4 Spine Surgeons on the Importance of Patient Satisfaction

Four spine surgeons discuss the steps they take to increase patient satisfaction. Ask Spine Surgeons is a weekly series of questions posed to spine surgeons around the country about clinical, business and policy issues affecting spine care. We invite all spine surgeon and specialist responses. Next week's question: Do you perform surgery in an outpatient setting?

Please send responses to Heather Linder at hlinder@beckershealthcare.com by Wednesday, Nov. 6, at 5 p.m. CST.

Richard Guyer, MD, Chairman, Texas Back Institute Research Foundation: The short answer is the golden rule — treat your patients the way you or your family would like to be treated by showing genuine interest and concern, seeing them in a timely fashion, providing clean and pleasant facilities and providing a caring and compassionate staff. A basic premise is the physician's attitude and how he treats his staff and patients sets the atmosphere for happy patients. I try to greet every employee with a smile and "good morning" and show a genuine interest and enthusiasm in caring for my patients.

The first employee a patient encounters, whether it is the operator or the front desk person, is the most important. A friendly smile and greeting is imperative when creating an inviting and caring environment for our patients suffering from neck and back pain. In our practice at Texas Back Institute, we have an internal survey system, and we get a weekly report from our patients about their encounters with our physicians and our employees. A little healthy competition helps our physicians and employees strive to get their names mentioned for exemplary care. By looking at the patient reports, it helps me improve on my patients' care.

Personally, I try to treat every patient as if they were my family. When I enter the room I will introduce myself and maintain eye contact throughout the examination. I always apologize when I am running behind. I sit in the exam room listening to the patient and this helps let them know they are the center of my attention, and I am not thinking about a thousand other things. I do not rush them through their history. At the end of this visit, I go over their X-rays, I try to explain what I think is causing their symptoms and then, finally, come up with a treatment plan to help them start feeling better. I tell my patients what I think their options are and what I would recommend to be best option for them. The last thing I do to ask if I answered all their questions and their concerns.

My last rule, that I teach my fellows, is to treat all patients with respect and dignity, regardless of how their pain is represented. Remember, every happy patient will tell five people about how great their experience was, but for every unhappy patient they will tell nine. With the prevalence of social media, these negative encounters may be far worse.

Christian Zimmerman, MD, Neurosurgeon, Idaho Neurological Institute, Boise: To conceptualize or even define the terminology of "patient satisfaction," then stratifying the spine patient into respective categories allows for a predictable outcome skewed, of course, by the uncontrolled variable or unforeseen adjustment. Recently promoted in the health system list of quality measures and calculated from arbitrary or blinded surveys, the patient satisfaction component of a surgeon's practice can bolster or denigrate a year-end evaluation and affect bonus packages one way or another.

In our hospital-employed complex spinal practice, the average American Society of Anesthesiologists' physical status classification is 3.4. This translates into a larger Medicare/Medicaid populace harnessed with numerous co-morbidities and higher acuity. The regimen for treatments of all patients remain the same — consistent dialog with medical providers from the outset with recommended office follow up for at least six months; proper attention to post operative concerns; 24/7 answering service and rapid explanation for anticipated delays and cancellations; and measured practice evaluations appreciated by patient and employee alike.

Since these measures are tracked by our health system and most insurers, this data set is made available to the surgeon and staff members. There is a recognized percentage of the patient populace that seemingly struggles with improvement and return to work. This growing number expects some level of satisfaction in care, even if the outcomes take a different path from the predictably successful majority of patients. Pre-operative expectations can be met if the appropriate discussion has occurred in the pre-emptive setting, and re-visiting those discussion points are helpful. 

Kenneth Pettine, MD, Spine Surgeon, The Spine Institute, Johnstown, Colo.: We typically send a nice bouquet of flowers to all of our postoperative patients. We also provide fresh homemade cookies during clinic along with complimentary cappuccinos and chai teas. Our staff dresses formally, including all of the women in the office. We try to encourage a gourmet approach to all of our patients. We also offer a concierge service for those flying in to Denver International Airport in terms of ground transportation and lodging.

Eugene Carragee, MD, Vice Chairman of the Department of Orthopedic Surgery, Stanford University School of Medicine, Palo Alto, Calif.: All healthcare systems in the U.S. are emphasizing patient satisfaction as a quality measure these days. It is an important customer-centered aspect of spine care.

However, it is important to recognize that patient satisfaction doesn't correlate neatly with the quality, effectiveness and safety of spine surgery. These may involve separate metrics. So ultimately, all spine surgeons need to come up with ways of enhancing patient satisfaction while still achieving the primary goal of high-quality surgical care. When we looked at patient minimum acceptable outcomes for common spine surgery, we found it so far above the so-called minimal-detectable or MCID, we simply stopped using the MCID success rates as a good indication for counseling patients about a reasonable expectation — and hopefully satisfaction — of outcome.

Like other spine care practices, we try to have a friendly, efficient clinic that runs on schedule and treats patients with courtesy and respect. We work to develop strong personal relationships and pay careful attention to patients' worries and concerns and their comfort and safety while in our care. As mentioned about establishing a patient's reasonable expected outcomes before surgery, we take the dictates of informed consent and shared decision making seriously. We discuss the potential benefits and risks of diagnostic and therapeutic options in a scientific manner, but in language that matches patients' health literacy and comprehension levels. We make repeated efforts to make sure patients understand their potential options and their long-term implications.

Before surgery, we also explicitly assess our patients' expectations regarding treatment outcomes. For instance, what are their minimally acceptable treatment outcomes in terms of pain, function, employment and use of narcotics? Do they want to return to physical work or specific sporting activities? This allows us to assess the extent to which their chosen treatment options can help achieve those goals. And look at the degree to which any confounding issues — diagnostic ambiguity, other illnesses, compensation issues and psychological distress — might serve as obstacles to those expectations.

More Articles on Spine:
Victory Medical Center Landmark Names Dr. Karl Swann Medical Director   
Hospital for Special Surgery Physicians Develop Patient Expectations Survey for Lumbar Spine Surgery
Dr. Stacey Wolfe Joins Satellite Practice in North Carolina