I Can't Get No Satisfaction

Dr. Robert Centor of the db's Medical Rants blog points to this article in The New Yorker, When Doctors Tell Patients What They Don't Want To Hear, highlighting the linkage of payment for physicians' services to Patient Satisfaction Scores.

Will our patients still like us if we tell them things they don’t want to hear? The challenge of communicating unpleasant, possibly profoundly upsetting information to patients is timeless. What has changed, however, is that physicians are now being judged, and compensated, based upon their ability to do it.

In October, 2012, Medicare débuted a new hospital-payment system, known as Value-Based Purchasing, which ties a portion of hospital reimbursement to scores on a host of quality measures; thirty per cent of the hospital’s score is based on patient satisfaction. New York City’s public hospitals recently decided to follow suit, taking the incentive scheme one step further: physicians’ salaries will be directly linked to patients’ outcomes, including their satisfaction. Other outpatient practices across the country have also started to base physician pay partly on satisfaction scores, a trend that is expected to grow.

We all hear the stereotype - Doctors are rude, egotistical bullies who don't listen to patients. There's a post on today's Dr. Kevin Pho blog on Doctor Bashing as a national sport. Yes, there are times when a physician can seem gruff and tactless. There's little excuse for that. However, telling someone what they do not want to hear is not always easy nor is it usually especially well-received. This is the one area where the customer service model falls flat on its face. Face it, the customer aka patient is not always right. Now while a patient with advanced cancer understands the grim prognosis after hearing the bad news, someone with Type 2 Diabetes might not well appreciate that in order to ameliorate the disease process, he would have to stick to the program - often, for life. People don't wish to hear that they need to lose weight or give up old habits, even if intellectually, they know it. Should the messenger be penalized for the message?

For myself, I realize that I too need to face reality - Patient Satisfaction Scores are not going away anytime soon. So I need to remember that the patient is as human as I am and needs to be "handled with care." For my part, I will try to deliver the bad news in a professional and caring manner. I would ask all of you kindly to not shoot the messenger.