In response to a 2016 article exploring the themes common among Yelp reviews of emergency department visits, critics noted that “satisfaction correlates only weakly with quality.”¹ In fact, a 2012 study linked positive patient satisfaction with increased mortality—a dreadful outcome that suggests patient satisfaction itself is not necessarily a patient-centered outcome.² And while many physicians remain dissatisfied with the comments and scores left by patients on physician-rating sites, executives realize that these reviews might work to drive traffic toward or away from hospitals.

Multiple studies have discovered the key correlates of patient satisfaction: empathy, wait times, perceived technical skill, pain management, and communication.^3,4

In this month’s EMRA+PolicyRx Health Policy Journal Club article, Kirstin Woody Scott, MPhil, PhD, discusses a 2019 article that explored the use of Yelp reviews in comparing the patient experience in emergency departments versus urgent care centers. Spoiler alert: When patients reference the “service” received, we in the emergency department tend to lose.

It pains me to admit that hospitals need to behave more like Disneyland or the Cheesecake Factory, but there must be a reason people keep going back to these places. So what is it that leads some organizations to create an indelible positive memory on their customers while the service we provide often yields negative thoughts?

After four years of medical school and several more years of residency training to perfect our craft, some physicians might consider it insulting that we have to cater to the whims and service expectations of our patients instead of simply providing high-quality care. For others, this has become demoralizing.⁵ While board certification assures us that the scientific portion of our work is sound, our patients penalize us most when we fail at delivering the more subjective art of medicine.

The art of medicine, like beauty, is in the eye of the beholder. Each patient might want something different—having a great bedside manner, connecting with the patient and all of their companions in the exam room, managing expectations. With each patient encounter, we must create both a technical and aesthetic masterpiece. 

Dr. Dark is assistant professor of emergency medicine at Baylor College of Medicine in Houston and executive editor of PolicyRx.org.

References

1. Ranney ML, Peimer CA. Online emergency department ratings, patient satisfaction, and the age-old issue of communication. BMJ Qual Saf. 2016;25(1):1-2.
2. Fenton JJ, Jerant AF, Bertakis KD, et al. The cost of satisfaction: a national study of patient satisfaction, health care utilization, expenditures, and mortality. Arch Intern Med. 2012;172(5):405-411.
3. Welch SJ. Twenty years of patient satisfaction research applied to the emergency department: a qualitative review. Am J Med Quality. 2010;25(1):64-72.
4. Kilaru AS, Meisel ZF, Paciotti B, et al. What do patients say about emergency departments in online reviews? A qualitative study. BMJ Qual Saf. 2016;25(1):14-24.
5. A physician struggles with customer service. Can she still be a good doctor? KevinMD website. Accessed Sept. 19, 2019.