Three Steps to Quality Care

Ethics and Patient Satisfaction Go Hand-in-Hand

Often a discussion of medical ethics is reduced to the maxim, primum non nocere — above all, do no harm. But your dermatology practice won’t get very high marks in patient satisfaction if you merely refrain from causing harm. A more meaningful description of this ethical duty is to balance the potential for harm with the anticipated good result.

And when you begin to regularly consider the ethical dimensions of the physician-patient relationship, you make great strides toward enhancing patients’ satisfaction and loyalty, improving employee morale, and increasing your own satisfaction with the practice of medicine.

In order to truly help your patients make informed decisions that reflect their personal values and needs, consider three tactics that you can incorporate into your practice that will respect every patient’s fundamental dignity and unique value — and result in improved patient satisfaction.

Respect the clock — and the person

Do you think you’re spending a lot of time with your patients? Try putting it to the test. Go to your local athletic-goods store and buy an inexpensive watch of the sort that runners use to measure their mile splits. Wear it — or keep it in your pocket — and just as you are entering the exam room hit “start.” When you’re leaving the room hit “split” and then “stop.” At the end of the day, review the times — and make weekly comparisons. You can use this information to determine optimum appointment timeframes that will allow you to provide the best care for your patients. Spending the right amount of time with your patients conveys the message that you respect them as people and don’t perceive them as obstacles to your busy day. Remember, your patients’ time is as valuable as your own.

Use the time data you collect in conjunction with patient satisfaction surveys to ensure your patients’ expectations for the visit are being met. If you’re not conducting satisfaction surveys, I recommend you start. It doesn’t have to be an elaborate and expensive process — something as simple as a few questions on a postcard is a good beginning. The important thing is to begin measuring; it’s the first step on the road to improving all of the elements that make up the patient experience. Respecting the patient goes beyond the issue of time — remember, your patient is a person. When seeing a new patient in the office, have the initial encounter with the patient fully clothed. Avoid having the patient’s first — or only — encounter with you be for a few scarce moments while you perform a quick diagnosis or procedure.

Discussing advance directives

The practice of dermatology offers a unique role for addressing end-of-life decisionmaking. Some dermatologists may not be comfortable in this role but when you are caring for patients with pre-cancerous or cancerous skin conditions, there is a definite opportunity to introduce advance directives and explore patients’ potential options with them. Do not presume that your patient’s primary-care physicians will address end-of-life decisionmaking. Although it can be difficult, having this conversation with patients can greatly enhance their satisfaction with your practice and give you the confidence that you have been thorough in your provision of care.

Put conflicts of interest in the open

Conflicts of interest are inevitable because of our multiple relationships in healthcare. Dermatologists should heighten their awareness of potential conflicts of interest, especially if you sell health-related products in your office. Your patients trust you for your knowledge and expertise; they expect you to act in their best interests. The mere perception that you are putting your interest above theirs is something to avoid strenuously. How?

Develop a review process for evaluating potential conflicts of interest. Have someone who can offer you an objective opinion, review your business model, and if a conflict is identified, work to eliminate it. If you can’t, at least minimize it and disclose the conflict to your patients. Try to keep everything above board — transparency is a good guiding principle.

Healthcare will continue to experience dramatic changes and the practice of dermatology will not be exempt from adapting to them. Dermatologists who want to offer the highest quality care and who wish to achieve high patient satisfaction should regularly incorporate ethical considerations — am I respecting the patient as a person and giving him the information to make informed decisions? — into the physician-patient relationship.

Top 10 List for Better Satisfaction

(Yours and Your Patients’)

1. Look for ways to improve patient flow and work flow.
2. Eliminate redundancies — don’t ask patients for the same information two or three times.
3. Hold regularly scheduled staff meetings about how to improve your patients’ experience.
4. Hold an annual staff retreat and review your practice’s bigger-picture goals.
5. Initiate a patient satisfaction survey that gives you immediate feedback at the end of an office appointment.
6. Have an office open house to showcase your practice’s services or offer a demonstration on the latest advances in dermatology. Be sure to have refreshments.
7. Start a monthly newsletter for patients.
8. Spend time with your office staff. The better you care for them, the better they will take care of your patients.
9. Volunteer in your local community. Share your knowledge of dermatology with local groups such as Rotary International or at senior centers. Your generosity will return to you 100 times.
10. Keep yourself physically, mentally, and spiritually fit. You can only function at a high level at work with sufficient reserves of these important ingredients.

©2005 The Hooyman Group, Inc. All Rights Reserved

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Disclaimer: The material above has been prepared by Physicians Practice. It has not been reviewed by the DermQuest Editorial Board for its accuracy or reliability. Reference to any products, service, or other information does not constitute or imply endorsement, sponsorship, or recommendation by members of the Editorial Board.