UC Davis study found that patient satisfaction varies depending on the type of health plan, time spent and physician's empathy for the patient's condition

In a recent study, researchers at UC Davis discovered several key factors that influences a patient's satisfaction with an office visit.

In today's market, patient satisfaction is not only measured by HMOs, but preferred provider organizations, independent physician associations, state departments, business groups and many others. The physicians experience is reviewed more today than ever before.

UC Davis researchers found that patient satisfaction was higher with independent physicians when compared with physicians who work at Kaiser Permanente, the state's largest HMO. "Primary Care Visit Length, Quality, and Satisfaction for Standardized Patients with Depression" study is in the December 2007 issue of the Journal of General Internal Medicine.

Identifying the key predictors that drive the length of doctor visits have remained elusive, despite much effort by researchers. Using what are called "standardized patients" — actors who have been carefully coached to simulate either depression or muscular skeleton problems — the actor patients visited physicians. They were equipped with a tape recorder, and the physicians knew they were in the study, but didn't know which patients were actors. This allowed researchers to control patient presentations and more accurately gauge physician practices, said Dr. Estella Geraghty, one of the lead UC Davis researchers on the study.

Researchers found that visit length for patients with similar conditions varied widely among primary care physicians, with much of the variation attributed to individual physician styles.

"In a sense there wasn't a surprise that physicians in HMOs had shorter visits," said Geraghty. "HMOs were 26 percent shorter in visit length than solo practice types."

Doctors working at Kaiser and those with the busiest schedules, for example, spent significantly less time with patients. Physicians with personal or vicarious experience with depression, however, spent more time with their patients. They spent as much as 11 percent more time with depressed patients than doctors who did not have that personal connection with the ailment.
The study found that despite using standardized patients to control for variability in cases, visit times still ranged significantly, from about six minutes to more than 72 minutes, with an average visit lasting approximately 22 minutes. Independent physicians not in an HMO plan spent 26 percent more time with a patient on average when compared with an HMO doctor, Geraghty said.

Overall, patients felt more satisfied when the physician spent more time to discuss their problems. However, one of the biggest factors that influenced patient satisfaction was the physician's ability to empathize with the patient's problems for depression.

Geraghty's team also found that physicians who worked the most hours in the week had less favorable satisfaction rates with their patients compared with physicians who worked fewer hours.
Meeting patients' desires for longer visits tends to conflict with the pressures faced by most physicians to see as many patients in a day as possible, said Geraghty.

"Physicians who work in HMOs or who have busy practices risk jeopardizing patient satisfaction because, inevitably, their patient visits are shorter," she said. "There is a constant tension between practice efficiency and providing a long enough visit to satisfy the patient."

Patient satisfaction is an important component of care because it influences how well a patient follows the physician's advice, and in some cases it's tied directly to reimbursement. Many health plans pay bonuses to practices that get a high approval rating from their enrollees.

Doctors who can't easily spend more time with their patients can find other ways to improve patient satisfaction. She said small steps, such as exhibiting greater empathy, enhancing active listening skills, decreasing waiting-room time, asking more open-ended questions about primary complaints and allowing patients to respond with minimal interruption could help compensate for unavoidably short visit lengths.

The study involved 298 primary care visits by 18 standardized patients to physicians at medical offices in California and New York. Standardized patients are healthy persons trained to portray the personal history, physical symptoms, emotional characteristics and everyday concerns of an actual patient. Using these actor-patients helped Geraghty and her colleagues limit the uncontrolled variability associated with patient differences encountered when using real-life patients, she said.

The researchers concluded that more study is needed to examine the relationship of quality and visit length and to understand how physicians can maximize patient satisfaction within a reasonable amount of time— as well as find if patient satisfaction has any influence on outcomes of medical care. The theory is that a patient who walks away satisfied was able to better understand their duties to improve their treatment outcome.

Co-authors on the study were Richard L. Kravitz, professor of internal medicine, and Peter Franks, a professor of family and community medicine.

The study was funded by a Health Resources Services Administration training award that Geraghty received, and by National Institutes of Health grants.

—By Troy May

Troy May is the executive editor of the Healthcare Journal. You can reach him at tmay@healthcarejournalnorcal.com.