DENVER – In the opinion of Dr. Steven R. Feldman, key elements of the therapeutic process include making the right diagnosis, prescribing the right treatment, and getting patients to use prescribed medication.
"These three elements can be considered technical aspects of care, but patient satisfaction is also critical in its own right, because it determines the outcomes of care," Dr. Feldman said at the annual meeting of the American Academy of Dermatology.
Getting patients to use prescribed medication, for example, "is critical to treatment success and depends on the quality of the interaction between patients and clinicians," he said. "You want that interaction to be good. Not only is it good for business and reduces malpractice risk, it is essential for getting patients well."
Dr. Steven R. Feldman
In dermatology, medication compliance among patients with acne and psoriasis is notoriously poor, but physicians can make an impact by focusing on trust, motivation, and understanding, said Dr. Feldman, professor of dermatology, pathology, and public health sciences at Wake Forest University, Winston-Salem, N.C. "These factors are just as important as the right diagnosis and the right treatment, and they’re largely under our control," he said.
Dr. Feldman, who founded the online patient satisfaction survey service www.DrScore.com, listed seven traits that patients identify in outstanding physicians: access, communication (including listening, forming partnership with the patient, and giving information); a personality/demeanor that projects empathy; medical care (including technical competence, timely diagnoses, treatment, and thoroughness); follow-up (including test results and referrals); facilities; and office/staff coordination.
"Traits patients don’t like include poor access, poor communications, poor follow-up, and a lack of interpersonal skills," said Dr. Feldman, who also is a member of the AAD Outcome Study Workgroup. "In good medical practice you want to make the right diagnosis, prescribe the right treatment, communicate and follow up, and project the appearance of empathy. Think about how you are going to pay attention to this particular patient just before you enter the room."
He noted that, when it comes to patient satisfaction, projecting the appearance of empathy is actually more important than being empathetic.
"I assume all doctors care deeply about their patients," Dr. Feldman said. "But if the patient doesn’t realize the doctor cares, then the patient will not be satisfied, won’t be trusting, and is at risk of poor adherence and poor treatment outcome."
Patient satisfaction studies suggest that patients care more about having a caring/friendly physician than the physician’s age, gender, or office wait time.
"It’s not just the doctor’s behavior that’s important," he continued. "Attend to warmth and fuzziness in your entire practice as though it matters, because it does. Our beliefs are strongly influenced by context."
Simple ways to foster positive physician-patient interaction include using images to communicate risks in perspective, providing written instruction for care, and giving your cell phone number to patients. That gesture alone "is a powerful statement of how much you care about the patient," Dr. Feldman said. "Leave your patients with the clear realization that you care about them."
Counseling patients about the potential side effects of medications is also important, "because fear of [side effects] can reduce compliance," he said. "For acne patients on spironolactone, you might say something like, ‘This drug is a diuretic. In addition to its effects on your acne, you may also notice some weight loss.’ For patients with scalp psoriasis, you might tell them that their recommended treatment may sting. The stinging is a sign that it’s working."
Dr. Feldman disclosed that, in addition to founding DrScore.com and the adherence company Causa Research, he has received grants and/or research funding from numerous pharmaceutical companies.