A physician who had a side gig as a pig farmer wanted to breed his three female pigs with the boars on a neighboring farm. He loaded them into the back of his pickup truck and took them to visit several boars at the nearby farm. While the pigs were getting acquainted, the farmer of the female pigs asked the second farmer, “How will I know if my pigs are pregnant?”

“That is easy,” said the second farmer. “They wallow in the grass when it takes, and they wallow in the mud when it does not take.”

The next morning, the farmer awoke, looked out the window, and found his pigs wallowing in the mud. He loaded them into the truck and returned them to the boars. But the following morning, the pigs were still wallowing in the mud. Undaunted, the farmer once again loaded the pigs into the truck and returned them to the boars for a third time, hoping for better results.

On the third morning, the farmer was away from the farm, so he anxiously phoned his wife and asked, “Are the pigs wallowing in the grass or the mud?”

“Neither,” replied the wife. “Two of them are in the back of the pickup truck, and the third one is up front, blowing the horn!”

Moral: You get what you reward.

Defining patient satisfaction

Most of the medical profession believes that most patients are satisfied and appreciate the care they receive from doctors, nurses, and allied professionals. Patient satisfaction is an elusive concept and is often difficult to measure. However, systems and metrics are in place to provide objective evidence of patient satisfaction beyond patient satisfaction surveys.

The need to improve health care quality is increasing. When patients can go to Amazon and order a product with just a few clicks, have it delivered in one to two days, they expect that level of efficiency in their health care experience as well. The Centers for Medicare & Medicaid Services (CMS), hospitals, and insurance providers are working to better define and measure health care quality. Doctors and staff must understand that patient satisfaction is a major component of health care quality. Furthermore, patient satisfaction is important for patient compliance and outcomes, including lower mortality, fewer readmissions, improved treatment adherence, and greater patient engagement in their care. Patients who are satisfied often experience higher-quality care and better communication, and feel more empowered to manage their health, leading to improved clinical outcomes.

Good patient-staff interactions and clear communication are central to satisfaction and better outcomes. When patients trust their doctors and feel heard, they are more likely to engage and participate in their own care.

My take-home message is that patient satisfaction is not just about “feeling good”; it is a meaningful indicator of the quality, safety, and effectiveness of the services you provide.

The impact of policy and demand

Potential changes to health care policy and insurance coverage may create millions of patients who do not have health care insurance. As a result, many of these patients will avoid health care and become sicker than patients who have insurance and access to care. Consequently, these patients will require more of a physician’s time. This is compounded by slow reimbursement growth and rising overhead costs. That translates into a decrease in physicians’ incomes. All of this means health care providers will have to see more patients than previously.

When doctors see more patients and spend less time with each, there is a greater risk of declining patient satisfaction and increased litigation risk. This increase in service demand results in reduced access to care, longer wait times, and physicians looking at their computers rather than patients. This results in greater dissatisfaction among our patients and increased stress for doctors and their staff. With this increased demand for services in an already chaotic atmosphere, who has time to worry or even care about patient satisfaction?

The power of reputation

Practices and doctors need to demonstrate to the community that they are committed to quality care, and they need to identify ways to improve quality to remain competitive. Patients are our customers, and as customers, they have the right to choose where to receive medical care. Patients are easier to serve if they feel their needs are being met. This results in happier staff and patients.

Conversely, when patients’ needs are not met, we often hear about it through angry letters, poor satisfaction scores, or negative reviews on online review sites. In the past, if a patient had a negative experience with a doctor or their practice, they might have told 10 to 20 others. Today, that same patient, with a negative experience, can go online and post a scathing review that hundreds, if not thousands, of viewers will see. This affects more than doctors’ ratings. A negative review can deter existing patients and potential patients from seeking medical care elsewhere. This is why patient satisfaction is extremely important to your practice.

Certainly, our challenge as physicians is to continue striving for high RVUs while maintaining high patient satisfaction scores to bolster our reputation, not to mention our own job security and participation in various health care plans. In addition, patient satisfaction will be a scorecard used to determine physicians’ compensation, as those with low patient satisfaction scores will not receive salary bonuses.

Managing the wait

Our patients come to us when they are vulnerable and in pain. They are often scared and anxious, and then accept long wait times. Patients wait in the reception area, wait to return to an exam room, wait to be seen by a physician, wait for test and imaging reports, wait for emails to be answered, and wait for their telephone calls to be returned. This all leads to decreased satisfaction.

Satisfaction trends will have peaks and valleys, but the overall trend should always be increasing. Making patients feel unique and keeping them updated during their wait times may also help increase patient satisfaction. How we speak and act influences our patients’ healing process. When patients feel more comfortable, their anxiety decreases, and they are better able to understand their treatment plan and the importance of adhering to the physician’s recommendations. We may all reach the same diagnosis for a patient, but satisfaction also depends on how the patient was treated while we reached it.

Communication is key to patient satisfaction. We must acknowledge our patients’ feelings and concerns and let them know we understand and are actively listening to both their verbal and nonverbal communication. It is not only what we say, but also how we say it. Our patients must feel that we care and have their best interests at heart. When dealing with angry or upset patients/families, several techniques can help defuse the situation, all based on how we communicate.

Suggestions for improving the patient experience

Suggestions for improving the patient experience and improving patient satisfaction scores include:

• Start with the telephone. Try to answer the phone in three rings; the receptionist should identify themselves; avoid phone trees and placing callers on hold; and finally, use the caller’s name during the phone call.
• The doctor or nurse should knock on the door before entering the exam room. Knock and then wait two to three seconds to allow the patient to become physically and psychologically ready for the encounter.
• The doctor or medical assistant should introduce themselves. Introduce yourself not only to the patient but also to the patient’s family and friends. I also suggest that staff and the doctor have their names on their white coats or uniforms.
• Sit down and maintain eye contact. The doctor or the person taking the history, such as a scribe, should sit down, be at eye level, and maintain eye contact. If possible, do not allow the exam table or other barriers between the health care provider and the patient.
• Do not turn your back on the patient. Don’t turn your back on the patient while entering data into the electronic medical record (EMR). Configure the rooms so the doctor can view the computer and the patient simultaneously, or use a tablet or iPad to enter data, allowing the physician to look at both the patient and the computer.
• Your body language is important. I suggest you lean slightly forward and avoid holding your arms across your chest, as this is a defensive posture.
• Make sure the patient is comfortable. If your patient requests a blanket, obtain it yourself rather than relying on someone else. Remember, our behavior sometimes speaks louder than words.

Bottom line: Patient satisfaction means putting patients first or adopting a patient-centric philosophy so that every patient has a positive experience with the physician and the practice. And like the three pigs, you will be rewarded with stellar patient satisfaction scores.

Neil Baum is a urologist.