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Sorry doctor, the patient *really does* know best – experience again proven to predict clinical outcomes

February 13, 2014

Surely, you say, there cannot be anyone left on the (healthcare) planet who is still arguing against patient experience being a valuable, robust way to assess the quality of care. (Of course, it does need to be measured robustly, comparatively and with a sound, reproducible methodology – however that is not the subject of this blog.)

I’m sorry to be the bearer of bad news, but I do still occasionally meet clinicians who argue against the fundamental role and importance of patient experience, along the lines of “but it’s not as important as clinical outcomes, isn’t it just something that depends on the nurses being kind and the clinic running on time?”.

If you happen upon those poor misguided souls, and all the previous (and growing) weight of evidence-based publications has not yet persuaded them of their out-of-date, incorrect, misguided ways, then here is yet another BMJ publication to help explain why all the best doctors, dentists, nurses and hospitals now systematically – and continuously – ask all patients to “rate and review” their care. Not just for a few weeks a year, or a few sampled patients – but all patients, all the time, in all care settings.

In a nutshell, this paper from Professor Nick Black’s team at the London School of Hygiene and Tropical Medicine shows a positive association between experience and effectiveness for all three elective surgical procedures they studied: 4089 hip replacement patients, 4501 knee replacements and 1793 groin hernia repairs (not all in the same patient!).

The aspect of experience most strongly associated with a better outcome was the level of communication with and trust in their doctor.

All the relationships observed were consistent over time, between different types of patients (age, sex, socioeconomic status) and between providers.

What this means is that simply asking patients whether their doctor listens to them, and if they trust their doctor is a consistent, reliable way of detecting those clinicians who are likely to give great care, from those who merely achieve average outcomes.

This is why more and more commissioners are now using patient experience metrics as measures for outcome-based contracting: they work, they are quick and simple to collect and easily understood by all involved: indeed if you use a real-time system the answers to the questions about trust and communication can be collected in the immediate aftermath of the surgery.

But of perhaps even more importance in a world where healthcare is increasingly “consumerised”, where the public routinely seek reliable information to guide their choice of doctor, this paper provides scientific evidence that choosing a doctor or dentist based on how others rate their listening skills and how many stars they’d give them for trust (like Amazon!) will guide you to better care.

And that is of course why iWantGreatCare has enabled patients to rate their doctor, surgeon or dentist on exactly these criteria since 2008. And for all those who use the ratings and reviews of fellow patients to help guide their choice – you can be confident that the evidence backs your instinct – the patient really does know best, at least when it comes to finding great care.






One Comment leave one →
  1. November 25, 2014 4:00 pm

    Reblogged this on Science in our lives.

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