Physician rating website reveals formula for good reviews
■ The factors that patients zero in on are not necessarily the most clinically important.
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One physician online rating site says it has found what makes for a happy patient: a short time in the waiting room and a longer time in the exam room with the doctor.
DrScore.com analyzed 36,000 patient satisfaction surveys submitted to the website in 2011 for its Annual Report Card, released in February. The analysis found that patients don't want to wait more than 15 minutes to see a doctor. And when they get into the exam room, they expect visits of at least 10 minutes. When those thresholds are not met, satisfaction declines, and the physician will have a tougher time being perceived as caring in the ratings.
DrScore measures patients' satisfaction by asking them to rate their experience on a scale of one to 10. They have the opportunity to leave additional comments. Questions cover aspects of clinical quality of care, including how successful the treatment was. Others deal with such factors as wait times, the physician's ability to communicate and answer questions, and how good he or she was about following up.
DrScore concluded that overall ratings were based on time in the waiting room and the exam room -- rather than perceived clinical quality -- by analyzing which categories tended to lead to the least and most critical responses from patients.
Fifty percent of the surveyed patients reported wait times of less than 15 minutes. Those patients gave their doctors a mean rating of 9.2 on the 10-point scale. For waits of 15 to 20 minutes, the mean rating dropped to 8. Physicians who kept patients waiting for more than an hour had a mean rating of only 3.5.
On the issue of time spent with physicians, patients gave a mean rating of 9.2 for visits lasting more than 10 minutes; for meetings of less than five minutes, the rating fell to 2.7.
If you leave patients waiting but can convince them you are a caring person, you can still get a good rating, said Steven Feldman, MD, PhD, founder and CEO of DrScore.
However, he said: "It's hard to make people convinced that you are a friendly, caring doctor if you keep them waiting a long time and if you don't spend much time with them. People feel like they're disrespected if you leave them waiting in the waiting room or give them an appointment and you don't keep it."
Hate to wait
DrScore is not alone in concluding that experience, rather than clinical quality of care, is the major factor in patient satisfaction, which in many cases is used to set physician pay.
The 2011 Pulse Report by Press Ganey, a health care performance surveyor and consulting firm in South Bend, Ind., also found that "outpatients expect their visit to be quick and efficient. When organizations fail to meet this expectation, outpatients complain and feel their time is not valued and that the provider is not sensitive to their needs."
The Press Ganey report found that the physician's response to complaints and concerns during a visit held the highest priority. But "the longer a patient spends waiting, the more it impacts their overall satisfaction with the visit," said Patty Riskind, senior vice president of medical services for Press Ganey.
Press Ganey found that the average satisfaction score for wait times of zero to 15 minutes was 94.3 on a 100-point scale. The score fell by nearly four points if the wait exceeded 15 minutes, and it fell to 86.1 for waits of more than an hour.
"There is forgiveness if the physician spends more time with the patient because there's a rationalization that, 'Oh, I was waiting because this physician spends a sufficient amount of time with his or her patients,' " Riskind said.
Meanwhile, a study posted online Feb. 13 by the Archives of Internal Medicine found a correlation between high satisfaction, and high health care utilization and bad outcomes. It found that higher patient satisfaction was associated with less emergency department use, but higher inpatient use, higher health care and prescription drug costs, and increased mortality.
Joshua Fenton, MD, MPH, assistant professor of family and community medicine at the University of California-Davis and co-author of the report, said satisfaction in his study did not specifically address wait time and length of visit. Respondents were asked about satisfaction over a year, not in an individual visit. Therefore, the results may not be comparable to other patient satisfaction metrics, he said.
Dr. Fenton does agree that there is evidence that satisfaction and clinical quality are not correlated.
DrScore's Dr. Feldman, a practicing dermatologist, said physicians assume that the key to success is the right diagnosis. He found from personal experience that this wasn't the case.
"I thought being a dermatologist meant making the right diagnosis and prescribing the right drug. And I got really good at that," he said.
He said he got so good he could identify psoriasis from across the room and have a prescription written by the time he walked through the door of the exam room. "Then I get feedback from some patients who said, 'Yeah, he's good.' Then from others: 'I wouldn't send my dog to him. He's an uncaring jerk. He didn't do a thorough examination. He doesn't care about his patients.' "
Now, Dr. Feldman said he walks into each exam room reminding himself that although he will get the diagnosis correct, "Don't forget. Make sure this patient realizes how much you care about them."