From the Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, TX (Dr. Kortlever, Ms. Haidar, Dr. Reichel, Dr. Driscoll, Dr. Ring, and Dr. Vagner) and University Medical Center Utrecht, Utrecht, The Netherlands (Dr. Teunis).
- Objective: Patient satisfaction is considered a quality measure. Satisfaction is typically measured directly after an in-person visit in research and 2 weeks later in practice surveys. We assessed if there was a difference in immediate and delayed measurement of satisfaction.
- Questions: (1) There is no difference in patient satisfaction (measured by Numerical Rating Scale [NRS]) and (2) perceived empathy (measured by the Jefferson Scale of Patient Perceptions of Physician Empathy [JSPPPE]) immediately after the initial visit compared to 2 weeks later. (3) Change in disability (measured by the Patient-Reported Outcome Measurement Information System Physical Function-Upper Extremity [PROMIS PF-UE]) is not independently associated with change in satisfaction and (4) empathy after the initial visit compared to 2 weeks later.
- Methods: 150 new patients completed a survey of demographics, satisfaction with the surgeon, rating of the surgeon’s empathy, and upper extremity specific limitations. The satisfaction, empathy, and limitation questionnaires were repeated 2 weeks later.
- Results: We found a slight but significant decrease in satisfaction 2 weeks after the in-person visit (–0.41, P = 0.001). There was no significant change in perceived empathy (–0.71, P = 0.19). Change in limitations did not account for a change in satisfaction (P = 0.79) or perceived empathy (P = 0.93).
- Conclusion: Satisfaction and perceived empathy are relatively stable constructs that can be measured immediately after the visit.
Keywords: satisfaction, empathy, change, upper extremity, disability.
Patient satisfaction is increasingly being used as a performance measure to evaluate quality of care.1-8 Patient satisfaction correlates with adherence with recommended treatment.1,6,8-10 Satisfaction measured on an 11-point ordinal scale immediately after the visit correlates strongly with the perception of clinician empathy.2,3 Indeed, some satisfaction questionnaires such as the Medical Interview Satisfaction Scale (MISS)11,12 have questions very similar to empathy questionnaires. It may be that satisfaction is a construct similar to feeling that your doctor listened and cared about you as an individual (perceived physician empathy).
Higher ratings of satisfaction also seem to be related to a physician’s communication style.1,4,7-10 One study of 13 fertility doctors found that training in effective communication strategies led to improved patient satisfaction.7 A qualitative study of 36 patients, health professionals, and clinical support staff in an orthopaedic outpatient setting held interviews and focus group sessions to identify themes influencing patient satisfaction.4 Communication and expectation were among the 7 themes identified. We have noticed a high ceiling effect (maximum scores) with measures of patient satisfaction and perceived empathy.2,3 Another study also noted a high ceiling effect when using an ordinal scale.5 It may be that people with a positive feeling shortly after a health care encounter give top ratings out of politeness or gratefulness. It is also possible they will feel differently a few weeks after they leave the office. Furthermore, ratings of satisfaction gathered by a practice or health care system for practice assessment/improvement are often obtained several days to weeks after the visit, while research often obtains satisfaction ratings immediately after the visit for practical reasons. There may be differences between immediate and delayed measurement of satisfaction beyond the mentioned social norms.
Therefore, this study tested the primary null hypothesis that there is no difference in patient satisfaction (measured by Numerical Rating Scale [NRS]) immediately after the initial visit compared to 2 weeks later. Additionally, we assessed the difference in perceived empathy immediately after the initial visit compared to 2 weeks later, and whether change in disability was independently associated with change in satisfaction and empathy after the initial visit compared to 2 weeks later.