Dr. Welch is the quality improvement director in the emergency department at LDS Hospital in Salt Lake City, a clinical faculty member at the University of Utah School of Medicine, faculty at the Institute for Healthcare Improvement and the Urgent Matters Project for the Robert Woods Johnson Foundation, a quality improvement consultant to Utah Emergency Physicians, and a member of the Emergency Department Benchmarking Alliance.
Not surprisingly, patients have very definite ideas about what they like and don't like about our behavior, dress, manners, and communication skills. Using this information could help emergency physicians who find patient interactions difficult and improve patient encounters for all of us.
A number of physician attributes and behaviors have been studied and deserve mention. Does the gender of the physician affect patient satisfaction? The simple answer is yes and no. Female physicians are positively associated with women's satisfaction in the ED (J Gen Intern Med 2001;16:218), and this can be factored into physician assignments, especially where more invasive examinations and procedures are required on female patients, particularly adolescents or those whose religious background makes interacting with male physicians difficult.
Patients and specialists who interact with the ED have definite preferences for the appearance of emergency physicians. Although patients were more tolerant of casual dress than other physicians, half of patients said they prefer to see their emergency physician in a white lab coat, and 18 percent did not like scrubs. Physicians and patients alike disliked jeans and sandals, and they didn't like ribbons and ruffles, excessive jewelry, and long fingernails either. (Ann Emerg Med 1989;18:145.)
In another study, patients had the highest confidence in images of physicians dressed in scrubs with a white lab coat and the least confidence in images of physicians dressed casually. (Am J Obstet Gynecol 2002;190:1484.)
While patients mistakenly remembered whether their physician was wearing a tie 30 percent of the time, they did correlate wearing a tie with a positive impression of the physician. Although this did not affect their impressions of the care they received, they preferred a physician in a tie. (J Emerg Med 1998;16:541.) Handing a patient a business card also correlated with enhanced patient satisfaction. (Am J Emerg Med 1994;12:125.)
Patients also want their emergency physicians to call them by name, and while most physicians addressed patients by surname, almost half of patients expressed a preference for being called by their first names. (Ann Emerg Med 1989;18:145.) Another study concluded that physicians cannot reliably predict how a patient wants to be addressed so a more formal approach may be best. (J Am Board Fam Prac 1992;5:517.) In any case, patients like formal introductions from each staff member on their care team.
Perceived technical skill correlates well with positive perceptions of staff (Hosp Health Serv Admin 1996;41:515), and perceived good technical skills have been found in two studies to be the best predictor of global satisfaction (Health Care Manager Rev 1995;20:7; J Emerg Med 1996;14:679), even more than bedside manner! This may be a troublesome realization for emergency physicians at our nation's teaching hospitals.
If technical skill is highly correlated with patient satisfaction and an enhanced patient experience, should we have the least experienced among us learning their technical skills on ED patients? The data on this topic are somewhat mixed. One study found that ED patients would allow medical students to perform simple noninvasive procedures such as starting IVs, placing splints, and suturing. (Acad Emerg Med 2002;9:495.)
Another study, however, concluded that patients are reluctant to have medical students perform a first procedure on them, and many would not allow medical students to perform some procedures at all. (Acad Emerg Med 2002;10:1329.) This presents dilemmas in medical education and informed consent. This may be an area where scripting could help, and guidelines for effectively enrolling patients in such learning encounters may need to be set for teaching hospitals.
Next month: How do emergency physicians' technical skills, including pain management, affect patient satisfaction?
PHYSICIANS' APPEARANCE AND PATIENT SATISFACTION
▪ Female patients prefer and feel more comfortable with female physicians.
▪ Patients prefer their physicians to wear a white lab coat. Leave the jeans and sandals at home.
▪ Patients dislike ruffles and ribbons, excessive jewelry, and long nails.
▪ Patients have more positive perceptions of male physicians who wear ties.
▪ Patients want everyone on the emergency care team to introduce himself formally.
▪ A simple, inexpensive business card handed to the patient correlates with enhanced patient satisfaction.