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with Rod Moser, PA, PhD

Stories from behind the examining room door, as told by Rod Moser, PA, a primary care physician assistant with more than 35 years of clinical experience.

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Friday, January 13, 2012

The Fine Art of Giving (and Receiving) Feedback

By Rod Moser, PA, PhD

Someone once told me that the best boss is one that can step on your toes without ruining the shine on your shoes. It is not easy to give constructive feedback…to a child, to your spouse, or to a co-worker. It is, indeed, an art.

My first experience in getting evaluations was at a university where I was a professor. While it is true that you cannot please everyone all of the time, reading your course evaluations at the end of the semester can be eye opening. You think you did a good job, but when you get the student feedback, the amount of negativity is gut-wrenching. Faculty members often share comments. I vividly remembering a very nice female faculty reading: “I felt that [Professor X] made my life a living hell!” Of course, no one reveals their names, so she spent the better part of the next month comparing handwriting to identify the culprit!

All of those comments, positive and negative, go into your reappointment package. If you have too many negatives, the Dean will call you in for a talk.  As much as we hated to admit it, the students’ tuition paid our salaries, and they knew it.

Faculty quickly learned that handing out the evaluations after finals is not a good idea. To students, there is nothing called a “good test.” Exams are a key tool for evaluations, but no matter how much time you spend on writing good questions, a certain percentage of the class is going to call foul. I once taught a review class where I promised to give the answers to three of the questions on the final if students paid attention. At the end, I told them that three answers were: A, C, and None of the Above. I never promised them I would give the corresponding question to those answers, so it sort of explains a lot of complaints that I received that semester.

Large medical groups, like the one that I am in, send out evaluations to nearly all of our patients. This is done through an unbiased third party now. In the past, evaluations were left in exam rooms for patients to complete after their visits. At least one of the doctors in my group admitted to filling out his own evaluations. Obvious, they were exemplary.

The medical group now mails a written evaluation after random office visits, or may actually call patients on the phone.  Then, the several hundred medical providers in our group are ranked by popularity, if you can believe it. One of our providers was gloating about her perfect 100% score, accepting kudos from other providers.  We were puzzled, since she had been on leave for most of the year, so we checked her “n” column – the number of responses that determined her score. The number was two; only two patients responded to the survey and both of them loved her. This gave her a 100% approval and moved her to the top of the popularity list. If only one of the two had complaints, she would have scored 50%; indicating that half of her patients disliked her!

High rankings on these evaluations convert to cash for the medical group, often paid by insurance companies. The medical groups are financially rewarded for their high marks, and in turn may give bonuses to the individual providers. The message is: Be nice for a price.

Personally, I think ALL medical providers should be nice. People (or their insurance companies) are paying big bucks for care. An office visit in the U.S. can cost well over a hundred dollars or more now. Specialty consultations are two to three hundred dollars for the first visit. For that kind of money, medical providers would be remiss not to be nice, but being nice does not always imply a good visit.

Some medical visits can be touchy, so to speak. If I smell cigarette smoke on someone’s clothes and comment about their smoking, it may annoy them. Upset patients give bad evaluations. My wife brought up a teenager’s weight (too much) and it came back to haunt her on the evaluations. The teen’s mother was livid that my wife would address her weight problem, so she complained. My wife ranked lower on the popularity scale as a result and it really hurt her feelings. I seriously doubt she will change her practice style over this one incident, but it makes you feel that not giving a patient what they want is going to be detrimental.

The federal government has been tweaking the medical profession for years, and groups that conduct these evaluations get financial rewards and other acknowledgments, such as being considered “one of the best hospitals in America.” Most patients are not aware that groups that have switched to electronic medical records have done so for the financial incentives offered by our government. Granted, this is an expensive venture, but the medical group does not have to bear the entire cost of the conversion.

A good medical provider “tells it like it is,” but should do so with sensitivity and finesse. If your medical provider hesitates before bringing up a sensitive health issue, try not to be upset. A bad provider may simply ignore them. If you are given an opportunity to give feedback on an evaluation, don’t do so in anger. Think about it first. Medical providers have feelings, too, and they may have just been doing their jobs. If you want to make your doctor’s day, write a nice letter or card for something good they have done for you.

The most important part of health care is the “care” part.  It goes both ways.

Posted by: Rod Moser, PA, PhD at 2:55 pm

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