Editor’s Note: We received many responses to February’s article, “Time to Walk the Walk: Choosing Wisely and knowledge translation” by Dr. Klauer. Here are a few of the comments from the emergency medicine community.
I enjoyed reading your article and agree! For me, the challenge remains how do we not give a patient what he/she wants (regardless of need!) and still obtain 5/5 on our patient satisfaction scores?
Patients expect antibiotics for everything and new exciting scans and tests, even if the onset of the symptoms is exactly five minutes longer than their door-to-provider time. We expect them to pay a ridiculous copay in credit card or cash at the time they are seen. (My employer’s plan has a $250 copay for every ED visit.) Then we “refuse” to give them what they want, and we expect them to be happy for it and give us positive reviews? I have worked in several large EM groups and have heard numerous clinicians state they have dramatically increased their patient satisfaction scores by 1) ordering every scan patients wants and 2) giving patients any prescription they want regardless of indication, medical necessity, or need.
For many years, providers were able to tell patients, “This is not in your best interest and can even be detrimental to your health,” “Studies have shown …” when discussing tests, treatments, scans, and prescriptions. “No, ma’am, your child does not need a CT scan of his head after being shot in the head with a Nerf gun from across the room. His risk of cancer from the scan far outweighs any potential benefit.” You can explain and produce research until the cows come home, but Mom is in the ED to get a CT scan, and sending her home without it leads to an unsatisfied patient experience, resulting in patient complaints and poor satisfaction scores, and directly effects both your income and the income of your employing institution.
My family went out to eat last night. If the server had refused to serve the food I ordered because I am expanding at the waistline and hundreds of studies and years of research had shown this particular dish to be detrimental to my health, I likely would have refused to pay the bill, skipped the tip, and posted something unflattering on a website reviewing that establishment. Let’s be honest: Most patients are not in the ED to hear about what is best for them or what a study shows. Patients are in the ED to get what they want. And if they don’t, they will be unsatisfied with their visit, period. If IV vancomycin “cured my sniffles in 30 seconds flat last time I was here,” then they expect IV vancomycin at every visit for those complaints.