Physician quality ratings

[Deebs]

Here's the problem - even physicians can't agree. Having worked in a position where I oversaw Quality and patient satisfaction, I can tell you in the inpatient setting, more often than not, those with the lowest satisfaction received the highest quality care, and vise versa. Some of the docs that patients loved and raved about I wouldn't have recommended to my worst enemy. Another huge problem in emergency care is that drug seekers who aren't given narcotics tend to have very low patient satisfaction scores.

[Liisi]

Good point, Deb. There are certainly some patients who would only be satisfied with a doctor they could bully into giving them a lifetime supply of narcotics.
Yes, all of the issues are very complicated. And I'm sure there's tons I don't understand and/or an misinterpreting, or not seeing the entire picture of, since A) I'm not personally in the medical field, and B) my SO has only been a doctor for less than a year, and C) everything seems to be changing at lightning speed.

[diggitydot]

Here's the problem - even physicians can't agree. Having worked in a position where I oversaw Quality and patient satisfaction, I can tell you in the inpatient setting, more often than not, those with the lowest satisfaction received the highest quality care, and vise versa. Some of the docs that patients loved and raved about I wouldn't have recommended to my worst enemy. Another huge problem in emergency care is that drug seekers who aren't given narcotics tend to have very low patient satisfaction scores.

Precisely. How a patient feels about their doc is an exceedingly small aspect to their care. Yeah, it would be great if all health care providers somehow magically connected with all of their patients, but personality conflicts exist everywhere. If I had a doc that was super-duper warm and fuzzy, my head would probably explode.

Actually, come to think about it, the doc that has pissed me off most in my entire life was some freaky-weird über touchy-feely gal who obviously missed her calling to be a kindergarten teacher. I seriously wanted to rip her head off. At the time, I kept thinking, "Why the fuck are you talking to me like I'm a naughty 3 year old, bitch? I'm IN LABOR. Fuck off and admit me before I pop this kid out in your damn triage."

I'm not particularly pleasant when I'm in labor, but that chick bugged. However, her pay shouldn't be based on whether some crazy hormonal woman gave two shits about her.

[Vanquisher]

I am scared, and bundling sounds heinous!!!!!

That's all I've got.

[poky]

Actually, come to think about it, the doc that has pissed me off most in my entire life was some freaky-weird über touchy-feely gal who obviously missed her calling to be a kindergarten teacher. I seriously wanted to rip her head off. At the time, I kept thinking, "Why the fuck are you talking to me like I'm a naughty 3 year old, bitch? I'm IN LABOR. Fuck off and admit me before I pop this kid out in your damn triage."

HA! That *actually happened* to an acquaintance of mine - labor with first kid was pretty quick, and when the second kid was ready, she was *ready* - barely made it to the hospital, and the triage nurse was *insisting* on getting all the paperwork finished FIRST, even though she was literally crowning. Dad ended up catching before they were fully admitted, IIRC. Oh, and the best part? Mom was an employee of the hospital, even.

[scrub-jay]

And it doesn't just have to be narcotics or drug-seeking patients, with direct-to-consumer advertising, a patient might be "very unsatisfied" if a doc refuses to prescribe an inappropriate med, which is good medicine that would result in lower "quality ratings" and pay. What are the incentives here?

[Liisi]

No, doctors' pay shouldn't be based on their personalities or how many love letters they get from patients. And yes, sometimes, a patient receiving quality care has very little to do with their feelings for the doctor or the doctor/patient emotional connection. The importance of doctors' rapport with their patients often depends on the type of doctor they are, and/or the type of care/treatment the patient needs. I despised my radiation oncologist, but that was nearly irrelevant to my care - I put up with him in order to stay at that treatment center because I needed radiation for 33 week days in a row, so geographic location was much more important to me than whether or not I connected with the doctor. And if I had to be rushed to the ER for a life-threatening injury, I'd be so grateful to whoever saved my life, even if they didn't even know my name or were a jerk.

BUT, I would never stay with a primary care doctor whom I didn't like, was rude or dismissive, didn't listen to me, etc. Because sometimes, a patient's relationship with their doctor really does matter, and often it's correlated with how much time the doctor is able to spend with a patient. Sometimes patients who don't feel comfortable with their (primary care) doctor are dishonest or vague about their symptoms/health/lives, and thus receive incomplete or wrong treatment. If a doctor knows a patient needs a certain treatment but the patient is scared or mistrustful and there is no doctor/patient rapport or trust, the patient's health suffers. Sometimes a patient comes in with some vague complaint, and it's not until 30 minutes into the appointment, after the doctor has been slowly gaining the patient's trust, that the patient admits what the real problem is. That's the kind of stuff that has to be factored into the definition of "quality care" somehow. It takes time to provide quality care in primary care, but the system is set up to make primary care doctors rush through their appointments with patients in order to get all the paperwork done in time. The goal is always fasterfasterfaster.