing not mentioned is patients (or any customer in general) will give higher ratings to docs or salesmen who are good looking. It's a sad fact but it's been proven by research.

For docs that get canned for bad Press-Ganey surveys, they really have grounds to sue and they should. Perhaps a few lawsuits lost by health systems that have fired docs because they didn't give out narcotics, etc would change this patient satisfaction trend for the better.

 

[WilcoWorld]

Another thing not mentioned is patients (or any customer in general) will give higher ratings to docs or salesmen who are good looking. It's a sad fact but it's been proven by research.

For docs that get canned for bad Press-Ganey surveys, they really have grounds to sue and they should. Perhaps a few lawsuits lost by health systems that have fired docs because they didn't give out narcotics, etc would change this patient satisfaction trend for the better.

SD & I don't agree often, but I'd like to commend this post. A successful lawsuit would likely do more than most other measures we can come up with.

Hear, hear!

 

[ccfccp]

The lengths our hospital has gone to in order to insert "Excellent" (ie the only acceptable response for surveys) into our patients' vocabulary so that one might utter it in a "random phone survey" is getting ridiculous.

We had signs put up in our elevators about a year ago that says something along the lines of, "We want you to be satisfied so that you'll "definitely recommend" us."

Made me throw up in my mouth a little.

 

[gutonc]

We had signs put up in our elevators about a year ago that says something along the lines of, "We want you to be satisfied so that you'll "definitely recommend" us."

Made me throw up in my mouth a little.

I went to visit my Dad in the hospital the other day and on the whiteboard in his room with all the usual information (Dr., RN, CNA, Rm #, Date, Dispo Plan, etc) it had a space for "Excellent care to me means:"

He told me they made him come up with something to put there...like an end-stage COPDer with PNA needs to participate in a role-playing exercise. He told them "get the hell out of here." They wrote, "go home as soon as possible."