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The Hospital Consumer Assessment of Healthcare Providers and Systems is a term I was not familiar with during residency. But now, as an attending, HCAHPS is not only familiar to me but it is – rightly or wrongly – top of mind in nearly every patient encounter I have.
The jury may still be out on whether patient satisfaction is correlated with outcomes, but all things considered, I think it is a totally reasonable goal for the majority of patients. And therein lies the rub: that "minority" of patients for whom the quest for patient satisfaction scores was lost before it even began.
Like pain management, patient satisfaction can and should be a goal for most patients. I would want it for my own family members. The problem is, there always seem (key word, seem) to be 1 or 2 on my team of about 14 patients, who need excessive amounts of time to complain, have unrealistic or perhaps pathologic goals of pain management, or who (either themselves or their family) require long explanations every day, and sometimes (though it seems like often) all three.
For the most part, these requests are reasonable; but what happens when the 1 or 2 patients begin to affect the care of the other 12?
There have been multiple days in which I have spent the most time and energy with my least sick patients. Some days, that is OK, but when it is the same patient every day for the 7-10 days that I am on service, how can I justify that time – in my mind at least – to the other patients on my team? It is not fair to them.
It is often the stoic elderly man who has a newly found mass or the women with a large effusion, whose pain and satisfaction needs I absolutely want to meet, but whom, because they complain the least may get less of me. Furthermore, it is the one or two that, over time, jade a practitioner’s mind to make the leap to the faulty mindset of "all patients are pain seekers" or "all my patients are social nightmares."
On days when I begin to feel like that, I objectively count how many patients on my list for which this is actually true. The number is small.
I am usually surprised by how the tiring encounters with the few have jaded my view of all, and this, I believe, is a pervasive problem throughout health care.
So, my question is, what should I, what should the system, do about it?
Can I tell the one or two patients, in the most polite way possible, that I only have X amount of time today because I have other sick patients I need to see? Can I tell the rude patients that they shouldn’t/can’t talk to their care team in such a manner?
Part of me says no – this is the art, these people are suffering, it is my job to listen. But again, when I see the toll they are taking on the entire staff, I think I should intervene. Because of all the time spent on the one today, there was not enough time to find disposition for the other two; they will be staying an extra night. Is that fair? Can I – and is it my job to – draw boundaries to protect my other patients, the staff, and health care resources from those one or two patients?
Do I have the right, the duty, to refuse some requests? Or is every customer always right?
What do you think? Write to [email protected] with STARTING OUT in the e-mail subject line.
Dr. Horton completed his residency in internal medicine and pediatrics at the University of Utah and Primary Children’s Medical Center, both in Salt Lake City, in July and joined the faculty there. He is sharing his new-career experiences with Hospitalist News.
The Hospital Consumer Assessment of Healthcare Providers and Systems is a term I was not familiar with during residency. But now, as an attending, HCAHPS is not only familiar to me but it is – rightly or wrongly – top of mind in nearly every patient encounter I have.
The jury may still be out on whether patient satisfaction is correlated with outcomes, but all things considered, I think it is a totally reasonable goal for the majority of patients. And therein lies the rub: that "minority" of patients for whom the quest for patient satisfaction scores was lost before it even began.
Like pain management, patient satisfaction can and should be a goal for most patients. I would want it for my own family members. The problem is, there always seem (key word, seem) to be 1 or 2 on my team of about 14 patients, who need excessive amounts of time to complain, have unrealistic or perhaps pathologic goals of pain management, or who (either themselves or their family) require long explanations every day, and sometimes (though it seems like often) all three.
For the most part, these requests are reasonable; but what happens when the 1 or 2 patients begin to affect the care of the other 12?
There have been multiple days in which I have spent the most time and energy with my least sick patients. Some days, that is OK, but when it is the same patient every day for the 7-10 days that I am on service, how can I justify that time – in my mind at least – to the other patients on my team? It is not fair to them.
It is often the stoic elderly man who has a newly found mass or the women with a large effusion, whose pain and satisfaction needs I absolutely want to meet, but whom, because they complain the least may get less of me. Furthermore, it is the one or two that, over time, jade a practitioner’s mind to make the leap to the faulty mindset of "all patients are pain seekers" or "all my patients are social nightmares."
On days when I begin to feel like that, I objectively count how many patients on my list for which this is actually true. The number is small.
I am usually surprised by how the tiring encounters with the few have jaded my view of all, and this, I believe, is a pervasive problem throughout health care.
So, my question is, what should I, what should the system, do about it?
Can I tell the one or two patients, in the most polite way possible, that I only have X amount of time today because I have other sick patients I need to see? Can I tell the rude patients that they shouldn’t/can’t talk to their care team in such a manner?
Part of me says no – this is the art, these people are suffering, it is my job to listen. But again, when I see the toll they are taking on the entire staff, I think I should intervene. Because of all the time spent on the one today, there was not enough time to find disposition for the other two; they will be staying an extra night. Is that fair? Can I – and is it my job to – draw boundaries to protect my other patients, the staff, and health care resources from those one or two patients?
Do I have the right, the duty, to refuse some requests? Or is every customer always right?
What do you think? Write to [email protected] with STARTING OUT in the e-mail subject line.
Dr. Horton completed his residency in internal medicine and pediatrics at the University of Utah and Primary Children’s Medical Center, both in Salt Lake City, in July and joined the faculty there. He is sharing his new-career experiences with Hospitalist News.
The Hospital Consumer Assessment of Healthcare Providers and Systems is a term I was not familiar with during residency. But now, as an attending, HCAHPS is not only familiar to me but it is – rightly or wrongly – top of mind in nearly every patient encounter I have.
The jury may still be out on whether patient satisfaction is correlated with outcomes, but all things considered, I think it is a totally reasonable goal for the majority of patients. And therein lies the rub: that "minority" of patients for whom the quest for patient satisfaction scores was lost before it even began.
Like pain management, patient satisfaction can and should be a goal for most patients. I would want it for my own family members. The problem is, there always seem (key word, seem) to be 1 or 2 on my team of about 14 patients, who need excessive amounts of time to complain, have unrealistic or perhaps pathologic goals of pain management, or who (either themselves or their family) require long explanations every day, and sometimes (though it seems like often) all three.
For the most part, these requests are reasonable; but what happens when the 1 or 2 patients begin to affect the care of the other 12?
There have been multiple days in which I have spent the most time and energy with my least sick patients. Some days, that is OK, but when it is the same patient every day for the 7-10 days that I am on service, how can I justify that time – in my mind at least – to the other patients on my team? It is not fair to them.
It is often the stoic elderly man who has a newly found mass or the women with a large effusion, whose pain and satisfaction needs I absolutely want to meet, but whom, because they complain the least may get less of me. Furthermore, it is the one or two that, over time, jade a practitioner’s mind to make the leap to the faulty mindset of "all patients are pain seekers" or "all my patients are social nightmares."
On days when I begin to feel like that, I objectively count how many patients on my list for which this is actually true. The number is small.
I am usually surprised by how the tiring encounters with the few have jaded my view of all, and this, I believe, is a pervasive problem throughout health care.
So, my question is, what should I, what should the system, do about it?
Can I tell the one or two patients, in the most polite way possible, that I only have X amount of time today because I have other sick patients I need to see? Can I tell the rude patients that they shouldn’t/can’t talk to their care team in such a manner?
Part of me says no – this is the art, these people are suffering, it is my job to listen. But again, when I see the toll they are taking on the entire staff, I think I should intervene. Because of all the time spent on the one today, there was not enough time to find disposition for the other two; they will be staying an extra night. Is that fair? Can I – and is it my job to – draw boundaries to protect my other patients, the staff, and health care resources from those one or two patients?
Do I have the right, the duty, to refuse some requests? Or is every customer always right?
What do you think? Write to [email protected] with STARTING OUT in the e-mail subject line.
Dr. Horton completed his residency in internal medicine and pediatrics at the University of Utah and Primary Children’s Medical Center, both in Salt Lake City, in July and joined the faculty there. He is sharing his new-career experiences with Hospitalist News.
