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The Best Patient Satisfaction Strategy: Honesty

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Patient complaints. If you practice medicine long enough, you will get one.

Physicians have been taught since their first year in medical school to exhibit the highest professional standards at all times. In fact, as a third-year medical student I heard rumors the chairman of surgery would fail a student if they were found eating in a public space — because, as he put it, patients view us as machines, not succumbing to human needs or emotions.

The more I’ve practiced, the more I have come to believe the chairman’s sentiment. When conversations and stakes are crucial, as they are in medicine, the physician is expected to be infallible and emotionless, only using science and logic to make decisions.

We are human, however, and we react with similar emotions as our patients and their loved ones. It is this incongruence that leads to many patient complaints. How organizations handle complaints tells a lot about what’s valued by leadership.

Recently, a patient’s daughter told me of a complaint she filed against another physician. The physician and she were discussing end-of-life care for the patient. The physician, I later learned, had seen many other hospitalized patients that day — including one who had coded. The patient had terminal liver cancer that spread to her abdomen and caused fluid to build up in her stomach, low blood pressure, and confusion. The physician strongly advised the daughter to let the patient die in peace, without resuscitation.

The daughter, after many trips to the hospital and doctor offices watching her mother suffer but still holding out hope she would improve, was unwilling to consider the treating physician’s proposal. In fact, she raised her voice and told the physician to not bring that subject up again. At this point, the physician told the daughter to not cut her off while she was talking. The conversation ended with two people emotionally distraught.

The daughter told me she was so upset at the physician’s behavior she sent an email to a hospital administrator, detailing the physician’s conduct. The complaint initiated an internal investigation, for risk management purposes, which damaged the physician’s reputation to the administrators.

As I’ve been working to improve my own communication over the last year, I’ve learned the value in intentionally creating a safe environment for dialogue. When we feel safe in communication with another person, we are more apt to engage in meaningful, even difficult, conversations by building on shared interests and honest expression. We feel the other person actually cares about finding a mutually beneficial solution. If either party doesn’t feel safe, depending on their personality type, they either shut down, become passive aggressive, or try to win the conversation by being overbearing or domineering.

Because the physician and patient’s daughter did not feel safe with each other, the conversation broke down, resulting in a complaint. Instead of the complaint being used as an opportunity to determine the underlying motives behind each person’s positions, it was flagged for risk management. More than likely, another administrator performed data analysis on the complaint for correlation to Hospital Consumer Assessment of Healthcare Providers and Systems or other patient satisfaction surveys.

In this case, the physician was trying to avoid coding another person with low likelihood of meaningful quality of life. The daughter, exasperated, was trying to hold on to her mother for a little longer. Once the conversation broke down, each side resorted to trying to "win."

Clinicians are put in a precarious situation. On the one hand, physicians are expected to be almost emotionless in dealing with inherently emotional human situations, as the bottom lines of our organizations are increasingly tied to patient satisfaction. But performing our duty to provide honest, well-thought-out medical care does not always result in patient satisfaction, especially if the outcome is not what the patient or family expects.

In my view, our best option to move conflict to resolution is to try our best to maintain safe communication in two general ways:

1) Verbalizing at the outset that we want to honor the patient's and family's wishes. After all, it should be the truth in all our patient and family interactions. Thus, any seemingly challenging statements we say are said to educate and fully explain the case from our physician viewpoint so they can make the best decision possible.

2) Honestly explore our limitations. We need patients and families to be honest with us so we can best treat and advise them. The reverse is also true: they need us to be honest with our biases and limitations so they can make the best decisions regarding their health. Therefore, if we cannot accommodate a request, we should be upfront about it. If we disagree with a logical statement from a patient or family member, then we should respectfully give our take.

If we consistently show our humanity to our patients and families, they will come to realize what we already know — that in fact, we have the same emotions and fallibility as everyone else. It may be the best patient satisfaction strategy.

What is your best patient satisfaction tip? Strategize in the comments.

Dr. Freeman is a family physician and hospitalist with the Hospitalist Associates of Virginia, as well as a physician at Pathways Residential Treatment Center. He graduated from the University of Louisville School of Medicine and completed a residency in family medicine at VCU/Fairfax Family Practice. Prior to joining the hospitalist group, he was the Director of Adult and Family Medicine at Johnson Health Center and a National Health Service Corp Scholar. His interests include addiction medicine, primary care management of mental health disorders, and patient and family communication. Outside of work he enjoys spending time with his wife and three children, as well as real estate investing. He is a 2020–2021 Doximity Op-Med Fellow.

Illustration by April Brust

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