I have a love-hate relationship with patient reviews and satisfaction scores. I love good reviews and hate bad ones. Actually, I skim good reviews and then dwell for days on the negative ones, trying to rack my brain as to what I did wrong. Like everyone else, I have off days when I’m tired or distracted or just overwhelmed. Though I try to bring my A game to every patient visit, realistically, I know that I don’t always achieve this. But, for me, the difference in my best visits and good-enough visits is the difference between a 4-star and 5-star review. What’s up with those 1-star reviews?
Many, many years ago, when patient satisfaction scores were in their infancy, our clinic rewarded any physician who got a 100% satisfaction score. On the surface that makes perfect sense – of course, our patients should be satisfied 100% of the time, right? When I asked one of the winners of this competition how he did it (I never scored 100%), he told me, “I just do whatever the patient wants me to do.” Yikes, I thought at the time. That may be the recipe for an A+ for patient satisfaction but not for quality or outcomes.
Sometimes, I know that they are going to be unhappy, such as when I decline to refill their drug of abuse. Other times, I have to exercise my best medical judgment and hope that my explanation does not alienate the patient. After all, when I say “no” to a patient request, it is with their overall health and well-being in mind. But I would be lying if I said that I have matured to the point that I’m not bothered by a negative review or a patient choosing to take their care elsewhere.
Most of us seek and welcome feedback. Over time, I’ve learned to do this during the visit by asking “Am I giving you too much information?” or “What do you think of the plan?” or “What’s most important to you?” There are times when I conclude the visit and know that the patient is not satisfied but remain unable to ferret out where I let them down – even, on occasion, when I ask them directly. Ideally, any feedback we get from our patients, positive or negative, would be specific and actionable. It rarely is.
There is no doubt we have entered the era of consumer medicine. Everything from the physical appearance of our clinics to the response time to electronic messages is fair game in how patients judge us. As we all know, patients assume competence – they are not usually impressed by your training or quality outcomes because they already believe you are clinically competent (or arguably they’d never set foot in your office). Instead of judging us how we often judge ourselves, patients form opinions about us by how we enter the room, whether we sit or stand, how long they wait in the exam room before we come in, or whether they like the nurse with whom we work. So many subtle things – many of which are outside of our control.
I often struggle with staying on time. When I am invariably walking into the room late, I make a point of thanking patients for their patience. When I’m very late, I offer a more detailed, HIPAA-compliant explanation. What I wish my patients saw was that I am often accommodating a patient who arrives late for their appointment or who wants me to address every concern they’ve had for the past 5 years. While I aspire to not allow the patient’s perception of the visit to unduly influence how I handle the visit, it inevitably does. I do want to have patients who are happy with their experience.
One of my friends is enviously pragmatic in her view on patient experience. “I’m not their friend and they don’t have to like me.” She emphasizes the clinical care she is providing and does not allow patients who are upset with some aspect of the care to weigh heavy on her. It may be that specialists are more likely to enjoy the luxury of putting aside how patients feel about them personally. In primary care, the patient-physician relationship is so central to what we do that ignoring your “likability” has the potential to threaten your professional viability.
I conclude this blog much like I started it. My desire is to allow the negative reviews, particularly if they have nothing actionable in them, to roll off my back and to keep my focus on the clinical care that I am providing. In actuality, I care deeply about how my patients experience their visit with me and will likely continue to take my reviews to heart.
Dr. Frank is a family physician in Neenah, Wisc. She disclosed no relevant conflicts of interest.
A version of this article first appeared on Medscape.com.