Saturday 6 September 2014

Are you satisfied with your doctor?

On a regular basis I receive a letter from the NHS. It's a survey which asks me to complete several questions about how satisfied I am with my GP. Invariably, the letter goes straight to the bin. And here is why.

The NHS have conducted patient satisfaction surveys for several years now (done by CQC) and they are beloved by politicians of all colour. Whenever the discussion turns to productivity or care outcomes in the NHS,  politicians are quick to point out that patient satisfaction is at an all time high in the NHS (it currently is about 96%). Somehow patient satisfaction rates are meant to counter any criticism of the NHS. I believe this is a spurious argument and one that does not stand up to scrutiny.

There are clearly some things surveys can find out. They fall into the category of 'facts' such as how many times somebody has visited their doctor recently and the like. Although patient surveys are actually not the best way to establish good data on these things, I can see that you may want to ask them in a survey with some justification. I still think responses to these questions should still be treated with caution given that we are all human beings and our memories play tricks on us with even more mundane issues such as remembering whether it was raining yesterday or where we put our car keys.

Be that as it may, the real problems emerge when it comes to the responses these surveys are really after: patient satisfaction. A typical question of this sort runs like this (this is an actual question from the regular GP survey I receive): 'How would you describe your experience of your GP surgery'? 'Very good, fairly good, neither good nor poor, fairly poor or very poor.

Well, let me think about this... First of all, I am not sure what this question refers to. Do they ask me to rate the pictures hung up on the surgery walls? Or are they after my opinion about the doctor's willingness to give me the drugs I want?

Yet, it is not only the fuzziness of the question that makes this survey an exercise in futility. More importantly, how would I know what is a 'fair, good or poor' experience? I tend not to visit my GP and then pop to another one down the road to see if she is any better. The nature of the healthcare experience is that it is rarely comparable. I have not heard of a single person who had a liver transplant at a London hospital and then, for the purpose of gaining comparative expertise, drove to Newcastle to test the local surgeon's skills by asking them to perform a similar operation.

Since the medical experience is most likely to be unique for most people, personal opinions of what constitutes a 'good' or 'poor' service are likely to be indiscriminately hovering in the 'satisfied' range, with only those patients blipping on the radar who have, for one or another reason, been seriously disgruntled about the service they received. Those are most likely to have encountered problems with their care which often end up at tribunals or on the desk of a solicitor. So, no surprise then that NHS surveys regularly indicate a high satisfaction rate of patients. We wouldn't know better! That's why the survey letter from my GP always goes straight to the bin. I happily profess my ignorance!

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