Do after-visit surveys help the doctor-patient relationship?

It’s a chance for patients to critique their doctors.

The information, collected through patient surveys, is commonly used by hospitals and medical clinics to rate the performance of both physicians and the organization.

Some patients relish the opportunity.

There are the thumbs up reviews — “the doctor is warm and empathetic, in addition to being highly knowledgeable,” wrote one Everett Clinic patient.

Others are more akin to a blunt Rotten Tomatoes movie review: “I am losing confidence in her abilities to maintain timely appointments,” another commented.

Yet patients are surveyed so often on their experience during medical appointments, it’s sometimes hard not to wonder: Does anyone really read these things? Does what I say really matter?

“I tell patients, ‘If you fill one out for us, my commitment is I’ll read it,’ ” said Erin Miller, a regional manager for Providence Health & Services.

One reason health-care organizations do pay attention: The difference between getting “good” and “very good” ratings can be the difference in whether patients return for more appointments and whether they recommend a specific doctor or the medical organization to others, she said.

Doctors and medical groups are very aware they’re being scrutinized and graded, and not just through patient surveys.

They often are publicly rated through a number of social-media sites, from those that award one to five stars based on patient comments to what is said about doctors on forums such as Yelp and Facebook.

“People listen to them,” said Dr. Erica Peavy of The Everett Clinic, whose duties include seeing the patient survey data. “That’s the reality we live with.”

If you really want to make an impression with your review, take the extra time to add comments.

Peavy said she pays more attention to those than the totals of the 1-5 scores asking about issues such as how well things went from the time they called to schedule an appointment to the moment they walked out the door.

“I read a lot of the comments every week,” Peavy said. “What people comment on gives me a sense of what’s really going on in the organization.”

‘The voice of the people’

Despite the widespread use of patient surveys, a recent Baylor University study has raised questions about their effectiveness. It focused on how they measure the strength of the doctor-patient relationship.

If the goal is to identify patients who really are disgruntled, current surveys will do that, said Keith Sanford, a professor in the Department of Psychology and Neuroscience.

The questions don’t do a good job in sorting the differences between people who think their care is marginally acceptable to extremely positive, the study found.

“It’s great at identifying the D’s and F’s, but can’t distinguish between A’s, B’s and C’s,” Sanford said.

Patients often have felt they don’t have the power to express concerns or criticisms to their physician. The surveys offer that opportunity.

They can help patients feel more empowered, he said. But Sanford said he hopes the questionnaires can be changed to make them more valuable in defining how good the relationship is between doctor and patient.

One recent change made by Providence is an example of the effect the surveys can have, Miller said.

A theme arose among women coming to its local clinics for pregnancy care — they wanted more consistency in who was treating them.

“They didn’t want to see a new provider every single month,” Miller said.

In January, the organization decided to designate a team of about three people to provide care to each patient through her pregnancy, she said. They’re checking in with patients to see how effective they think the change has been.

Both Providence and The Everett Clinic said that complaints noted on patient surveys are investigated.

Patient comments are reported weekly, Miller said. “If it’s great, we highlight them. If anyone expresses a concern, we review every single one of those and talk with all parties involved.”

The surveys help focus attention on doctor-patient communication. That’s something doctors didn’t get much training in until the past few years, Peavy said.

One clinic doctor, James Lusk, who oversees the walk-in clinics, was admired by his peers for his medical knowledge, Peavy said. But the surveys showed he struggled with patient communication.

One day he decided he wanted to fix that. He asked for coaching and, over a period of 18 months, his scores dramatically improved, Peavy said. He talks with fellow doctors about what he did to improve.

Comments made in patient surveys are part of physician performance reviews, she said.

“The way we think about the surveys is it really represents the voice of the patients,” Peavy said.

Sharon Salyer: 425-339-3486 or salyer@heraldnet.com.

Survey samples

Here is a sample of comments made by Everett Clinic patients as part of a survey on a recent appointment:

“I felt listened to. All my questions were answered. I was given treatment options and each was discussed thoroughly. We decided on a course of treatment based on lab results.”

“(The doctor) is warm and empathetic in addition to being highly knowledgeable, and I especially appreciate how skilled he is at explaining his thought process about any medical decisions that need to be made.”

“She listens and makes sure to answer all of our questions. She’s also always on time and has good availability. I also appreciate the promptness of her (and nurses’) replies through MyChart or phone calls.”

“(The doctor) did a wonderful job and helped diagnose a potentially life-threatening situation. I am very grateful.”

“Appointment felt rushed because so far behind in schedule. Provider did apologize for the delay.”

“I am losing confidence in her abilities to maintain timely appointments.”

Survey topics

Medical surveys question patients about topics such as:

• Whether it was easy to reach the clinic on the phone;

• The courtesy of reception staff;

• Friendliness of the nurse or assistant;

• Whether clear explanations were given by the doctor, physician assistant, nurse practitioner or midwife;

• Whether the patient feels the amount of time medical-care providers spent with them was adequate; and

• How well the patient was included in their medical decisions.