May 22, 2018

Understanding Your Patient

… the second in a series

Dr. Anthony Bevilacqua

In 2014, the National Institutes of Health noted, “Over the past 20 years, patient satisfaction surveys have gained increasing attention as meaningful and essential sources of information for identifying gaps and developing an effective action plan for quality improvement in healthcare organizations.”  It’s become as much an economic imperative as a good will one: as reported in our last issue, “…payers are more and more tying a portion of reimbursement to patient satisfaction scores.”

So how do patients measure their satisfaction?  Certainly when they feel their concerns have been addressed, when they believe they’ve been listened to and heard – when they feel they’ve been understood.  But how can a physician – with a standing-room-only waiting room and a call-back list a yard long – get to really know and understand each patient?

It can be something as complicated as reviewing Medicare records (see our Winter 2017 issue), or as minor as a simple ergonomic shift.  “If you’re not ergonomically designed to prevent it,” says Dr. Anthony Bevilacqua of Sports Medicine and Orthopaedic Center, “you’ll end up looking at the computer when you should be looking at the patient.”

He explains: “We had some room configuration issues in our old offices, and it could be very challenging to face our patients.  When we moved, we bought computers on wheels, so we could look directly at the patient, rather than the computer screen.”  That’s important, he says, because actually looking at patients provides so much information – “body language tells us a lot about the problem(s) they’re having, as much or more than they’re articulating.”

“To me,” Dr. Bevilacqua adds, “the treatment I prescribe has everything to do with who’s sitting in the chair.  A patient thinks because his pain is similar to his friend’s, he’ll get the same treatment; people think medicine’s a cookbook thing: you come in with knee pain, so I prescribe X.  But I’ve got 50 treatments for knee pain, and I have to figure out which one will work for the patient in the chair, whether or not his symptoms mirror someone else’s.  And now, with computers so omnipresent, if we’re focused on a screen, we can lose many of the vital visual cues we had before.”  And, unfortunately, the necessity to populate the EMR can overtake the need to learn about the individual patient, he says, if everyone’s looking at the computer all the time.

Dr. Bevilacqua resolves the issue by not touching the computer while he’s with patients.  A tech sits across the room entering data, while he sits directly across from each patient, making eye contact, asking questions and taking notes.  “I try to establish a personal connection with each patient,” he says, “and then I can add notes that will make that patient unique, which I can bring up at the next visit.”

It takes longer to document the care he renders, Dr. Bevilacqua concedes, but it helps patients trust that he’s treating them, not their chart.  And that kind of trust goes a long way toward building patient satisfaction.