John D. Kelly IV, MD, is a professor of orthopedic surgery at the University of Pennsylvania. He focuses his blog on helping surgeons reduce stress while achieving balance in their practices and families.

BLOG: Patient-related outcomes: A novel way to prevent burnout

The age of outcomes is upon us. In fact, payers are demanding health care providers collect data on exactly how well they do their job as perceived by the patient. These patient-reported outcome assessment tools are perceived by many as onerous and simply “one more thing to do.” There is evidence that the implementation of outcomes assessment instruments leads to better patient management and enhanced quality of life. However, determining patient satisfaction may contain a hidden benefit: physician wellbeing.

This month’s New England Journal of Medicine contains a potential landmark article by Rotenstein and colleagues entitled, “Making patients and doctors happier — The potential of patient-reported outcomes.” The authors present a cogent argument that collecting data on how patients perceive their outcome from a health care intervention may serve as a shield against burnout.

The authors offer the following reasons for how collecting patient-related data enhances physician well-being:

Improved relationships between physicians and patients

Patient-reported outcomes (PROs) afford a better understanding of symptoms. The authors reference a spine service gaining a better appreciation of the exact magnitude and duration of post-surgical pain. Appropriate interventions – ie, medication adjustment and behavioral pain specialist referral, can then be implemented. Furthermore, surgeons may be armed with a richer understanding of recovery profiles so that long-held assumptions of pain could be challenged and superior responsiveness to patients needs could ensue. When physicians more fully understand precisely what patients are experiencing, empathy and fortified relationships with patients follow.

Enhanced shared decision-making

Patients deserve and demand the truth. Instead of dealing with generalizations and abstractions, when real and locally procured data are presented to patients, more meaningful and satisfying shared decisions may manifest. The authors cite an example of an elderly patient who insisted on having a radical prostatectomy after a low-grade carcinoma was revealed on biopsy. When presented with real data on post-prostatectomy incontinence and impotence scores with time, the patient ultimately chose active observation. Both the physician and the patient were noted to feel more fulfilled after their data-driven informed decision.

Increased work flow efficiency

If patients can enter data electronically prior to their visit, more time can be dedicated to the “lifeblood” of a physician-patient encounter: the history and physical exam. When screening questionnaires, review of systems, and overall risk assessments are obtained and recorded before the patient enters the examination room, the patient concerns that demand the most attention can be addressed. Many orthopedic knee and shoulder PROs give keen insight to the nature of symptomatology and disability burden.

Help identify sensitive issues

Patient matters that may be sensitive or awkwardly discussed may be more easily brought to light electronically than in person. The authors cite matters of sexual dysfunction, domestic abuse and hygiene may be more readily disclosed in the comfort of an electronic pad as opposed to face to face.    

 Furthermore, routine screening questionnaires may reveal a depression or anxiety condition not comfortably mentioned otherwise.  Whether we like it or not, the collection of PROs appears to be here to stay.

Embrace the positive offerings of PROs because, ultimately, the consideration of patients’ perceptions of their care will guide us to take better care of their needs. Taking better care of patients in a more efficient manner will make us all feel good.

 

References:

Bombardier C. Spine (Phila Pa 1976). 2000;25:3100-3103.

Rotenstein L, et al. N Engl J Med. 2017;doi:10.1056/NEJMp1707537.

 

 

See more from Focus On: Physician Burnout