interesting article on rating doctor-patient communications

John Brush jebrush at ME.COM
Wed Aug 29 11:22:24 UTC 2018


Lyn:	I think you are bringing up a different issue and I actually agree with you. No one is satisfied with current medical care, which is fractionated and lacks continuity. Medical care has become way too complicated and impersonal.
	I was just simply responding to the question about the study that showed that patients gave 63% of their doctors an A+ and gave the rest a flat distribution of grades. People are talking about using patient satisfaction surveys in payment models, which means that money is redistributed based on these surveys. I think anyone would agree that the distribution of patient satisfaction scores in that study was skewed, which should lead to skepticism about whether the grading was valid. We need to be careful about this because we don’t want to design a system that is supposed to improve care, but ends up being arbitrary and capricious and unfair. Patients will be less satisfied and could be harmed in such a system because it won’t create the right incentives. It could induce gaming and could detract from the delivery of kind, compassionate, and effective medical care that patients really want.
	Let me be clear: no one is more centered on the welfare of patient than me. I am a patient. My family members are patients. I am graded by my patients and I pay close attention to their grades and comments. The primacy of the patient is central to professionalism. We need to figure out how to engage patients effectively so that we can obtain valid feedback that will improve care.
John

John E. Brush, Jr., M.D., FACC
Professor of Medicine
Eastern Virginia Medical School
Sentara Cardiology Specialists
844 Kempsville Road, Suite 204
Norfolk, VA 23502
757-261-0700
Cell: 757-477-1990
jebrush at me.com




On Aug 28, 2018, at 10:32 PM, Behnke, Lyn <lbehnke at UMFLINT.EDU> wrote:

At the risk of being booed out of the building, I respectfully disagree with Dr. Brush.  Patients have many encounters with physicians.  Many that aren’t discussed afterward because we all know that if you can’t say something good, you don’t say anything at all.  At this day and age, in medicine, patients have PCPs, generally in groups, so they may see anyone in the group.  Also, there are NPs and Pas in the group, so they may see one of them.  Then if they go to the hospital, they see at least 2 hospitalists.  In our case, if they were in for 5 days they would see 4.  Then there are the cardiologists in the group.  Of course, they have a primary cardiologist, but they aren’t on call 24/7 so there is the opportunity for another meeting or 2.  Then, if there is pulmonology, neurology and oncology, the same rules hold true in that most physicians, NPs and Pas practice in groups so there are many opportunities for physician encounters.  In my last hospitalization, I met the anesthesiologist, the nurse anesthetist, the vascular fellow, the vascular resident, the medical student, of course my vascular surgeon, and 2 hospitalists.  This was 8 encounters in 24 hours.

I recently had another stent (first of August).  My cardiologist was involved, his resident, the cardiac surgeon, his Fellow and Resident and an anesthesiologist.  So, between February and August, I met 14 physicians.  And that was just this year from February to August 01.  I was also at U of M Ann Arbor with a friend who had a post op wound infection post mastectomy.  To make matters worse, her physician group was in Maine.  I am her Primary Care in Michigan.  So, we had to encounter her primary care in Maine, her surgeon in Maine, her Oncologist in Maine and her Anesthesiologist in Maine, her hospitalist team at UM Ann Arbor, (2 hospitalists and 2 Residents), the Oncology team (Oncologist, surgeon, residents for both), anesthesiologist and infectious disease Dr.

My point here is that patients have a significant amount of exposure to physicians and health care providers.  They can and do evaluate physicians based on their experiences, however, may be reluctant to give a “poor rating” due to the possibility that the physician, NP, PA may find out and then give them poor care.



From: Ruth Ryan <ruth at RYAN-GRAHAM.COM>
Reply-To: Society to Improve Diagnosis in Medicine <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>, Ruth Ryan <ruth at RYAN-GRAHAM.COM>
Date: Tuesday, August 28, 2018 at 7:12 PM
To: <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>
Subject: Re: [IMPROVEDX] interesting article on rating doctor-patient communications

Hello All,

Thanks John.  Maybe we can also improve validity by reducing the number and length of the questionnaires we ask patients to fill out.  And the reading grade level required.

I well remember filling these things out for my elderly mother in waiting rooms and can attest that the length alone will bar most of the elderly, those with English as 2nd language, folks with less formal education, and all those with less patience or obedience to an unthinking authority. Considering who is left, that’s quite a skewing effect.

Ruth Ryan


From: John Brush <0000001122b4be5c-dmarc-request at LIST.IMPROVEDIAGNOSIS.ORG>
Sent: Tuesday, August 28, 2018 2:52 PM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
Subject: Re: [IMPROVEDX] interesting article on rating doctor-patient communications

Maybe we can improve the validity of patient evaluations by exposing them to a range of experiences through simulation.
John

John E. Brush, Jr., M.D., FACC
Professor of Medicine
Eastern Virginia Medical School
Sentara Cardiology Specialists
844 Kempsville Road, Suite 204
Norfolk, VA 23502
757-261-0700
Cell: 757-477-1990
jebrush at me.com<mailto:jebrush at me.com>



On Aug 28, 2018, at 2:38 PM, Tom Benzoni <benzonit at gmail.com<mailto:benzonit at gmail.com>> wrote:

That's the conclusion we're supposed to reach.
So where might the conclusion be wrong; can we dis-enthrall ourselves of the expected conclusion?
Where is the cognitive debiasing here?
There is extensive literature on "perceived authority is greater than actual."
I'm assuming we're willing to posit the authorities authority here.
Should we? We've made that error before.

tom

(It's ok to say I'm being an anarchistic here. I've just know too many "authorities" who aren't.)


On Tue, Aug 28, 2018 at 1:24 PM John Brush <jebrush at me.com<mailto:jebrush at me.com>> wrote:
63% of the patients gave their provider a 100% rating, which shows that either they weren’t very discerning, or were biased, or were maybe just quickly filling out the forms.
Both the physicians and the experts had ratings that were a bell shaped curves, suggesting that they were trying to discern good from bad. Not surprisingly, physicians were easier on themselves than the experts.
It raises questions about the reliability of patient evaluations of providers. Patients, of course, are the people who count, but they only have limited experience with a few doctors and don’t see the range of possibilities, so they may be less capable of reliable evaluations. Rating physicians, like anything, may improve with experience, but patients will usually have limited exposure to physicians.
Patient satisfaction is obviously of paramount importance, but may not be a good measure for things like pay for performance.
John

John E. Brush, Jr., M.D., FACC
Professor of Medicine
Eastern Virginia Medical School
Sentara Cardiology Specialists
844 Kempsville Road, Suite 204
Norfolk, VA 23502
757-261-0700
Cell: 757-477-1990
jebrush at me.com<mailto:jebrush at me.com>



On Aug 28, 2018, at 1:53 PM, Tom Benzoni <benzonit at GMAIL.COM<mailto:benzonit at gmail.com>> wrote:

I'm really confused by this.

IF:
Perfect = 100 (top of scale)
Patients scored their physicians = 94
Physicians scored themselves = 75
Experts scored the physicians = 57
THEN:
1. Physicians are hard on themselves; they're doing pretty good.
2. Experts are out of touch.
This brings into question whether experts are experts, given that the patients are the experts on communication.

Help me out here.

tom benzoni


On Thu, Aug 23, 2018 at 11:20 PM David L Meyers <dm0015 at comcast.net<mailto:dm0015 at comcast.net>> wrote:

http://www.annfammed.org/content/16/4/330.full

David
David L Meyers, MD FACEP
Listserv Moderator/Board member
Society to Improve Diagnosis in Medicine
www.improvediagnosis.org<http://www.improvediagnosis.org/> |
Save the Dates: Diagnostic Error in Medicine, November 4-6, 2018; New Orleans, LA
Diagnostic Error in Medicine-2nd European Conference, August 30-31, 2018; Bern, Switzerland
AusDEM2019, April 28-30, 2019;
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