Garner and Maintain Patient Satisfaction: Managed Care 101 in 2010 (Part II)

October 27, 2008

A survey of 262 physicians found that only 2/5 were satisfied with how they managed test results.

What Does Grace Mean to You?” by Dr. Pauline W. Chen appeared on October 16, 2008 in the NY Times' “Doctor and Patient” column. It spoke to playwright and actress, Anna Deavere Smith’s show, “Let Me Down Easy,” which is quite telling of healthcare, especially the part about listening to patients.

Ms. Smith offers: “When you first start to decide to listen in a way that is more than just listening in a conversation, it’s probably a good idea not to expect yourself to listen for very long… Practice keeping your own inner monologue out of the way of what is being said to you, so that you can hear not just what somebody is saying to you, but also what they’re trying to say.” She continues: “I would say that listening actually takes practice because you have to get out of the way of what it is that you’re hearing.”

A Study of Communication

A survey of 262 physicians1 found that only 2/5 were satisfied with how they managed test results4: 1/6 — 1/3 had no reliable way to ensure that results were actually received by their patients; worse, 1/3 didn't always notify patients of abnormals, often depending on follow-up visits to give results information.3

In a prospective, randomized controlled trial (RCT) of 570 patient encounters in 26 outpatient primary care practices (12/01/2002 - 4/31/2005), an automated test result notification system (ATRNS) that was integrated into the electronic health record (EHR), gave the practitioners a concise summary of results, a template-based, modifiable letter to send to patients, and patient contact information. The objectives of the ATRNS was/is to centralize and make available the collection of results, facilitate their review, flag abnormal results and stratify them by level of severity (data, only), facilitate communication with patients (if not reduce malpractice exposure) and, hopefully, meet or exceed patient expectations (especially those not articulated).

"Facilitating communication with patients: The clinician can use the system to act on each test result, either by automatically generating a patient notification letter, making a telephone call to the patient, or simply acknowledging receipt of the result and documenting that communication will be made at a later time. The results and the response are documented in the electronic health record, and each acted-on test result is cleared from the system’s inbox. Patient letters are prepopulated with the patient’s address, the quantitative test results, and a generic assessment of the results that can be modified and customized by the physician. The system prints the letter, which can then be mailed by a staff member."

Results

  • Satisfaction with communication of test results: increased from 82.5% before the intervention to 92.5% after (the control group's results were 89.9% and 85%, respectively).
  • Satisfaction with the information provided by physicians about conditions and treatments increased from 86.8% before the intervention to 95.8% after the intervention in the intervention group (control group: 95.3% and 93.5%, respectively).
  • Patient satisfaction with physician listening skills and their general communication: this aspect remained unchanged, probably because of factors that influence perceptions of general communication skills. (Here, most test results were delivered by letter or over the phone.)

Commentary

Unfortunately patients and/or their families normally do not discuss their preferences for test result notification with their doctors or practitioners, most patients want to be informed about all of their tests results. Nevertheless, security, "privacy, responsive and interactive feedback, convenience, timeliness, and provision of details… by someone knowledgeable enough to answer questions" remain essential considerations in interpersonal communication.

While not always practical, face-to-face interpersonal communication can be important way to garner and maintain patient satisfaction--the value of attentiveness, body language, expressions of empathy, understanding, feedback, etc. should not be underestimated. If time (or reimbursement) is not conducive to a face-to-face follow-up visit, regardless, one must tie the loose ends together and make certain the patient is confidentially informed, while documenting the same in the medical record. Clearly, having an EHR and automated test result notification system can aid in communication, but they are no substitute for it.

KEYWORDS

  • clinical competence
  • standards
  • communication
  • education
  • medical
  • interpersonal relations
  • personality
  • physician patient relation
  • teaching
  • patient satisfaction
  • malpractice

1"Primary Care Practices Improve Patient Satisfaction With Communication of Outpatient Laboratory Test Results." AHRQ - Innovations Exchange, Apr 14, 2008 [last accessed Oct. 20, 2008].

2 Poon EG, Gandhi TK, Sequist TD, et al. "'I wish I had seen this test result earlier!': Dissatisfaction with test result management systems in primary care." Arch Intern Med. 2004 Nov 8;164(20):2223-8.

3 Boohaker EA, Ward RE, Uman JE, et al. "Patient notification and follow-up of abnormal test results: a physician survey." Arch Intern Med.. 1996 Feb 12;156(3):327-31.

4 Baldwin DM, Quintela J, Duclos C,, et al. "Patient preferences for notification of normal laboratory test results: a report from the ASIPS Collaborative." BMC Fam Pract. 2005 Mar 8;6(1):11.