Why are so many people leaving their physicians?
Patients seek better communication, information
Most patients give their physicians high marks on patient satisfaction surveys, but they may not be telling everything medical groups need to know. One out of four American households switched doctors in the past two years. The primary reason: dissatisfaction with their physician.
A national study of health care decision makers conducted for VHA, a Dallas-based health care network, found that dissatisfaction now exceeds managed care restrictions as a reason people look for a new doctor. Meanwhile, 28% of Americans said they added or selected a doctor for the first time.
As they look for or change physicians, patients consider the personal aspects of the relationship — the physician’s personality — as one of their top criteria. Poor communication or a gruff and hurried manner can have more impact on their satisfaction than even the care itself. Consider these findings (see box, p. 90):
- Health care consumers said their No. 1 expectation from a doctor’s visit is to receive information and have the doctor listen to them. That ranked higher than seeing the doctor quickly or receiving high-quality care.
- Almost three in four consumers said they were given no literature or other information resource at their last physician visit.
- When extremely satisfied patients were asked to give the reasons for their satisfaction, more than half said their physician explained everything in detail and was a good communicator.
"People are immensely concerned about the physician’s ability to relate to them as a person, the physician’s willingness to show a genuine interest in their well-being, and the physician’s ability to communicate effectively," says Ken Smithson, MD, VHA’s vice president of performance quality.
Increasingly, patients are seeing themselves as consumers of health care, not just passive recipients of care. And as consumers, they are harder to please.
"We’re starting to take the same preferences we have as customers in other encounters to the health care system," he says. "We’re expecting a lot more from physicians than we used to in the past."
Market Strategies Inc., a market research firm based in Southfield, MI, conducted telephone surveys with nationally representative samples of 500 to 1,200 adults who said they were the health care decision makers of their household.
The surveys showed that half of American households are looking for a physician in a two-year period: 26% are changing physicians, 17% are adding a physician because of a new health need, and 14% are choosing a physician because they didn’t have one. (Some respondents fall into more than one category.)
How well a physician communicates to patients will affect that selection, says Smithson. "We’re talking about 50 million people who are going to be choosing physicians," he says. "The way they choose physicians is through word of mouth with other patients. They’re going to be talking to other people trying to find out what is the doctor’s personality like, what is the communication like, how is the access."
Previous studies also have shown the importance of the patient-doctor relationship in patient satisfaction. "If you’ve got a good relationship with your physician, bad parking, even a rude front-desk clerk, is not going to make you change physicians," says Jerry Seibert, MA, president of Parkside Associates, a Park Ridge, IL-based consulting firm that specializes in patient satisfaction. "If you have a poor relationship with your physician and you just had a very unpleasant experience and then you have to walk seven blocks to the car, that could be the last straw."
With carefully worded questions, surveys can uncover aspects of physician communication and manner. Parkside patient satisfaction surveys hone in on the doctor-patient relationship, providing information physicians can use to better respond to their patients’ needs, says Seibert. (See sample questions on p. 91.)
"Everything is secondary to the interaction between the patient and the physician," says Seibert. "There should be more questions about what happens between the patient and the doctor than anything else in the survey. If you’re going to make a short survey, that’s all you should ask about."
A dose of health information
At VHA, Smithson tries to uncover areas of improvement by asking patients: "How did your experience in your doctor’s office compare to your expectations?" With that line of questions, he hopes to draw patients away from the automatic tendency to give everything high marks.
VHA, a national network of more than 1,850 community-owned health care organizations, has focused on providing patients with something they value greatly — health care information.
"We identified some pretty big gaps that can be closed by physicians who are willing to recognize and do something about it," says Smithson. "The health care consumer has an increasing desire for information around health care issues so they can be better participants in their care."
VHA developed an Internet-based information resource called Laurus. It is available to the public at large, but VHA-affiliated physicians can place their profiles, practice philosophy, and even a map to their office on the site. Laurus and its call center [(800) 4-LAURUS] provide medical information from reliable sources on more than 450 topics.
"What we do know based on the research is that being provided good information by their doctors is one of the things people value most from their visit," he says. "Walking out the door with only a verbal set of instructions that they may forget by the time they get to the parking lot often leaves them frustrated."
While better information and communication skills can enhance patient satisfaction, the managed care environment can erode the doctor-patient relationship. Greater demands for productivity, more paperwork, and confusing authorization and referral rules can place a strain on doctors and their connection with patients.
"From our research, people complain that they wait longer than they had to wait in the past to see a physician," says Ellen Severoni, RN, president of California Health Decisions, an Orange, CA-based nonprofit organization that helps health care providers, purchasers, and health plans identify and address consumer issues. "When they do see a physician, they feel he or she has less time to spend with them. From their perspective that does diminish the quality of care they receive."
California Health Decisions conducts focus group research, telephone interviews, public forums, and small discussion groups to gauge the concerns of consumers. They found that patients are particularly unhappy with the process of referrals and authorizations to receive specialist care or certain treatment. In focus group discussions and telephone interviews with 1,000 health plan members, one-third of respondents reported having referral or authorization problems.
But patients don’t always understand the different role of health plans and physicians, says Severoni. They may become dissatisfied with a physician or medical group although authorization delays stem from the health plan.
The consumer perspective
Confusion over the different policies of different plans also makes it more difficult for physicians to act as advocates for their patients, says Klea Bertakis, MD, MPH, professor and chair of the department of family and community medicine at the University of California, Davis, in Sacramento.
"It can be difficult trying to explain to the patient why things are not covered," says Bertakis, who has studied interactions among patients and physicians. (See related story, p. 92.)
Yet by going beyond the traditional patient questionnaires to solicit consumer opinions, physicians can begin to heal the relationship, says Severoni.
Health plans as well as medical groups are beginning to integrate the consumer perspective into their practice, even setting up consumer advisory panels, she says. Accepting the voice of consumers in the health care process creates a wealth of good will, says Severoni. "People actually feel more like partners in their health care," she says.
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