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More Patient Satisfaction Ridiculousness

Pouting

Dr. Whitecoat refused to remove something that was hurting my ear. He was rude, insensitive, and refused to help me with my medical problem. I would never come back to your hospital if I knew he was working.

That little diatribe was in addition to all of the “1” scores that the patient used to rate my care. Of course, none of them were true, but satisfaction scores are a presumption of guilt, not a presumption of innocence.

What did I do to deserve this scathing review? I actually remember the case.

The patient’s complaint was “foreign body in the ear.” Easy enough. He was in his 70s, so it was probably just a piece of cotton from a Q-Tip.
When I got into the room, it wasn’t quite so easy. The patient had a tympanostomy tube placed about a year ago. He wasn’t sure why it was placed. But the day before he came to the emergency department, he had gone to get fitted for a hearing aid and the person who did the exam noted that the tube was still in his ear.  Then he showed up on a Saturday night.
“There’s a tube in my ear. I want it out,” he said, matter-of-factly.
After examining him, the tube was still in place. “It’s still in your eardrum,” I explained, “I can’t take it out.”
“Well … it hurts. You need to do something about it. They won’t put in a hearing aid until the tube is out.”
“I don’t do ear surgery. I don’t have the experience or the equipment to take the tube out. Besides, even if we were able to take the tube out tonight, they wouldn’t put in a hearing aid immediately. You’ll need to follow up with the ENT physician who put the tube in.”
“Are YOU going to get me an appointment?”
“I won’t be able to do anything on a Saturday night. You’ll have to call his office on Monday.”
Then the patient’s wife jumped in.
“The tube is giving him ringing in his ear, also. What are you going to do about THAT?”
“There usually isn’t much we can do with tinnitus. When did it start?”
The patient and his wife looked at each other.
“A few hours ago. And it’s really bad, too.”
“You didn’t have the ringing before a few hours ago?”
“No.”

So I went to the medical records. The patient’s last visit with the ENT physician was six months prior to his emergency department visit. The note mentioned that the tympanostomy tube was in proper position. It also mentioned that “Mr. Smith also complained about his chronic tinnitus. We had a long discussion about this and I informed him that there wasn’t much we could do to treat it other than possibly having him fitted with a hearing aid.”

I printed out a copy of the note and read it to the patient and his wife.
“I’m not sure what else I can do to help you tonight.”
“C’mon. We’re leaving,” the patient said to his wife, “It’s obvious that this doctor isn’t going to help me.”

So, based on four whole responses rating my care from the last set of Press Ganey questionnaires, guess whose care fell far below the rest of the physicians in the department.

But don’t worry. The results are statistically significant enough to compare me to the other doctors in our department and to all of the other physicians nationwide. Press Ganey says so … and their multi-million dollar business model depends on people believing it.

Want to see the truth behind Press Ganey scores? Check out the Patient Satisfaction articles on this site.

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This and all posts about patients may be fictional, may be my experiences, may be submitted by readers for publication here, or may be any combination of the above. Factual statements may or may not be accurate. If you would like to have a patient story published on Dr.WhiteCoat.com, please e-mail me.

 

8 comments

  1. Has there ever been in your entire career a survey filled out about you that was truthful and justified? Not a good one but a not so good one?

    • Of course. There are many times in which patients complain that they waited too long to see the doctor. Those are often truthful and justified – but they don’t take into account the underlying circumstances such as volume surges, physicians caring for critically ill patients, etc. There are also times when patients complain that they didn’t receive a test or a prescription. Those are also truthful, but if those desired tests/prescriptions are not medically appropriate, they aren’t justified. I can say that in the vast majority of cases, a complaint of being “rude” is just icing thrown onto the unhappy patient’s complaint to try to make it more compelling.
      The problem is that there are several questions that are graded and the statistics gleaned from those questions are compared across the country.
      For example, our set of questions is as follows (each graded on a 1-5 scale):
      – Courtesy of the doctor
      – Degree to which the doctor took the time to listen to you
      – Doctor’s concern to keep you informed about your treatment
      – Doctor’s concern for your comfort
      To grade anyone as “1” which equates to “very poor” across the board on these items is untruthful, and it certainly didn’t apply to the interaction I had with the patient above.
      These types of issues make satisfaction scoring (as opposed to patient feedback) not only baseless, but harmful.

  2. I’m saying this in a very nice way, because im not for them or against them. I’m only for truth and fairness for everyone! lucky for Doctor’s and Nurses who know the difference between right and wrong, and from good and bad care, always! bet big money you guys have an advantage over us regular lay folks “patients”. If you or one of your family members are unhappy with the care you received maybe most of you would never fill out a survey, but I’d bet some do!! Let’s be honest:) the great news for you guys though unlike the rest of us, you complaining probably would be taken more seriously, appreciated then addressed ASAP, so no need to fill out anything. Most people believe there not even read, good or bad, and that’s the truth.

    • You don’t have to explain. It was actually an insightful question.
      You’re wrong about the complaints, though. Every one gets reviewed.

  3. As long as you have enough patients I would expect the bad apples like this guy would average out and not be a problem. The problem with patient satisfaction is that it dings the doc for failing to provide desired but inappropriate care.

    • That’s the point. In a vast majority of cases, there aren’t enough patient responses, making the results statistically invalid. Then, when the difference between “excellent” and “very good” (which really amounts to “pass” versus “fail”) is 0.04 of a point on a 1-5 scale, a single bad survey widely skews the scoring.
      It is a racket that benefits no one but the companies compiling the data.

      • Do patients even KNOW that they may give feedback?

        Bad patients will always seek out a way of giving negative feedback, but what about the vast majority of your patients? Do they even know that feedback is possible?

        • Patients are randomly sent surveys, so the ones receiving surveys are obviously aware.
          And even if they don’t receive surveys, in a world full of online comment sections, online ratings, complaint forms, and feedback requests on cash register receipts, I find it difficult to believe that patients have no inkling that they can look into ways to provide feedback on their hospital experiences.

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