PracticeUpdate: Dermatology - Winter 2018

EDITOR’S PICKS 6

Determinants of Patient Satisfaction in a Dermatology Outpatient Clinic Journal of the European Academy of Dermatology and Venereology Take-home message • The authors of this prospective survey study of 133 consecutive, newly referred patients assessed the factors that determine patient satisfaction in an outpatient dermatology clinic in Denmark. On a Likert Scale of 1 to 5, with 1 indicating the highest expectations, patients reported very high pre-consultation expectations of their doctor being respectful and helpful (mean values, 1.25 and 1.33, respectively). Increasing age was associated with a greater expectation of receiving a full disease explanation, having a physical examination performed, having diagnostic tests performed, being given a specific diagnosis, and receiving reassurance. In general, patient expectations were not met with regard to the degree of patient involvement in making treatment decisions, receiving detailed explanations about conditions, discussing the benefits, side effects, and complications/risks of treatment, and having diagnostic tests performed. • Patients expect to be provided detailed information about their diagnosis and treatment options and to be actively involved in medical decision-making during their visits. Patient satisfaction improves with increasing age, the feeling of being able to influence the visit, and having expectations met. Jeffrey F. Scott MD

" I am quite sure I don't meet every patient's expectations, but sometimes I appear to be the first person to have told a patient

that I cannot cure his or her disease!

"

COMMENT By Eliot N. Mostow MD, MPH

P atient satisfaction is an obvious goal for every clinical prac- tice, including dermatology practices. While some will bristle at worrying too much about patient satisfaction as a metric of success (ie, isn't it enough to get the diagnosis and treatment right, thereby improving patient outcomes?), the present study and my own bias is that a few simple measures can often make a huge difference in patient satisfaction. Think back to your mentors. Many were exceptionally good clinicians and teachers, but they also demonstrated a knack for properly setting and exceeding patient expectations. I was inspired to do the same. As an inde- pendent physician, I don't have a business entity monitoring my actions via digital survey tools such as Press-Ganey. I am, however, affected by the online world of patient commentary that lets the whole world know "how well I'm doing." The authors rightly point out that meeting patient expectations with courtesy and under- standable explanations/information increases patient satisfaction. Of course, this is not too surprising; however, I'll offer my own com- mentary on this subject. While this forum does not routinely print readers' suggestions, if you have thoughts on this topic, please email me at emostow@neomed.edu. • "Work hard, be nice, accommodate when possible". Mike Rindler was an interim CEO at Akron General (one of our two major adult hospitals a number of years ago), and this was his mantra for institutional success. Space does not allow me to elaborate on the details, but the simplicity of this message is powerful. Each of us is part of a team that delivers healthcare. For more information about Mike Rindler, consider one of his and his colleagues’

books, especially the one on leadership ( www.integrityhospital. com/books/ ). • Jim Rasmussen, MD, was a passionate master clinician at the University of Michigan who often espoused the simple principle of "under-promise and over-deliver." Setting appropriate expec- tations is critical while a consistent message is communicated. I am quite sure I don't meet every patient's expectations, but sometimes I appear to be the first person to have told a patient that I cannot cure his or her disease! For many conditions, patients should expect flares of their skin disease and continue to follow the plans outlined for them to minimize these flares. This approach is vastly different than "curing” a streptococcal sore throat with a course of antibiotics. • Charles Ellis, MD, also at the University of Michigan, was and continues to be passionate about addressing patient satisfac- tion in many ways. He was very astute in teaching dermatology residents about the need to sit down to make sure that patients don’t feel rushed (even if we do) and to make sure our "shoes are shined" (this latter statement was both specific and figurative; that is, he knew the importance of meeting patient expectations regarding their physicians’ appearance). These are simple meas- ures that can prevent undermining confidence in our treatment plan. Of course, like most of us, Dr. Ellis is also excited about making the elusive diagnosis. If this was the ultimate measure of success, however, some patient would be in for a dose of bad news.

PRACTICEUPDATE DERMATOLOGY