Letters to the Editor
In Reply to Weissman: We appreciate the opportunity to reply to Dr. Weissman’s thoughtful concerns. We disagree, however, that the use of patient self-report is uninformative regarding the quality of care provided by physicians. Patient-centeredness has been identified by the Institute of Medicine as one of six essential quality aims.1 We cannot achieve a truly patient-centered health care system without input from and an assessment by the very patients who encounter the system. Patients who experience better engagement, interaction, and communication with their health care providers also experience better health care outcomes.2,3
We agree that well-designed multisource feedback (MSF) surveys that include patient ratings and feedback should be part of formative assessment in graduate medical education and maintenance of certification (MOC). In fact, a number of validated instruments, most notably the family of patient surveys developed by the Consumer Assessment of Healthcare Providers and Systems program, already exist to help physicians improve care4 and are already included in several MOC programs as formative assessment tools to help physicians improve patient experience and quality in their own practices. With regard to peers and others, hospital-based physicians who recently participated in an MOC pilot study of an MSF instrument assessing teamwork rated the quality of the feedback highly,5 and specialists who chose a peer survey of communication skills for their MOC program also reported high satisfaction and utility with the experience.6
Professionalism and interpersonal and communication skills are essential competencies for physicians. While perhaps not ready for summative purposes, MSF and patient care experience surveys can provide rich data for improving care. Such data can, as suggested by Dr. Weissman, be coupled with other types of performance measurement and assessment to help better determine physicians’ overall competence and also to facilitate more effective continuous professional development.
Eric S. Holmboe, MD
Chief medical officer and senior vice president,
American Board of Internal Medicine, Philadelphia,
Kathryn Ross, MBE
Research associate, American Board of Internal
Medicine, Philadelphia, Pennsylvania.
1. Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century. 2001 Washington, DC National Academies Press
2. Hibbard JH, Greene J. What the evidence shows about patient activation: Better health outcomes and care experiences; fewer data on costs. Health Aff (Millwood). 2013;32:207–214
3. Levinson W, Lesser CS, Epstein RM. Developing physician communication skills for patient-centered care. Health Aff (Millwood). 2010;29:1310–1318
5. Chesluk BJ, Bernabeo E, Hess B, Lynn LA, Reddy S, Holmboe ES. A new tool to give hospitalists feedback to improve interprofessional teamwork and advance patient care. Health Aff (Millwood). 2012;31:2485–2492
6. Hess BJ, Lynn LA, Holmboe ES, Lipner RS. Toward better care coordination through improved communication with referring physicians. Acad Med. 2009;84(10 suppl):S109–S112