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There are a number of factors that influence whether a patient will adhere to a treatment regimen. In part 2 of our discussion on adherence, Dermatology Times editorial adviser, Elaine Siegfried, M.D., and adherence expert, Steven Feldman, M.D., discuss physician-patient relationships as a critical component.
There are a number of factors that influence whether a patient will adhere to a treatment regimen. In part 2 of our discussion on adherence, Dermatology Times editorial adviser, Elaine Siegfried, M.D., and adherence expert, Steven Feldman, M.D., discuss physician-patient relationships as a critical component. According to Dr. Feldman, when patients trust you and perceive you as caring, they’re more likely to use their medicine. The two discuss the power of empathy and patient satisfaction measurements. Dr. Feldman is a professor of dermatology at the Wake Forest University School of Medicine, Winston-Salem, N.C.
Dr. Siegfried: A factor in influencing patient adherence is physician empathy. What mechanisms do you use in your office to convey empathy?
Steven Feldman, M.D.Dr. Feldman: I am a M.D., PH.D., a protein chemist, with no particular social skills whatsoever. I went into medicine with the idea that, “I’m going to give patients the right diagnosis. I’m going to give them the right treatment. My patients are going to do great. I’m going to be a great doctor.” I had no interest in psycho-social anything. Consequently, some of my patient satisfaction scores were low and I had to really work at, and think about, empathy. When I walk into clinic I think of it as an experiment in how to get patients to use their medicine. I’m getting the right diagnosis, I’m prescribing the right treatment, but if I want patients to get well I’ve got to get them to use the medicine.
Patients’ perception of physician empathy is the single most important thing I can do to get patients to use their medicine. If patients think I’m a caring doctor, they will trust me and they’re going to be much more likely to use the medicine.
So what do I do to convey a perception of empathy? First are the things the patient sees before you see them:
Other ways of interacting with patients that convey empathy:
To be efficient with an EMR, I have to type with my back to my patients. So, while I’m typing, I will say to the patient, “You know I really like the old days when I could sit and talk to you face to face. This typing really takes me away from that.” I may a joke with them. I’ll ask them what their job is, and then I’ll say “You know what my job is. I’m a highly paid typist now.” I’m trying to establish rapport with the patient and help them to understand that just because I have my back turned toward them doesn’t mean I don’t care about them.
I read recently about the value in listening to what patients say as opportunities to connect with them. I have to work more on that. Every moment that you’re with patients, you should be thinking about how you can better your interaction with them.
More in this series on medication adherence
Dr. Siegfried: I read with a lot of interest about your www.DrScore.com website. Can you talk more about this?
Dr. Feldman: Sure. Our university started doing patient satisfaction surveys a few years ago. One week every quarter, people were filling out surveys in the hallway, immediately after their visits. It wasn’t good for confidentiality or patient flow. The nurses would dress nicer during this week, and they’d treat people nicer. I thought a better way to do these surveys would be to collect patient satisfaction survey data online. Patients could respond after they got home, it would be more confidential, patients would feel more free to give us honest and open feedback, and we could ask every patient to do give us feedback all year round. This would mean the nurses would treat patients nice all year round, and we could communicate to patients that we care about them by asking for their feedback at the end of every visit.
I also thought it would be valuable to put the doctors’ overall scores online for a couple of reasons:
The public doesn’t really have an accurate sense of the quality of medical care in the United States. Even physicians do not have an accurate impression of the quality of medical care in the United States.
Patients look at their experiences. The general public knows the quality of American medicine by reading the newspaper. They look at the front cover of the newspaper, and they see stories about doctors: a University that gave a patient the wrong blood and the patient died; a pediatrician who abused children.
There are two million to three million office visits in America every year where everything goes great, and none of those are front page news. You get this warped sense that American medical care is much worse than it really is.
Doctors face the same kind of bias. I’ve seen patients who’ve been referred by family doctors and by dermatologists in private practice in my community. I think I can count on one hand the number of times that the patient was satisfied with the care they got from those other doctors. The obvious reason for this is that the patient wouldn’t have been referred to me if they were happy with the care they got and were cured of their disease. So doctors only see other doctors’ failures. You never see their successes. You get the idea that maybe the other doctors aren’t doing a very good job.
By putting a representative score out there for the world to see it would help the general public’s impression of doctors. We’ve published in The Dermatologist, the average scores of doctors, of dermatologists.[i]
We have representative data on dermatologists, because the American Board of Dermatology lets dermatologists use DrScore.com as one of the ways of collecting patient satisfaction surveys for maintenance and certification. We’ve collected a fair amount of data now, and we find that the average score of a dermatologist on a 0-10 scale, where 0 is horrible and 10 is great, is 9.5.
Nobody would have guessed that it was that high. Patients absolutely love their doctors. So I thought it would be very helpful for us to let people know.
Websites are putting open comments on the web. Doctors are beginning to put their patient’s open comments on the web. I think it’s a very reasonable thing to do, because for every bad comment you get, you probably have 10 or 20 super positive comments. Even I do - the protein chemist with the lack of social skills. The vast majority of my patients love me and say great things about me on the surveys.
Dr. Siegfried: There are so many of these doctor score websites. How does DrScore.com differ?
Dr. Feldman: Well one of the major differences is that DrScore.com doesn’t show the open comments. It only shows the numerical scores. DrScore.com collects patients’ open comments and provides them to doctors who use this as their patient satisfaction survey service.
DrScore.com is designed to serve two functions: It’s designed to give the doctors a very low cost, easy way to collect patient satisfaction survey data and to see how they’re doing relative to other doctors.
The other major way that it differs is in the patients who visit. Patients who visit doctor rating websites tend to be the unhappy patients. By creating a doctor rating website that doctors would actually send their patients to is a way of collecting much more representative data on the quality of care doctors are offering; so that the scores that are shown to the public are representative scores. Doctors have nothing to fear from representative scores.
You can actually do this with all the rating websites. If you have a bad rating or two on a website, just ask the next 10 or 20 patients to go to that website and provide feedback on their visit. I think that’s the best solution. If you try to fight doctor rating, it makes you look like you’re trying to hide something. We doctors have nothing to hide. I’m at like a 9.1, maybe a 9.3, somewhere in that range. That puts me solidly in the bottom half of American dermatologists.
Dr. Siegfried: So in your practice you recommend or request that patients go to this website to give you feedback and what kind, is that correct?
Dr. Feldman: So when I was actively using DrScore.com, I would give patients a card with the website, and ask them to provide feedback. It’s much more practical to put it on the back of the return appointment card. You can add a line that says, “We appreciate the trust that you put in us. We want to give you the best possible care. Please give us feedback on how we did today at this website.”
Dr. Siegfried: Of all the patients that you asked to do this, how many went on the website?
Dr. Feldman: That is a great question. I think if I personally asked them, I’d get a higher response rate, and even then it’s probably only one in 10.