To become more competitive, groups are teaching doctors to relate better to patients. Here's what the physicians are learning.
In a second-floor conference room at the Disneyland Hotel in Anaheim, 325 members of the Southern California Permanente Medical Group sip their morning coffee and preview their HMO's new television ad. Shown during the opening session of a daylong conference on enhancing patient-physician communication, the ad features vignettes of empathetic, personable, unhurried doctors chatting with their patients.
Patients are sure to find the promise of warm, personal attention appealing. But the ad makes several doctors in the room tense, as they readily admit later. How will they fit the requisite empathy and hand-holding into their already hectic daily schedules? No wonder that three-quarters of the physicians attending the conference crowd into the afternoon elective, "Working at Warp Speed: Stress, Time, and the M.D."
Like other physicians across the country, the Kaiser Permanente system's 9,329 doctors are under pressure to score well on patient-satisfaction surveys. With premiums virtually identical from plan to plan, patient satisfaction has become the biggest cannon in the battle for market share.
"Getting better is only a piece of what patients want," says Albert L. Mehl, a pediatrician and administrator at the Kaiser Permanente Medical Office in Boulder, Colo. "I had a patient say to me the other day, `There are plenty of good doctors out there. I'm going to look for someone who will spend the time and interact with me in a way that I like.' "
Multiple benefits from being attentive
The campaign to get doctors to be extra attentive to patients is more than a ploy to grab more market share, however. It's long been known that doctors who are outwardly caring are less often sued for malpractice. And large groups like Kaiser are testing the theory that a good patient-doctor relationship is measurably therapeutic. There's evidence that it improves outcomes by making patients compliant, more forthcoming about treatable emotional and behavioral problems, and accepting of conservative treatments. Physicians who take the time to listen closely to their patients are also more accurate in their diagnoses. Better outcomes, of course, reflect well on physicians because the health plan saves money.
Consequently, efforts to improve the patientphysician relationship can be cost-effective. The Colorado region of Kaiser Permanente, for instance, was able to reduce adverse events in teen pregnancies by hiring a guidance counselor to smooth relations between the teens and their doctors. "If we're nice to these kids, it will positively influence the delivery and the baby's health," says neonatologist Peter Hulac. "This was a win for us, in terms of lower hospitalization costs, a win for the babies, and a win for society at large."
And happier patients make for happier doctors. After the northern California group began offering a patient-relations course to physicians, the doctors reported feeling less irritated by their patients. Prior to the training, 52 percent of the physicians said that more than 10 percent of their patient visits were frustrating. After completing the course, only 34 percent felt the same way.
As uncomfortable as it is for a doctor to be told he isn't relating well to patients, facing that fact can save his career. Internist Scott K. Cunningham was among those whom the Colorado Permanente Medical Group singled out for observation and individual coaching. "It gets under your skin, having someone in the exam room listening to you," he says. "But the results were dramatic. This was the first time I realized that empathy is part of good medicine. I had a lot of frustration before that. This has led me to find much more enjoyment in my practice."
Unlike some HMOs and groups that merely score their physicians on …