What Patients Want
In the romantic comedy, “What Women Want”, Mel Gibson played a somewhat chauvinistic advertising executive, who after a fluke accident, gained the ability to hear what women were thinking, and what women really wanted. The result surprised and shocked him.
I feel the same way about American research examining what patients say they want most in their doctors. It seems, for example, that competence is way less important to most patients than location, which both stuns and alarms me.
What I would personally want in a breast surgeon, for example, is someone with sound clinical judgement and technical excellence. I would seek someone who was well trained, experienced and technically competent, with good outcomes/results, who came well recommended and I would expect to be treated with respect. I would prefer someone who had demonstrated a strong commitment to their career, as evidenced by having undergone post fellowship training overseas at a specialist international centre and I would want the breast surgeon to be well read and up to date.
This is not however what patients themselves want most according to American data. In fact, there appears to be a significant disconnect between how the nation’s medical system defines the quality of healthcare providers and how patients and prospective patients judge a “good doctor.” When it comes to defining provider quality, most Americans tend to focus on certain aspects of quality relating to doctor-patient interactions and doctors’ personality traits, rather than the effectiveness of the care provided or the patient’s own health outcomes.
It seems most healthcare consumers—even well informed patients—take it for granted that the doctor is clinically trained, experienced and qualified. Above and beyond that baseline, what patients want most appears to have very little to do with professional credentials. Most Americans focus on the doctor-patient relationship and interactions in the doctor’s office, with fewer thinking about the effectiveness of treatments or their own health outcomes according to survey findings by the Associated Press-NORC Center for Public Affairs Research (1)
In this survey, patient responses tended to focus on doctor-patient relationships and personality (59 percent), versus delivery of care or outcomes (29 percent). The top responses say that a high-quality doctor:
- Listens, is attentive, or shows interest (in the patient) [18 percent]
- Has a caring attitude [8 percent]
- Has a good bedside manner [8 percent]
- Exhibits other positive personality traits [7 percent]
- Spends time with patients [5 percent]
Relating to the delivery of care or patients’ own health outcomes, only 11 percent value most a doctor’s ability to accurately diagnose and fix their health problem, and 8 percent mention a knowledgeable doctor.
And, what about the makings of a poor-quality doctor? In this study, Americans describe poor-quality doctors as:
- Those who do not listen or are inattentive [17 percent]
- Do not spend enough time with patients [10 percent]
- Are overbooked or difficult to make appointments [9 percent]
Doctors with bad personality traits [6 percent], poor bedside manner [5 percent], and those who are uncaring [5 percent] are also frequently mentioned as poor-quality. Only nine percent mention a response related to health outcomes—that a poor-quality doctor is one who misdiagnoses or fails to fix their health problems.
Perhaps even more alarmingly in my opinion, according to the 2014 Healthgrades American Hospital Quality Report to the Nation (2) , “convenient location” is more than twice as important to consumers selecting a physician or a hospital, than success rates or outcome data. The report found that patients who have selected a physician in the past three years were more concerned about convenient location (62%); friendly office staff (56%); than success rates (22%).
These findings run parallel to a prior 2012 Healthgrades study (3) about consumer choices:
Factors Most Often Considered When Selecting a Physician
- Whether my physician is covered by my health insurance plan (72%)
- The physician’s office location (69%)
- Which hospital he/she is affiliated with (49%)
- How long it takes to get an appointment with that physician (47%)
According to a 2006 Mayo Clinic study “Patients’ Perspectives on Ideal Physician Behaviours” (4) the seven things that patents most appreciate in doctors are:
- Confident: “The doctor’s confidence gives me confidence.”
- Empathetic: “The doctor tries to understand what I am feeling & experiencing, physically and emotionally, and communicates that understanding to me.”
- Humane: “The doctor is caring, compassionate, and kind.”
- Personal: “The doctor is interested in me more than just as a patient; he/she interacts with me, and remembers me as an individual.”
- Forthright: “The doctor tells me what I need to know in plain language.”
- Respectful: “The doctor takes my input seriously and works with me.”
- Thorough: “The doctor is conscientious and persistent.”
According to the study, “thorough” was mentioned most frequently among these seven characteristics and more than 50 percent of that patient group selected “confident.”
Why do patients relate to doctor-patient interactions and personality traits first? Perhaps because it’s an area where they have direct exposure. They tend to expect effective care, and they have no means to judge clinical expertise. How physicians provide the service (how they behave) is not only important to patients but also easier for them to judge than technical quality, which is often difficult for patients to assess, even after the service is performed. In evaluating a service as anxiety producing, complex and important as medical care, patients are particularly attentive to what they can see. Research indicates if patients are forced to choose between technical quality and interpersonal quality, that even with this information available, a substantial proportion of the respondents (approximately one third) selected physicians high in interpersonal quality.
Whether Australian patients want similar things in their doctors is not known, as all the available data is from American research, but there is nothing to suggest they are different. Rarely are the stakes as high as they are for the medical services customer. A mistake in diagnosis, treatment plan, or procedure can do great harm to the patient. It may serve as an “Inconvenient Truth” for patients to learn that all doctors are not equal, and that in the same way as hairdressers and schoolteachers vary considerably in quality, so too do doctors. There are variations in experience, intellect, natural ability, attention to detail and work ethic and as Dr. Elliott Fisher of the Dartmouth Institute for Health Policy and Clinical Practice, points out, ‘some of the nicest doctors are the least competent!’
- 2014 Healthgrades American Hospital Quality Report to the Nation
- Consumer Research: America’s Readiness to Choose a Doctor or Hospital; Healthgrades; Prepared by Harris Interactive; October, 2012
- Bendapudi, N. Mayo Clinic Proceedings, March 2006; vol 81: pp 338-344.