Freedom from the Form: How Physicians Can Take Back Time and Sanity

In a coaching session, as I was exploring with my physician client on what goes on during clinic time and areas to increase efficiency, Dr. E shared with me that her institution uses patient evaluation forms. The physicians are required to review those questionnaires filled by patients on a regular basis, ideally once a week. There may be a system-issued flag if a physician receives a low score – yes, even from one patient. To ensure she gets a high score, Dr. E finds herself spending extra time with patients while keeping full engagement at all times during each patient encounter. She realized that by doing so, she is less efficient and is piling on more after hours charting.

Patient evaluation for physicians is meant to improve the quality of care each physician provides, and to elevate each patient’s experience. The areas of improvement usually include waiting time for appointments, communication and knowledge of the physician.

Dr. E explained that, in order to score high points in the patient knowledge section, she would spend time reviewing each patient’s chart, including the information from years ago. She wanted to make sure that she knew the patients inside out. That was, of course, time-consuming. Did it really significantly help with patient care? That was questionable.

Yes, measures for quality improvement in patient care are designed to mean well. As physicians, if your organization uses it, it does not mean you have to use it as the gold standard to direct patient care.

Review the questions. Are the questions helpful in enhancing quality care? Are the questions asked in a way that is specific yet allows room for incorporating more personal comments? Do you think there is a need to change any of those questions?

I invite you to use the questionnaire as a reference and not a goal to direct your patient care. In other words, the way you care for patients is to provide the best care you can for the patients. The main purpose is not to increase the evaluation scores.

Be ready for “haters”. We behave a certain way, and expect others to behave a certain way accordingly. Keep in mind that we cannot control what other people think or say. Some patients may be carrying a heavy emotional load (which may not even be related to your specialty) and express it in the evaluation. Some patients may give you a low score on purpose, not because you are doing suboptimal work. Non-constructive comments may fly away. Whatever it is, know your value. Question the comments. Be curious about them. Did the patient write it out of spite? Was there more unrelated emotional turmoil than a true complaint about the physician?

Focus on better patient care. Patient evaluation forms can be useful as a reference. Know your values. Be curious and question the patients’ comments, especially the negative ones – are they reflective of what you did, or are they a type of emotional rant?

It is important to know your patients before you walk into the exam room. Not a problem for the patients whom you have known for some time. For the new or relatively new patients, know just enough about them. Learn about the history pertinent to the visit. In other words, give yourself the permission that you do not have to know “everything” about the patient. The less you review, the more time you save. Do what you think is best for the patient while not sacrificing your well-being. Spending extra time with a patient does not mean better care or better scores in the patient evaluation. If you have the right relationship with the patient, you do not need to spend hours in the room for the patient to feel connected.

Patient evaluation is a helpful tool in gauging quality measures. Use it like that. Ultimately, you are the physician to decide if the comments or the answers are reflective of your work. Know your own values and decide what level of quality care you wish to offer patients while maintaining or even enhancing your efficiency. Let the patients voice their opinions. You get to decide to follow and act on those comments or not.