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Letter to the Editor: A Better Way to Assess Physicians

doi: 10.1097/01.EEM.0000453179.08669.82
Letter to the Editor

Editor:

I recently got my patient satisfaction survey results, which will be used to determine my compensation for my hours spent in the ED. They were not bad: not top, but not bottom, either. The results did make me think, which is always a dangerous thing for me to do.

One of the categories was the patient's perception of my empathy with the pain being suffered. I assume that most patients will interpret the question to mean, “Did the doctor give me pain medication?” Arguments that another meaning would be possible fall away quickly.

I should say at the outset that I number myself among those who feel that patients should feel that they are being cared for, should have their suffering relieved if possible, and that I have an obligation to them. I also feel, as do many of my colleagues, that the current methods employed to gather data on this subject are flawed.

Part of the rising tide within medical practice is the belief that we must all be the same. Guidelines are prolific. Mandates from government agencies or insurance companies meet us at every turn. Deviation from those standards of care is strongly discouraged, if not outright forbidden. One area of particular scrutiny is pain management and the use of narcotics.

Again, I hasten to say that I number myself among those who believe that the too-liberal prescription of narcotics as practiced in the past was dangerous and had little benefit to our patients, but I also believe that my years of training and experience have given me the necessary skill to determine when and what to prescribe. Clearly, the supervisors of the medical system do not agree.

I am faced with two mandates in opposition to each other. I must offer treatment to my patients, including treatment for their pain, but cannot offer them narcotic medication outside an increasingly strict set of guidelines. Now, my patient satisfaction score did not identify me as incompetent, but did raise a question in my mind: If I am going to be forced to practice under increasingly directed limitations on my practice, does that not mean the patients are really expressing satisfaction or dissatisfaction with the health care system? If they are distressed that their pain is not treated, isn't that a reflection of the guidelines that direct how pain medication should be prescribed, not on the individual who follows the guidelines?

The most commonly cited area of dissatisfaction of patients seen in the ED are long wait times and pain control. The former is an issue over which I have no control, and latter is one over which I will soon have even less control. The patient satisfaction surveys are evidence of dissatisfaction with a flawed health care system that seems to be getting worse, and practitioners are trapped in that system with their patients. Maybe there should be a survey given to practitioners to access their opinion of the system and the people who administer it, and have those results used to determine their salaries. Just a thought, but I think it's a good one.

Paul Janson, MD

Lawrence, MA

© 2014 by Lippincott Williams & Wilkins