Dataset Information

"A Phenomenal Person and Doctor": Thank You Letters to Medical Care Providers.

ABSTRACT:

Background

Thank you letters to physicians and medical facilities are an untapped resource, providing an invaluable glimpse into what patients notice and appreciate in their care.

Objective

The aim of this study was to analyze such thank you letters as posted on the Web by medical institutions to find what patients and families consider to be good care. In an age of patient-centered care, it is pivotal to see what metrics patients and families apply when assessing their care and whether they grasp specific versus general qualities in their care.

Methods

Our exploratory inquiry covered 100 thank you letters posted on the Web by 26 medical facilities in the United States and the United Kingdom. We systematically coded and descriptively presented the aspects of care that patients and their families thanked doctors and medical facilities for. We relied on previous work outlining patient priorities and satisfaction (Anderson et al, 2007), to which we added a distinction between global and specific evaluations for each of the already existing categories with two additional categories: general praise and other, and several subcategories, such as treatment outcome, to the category of medical care.

Results

In 73% of the letters (73/100), physicians were primarily thanked for their medical treatment. In 71% (71/100) of the letters, they were thanked for their personality and demeanor. In 52% cases (52/100), these two aspects were mentioned together, suggesting that from the perspective of patient as well as the family member, both are deemed necessary in positive evaluation of medical care. Only 8% (8/100) of the letters lacked reference to medical care, personality or demeanor, or communication. No statistically significant differences were observed in the number of letters that expressed gratitude for the personality or demeanor of medical care providers versus the quality of medical care (χ21, N=200=0.1, not statistically significant). Letters tended to express more specific praise for personality or demeanor, such as being supportive, understanding, humane and caring (48/71, 68%) but more general praise for medical care (χ21, N=424=63.9, P<.01). The most often mentioned specific quality of medical care were treatment outcomes (30/73, 41%), followed by technical competence (15/73, 21%) and treatment approach (14/73, 19%). A limitation of this inquiry is that we analyzed the letters that medical centers chose to post on the Web. These are not necessarily a representative sample of all thank you letters as are sent to health care institutions but are still indicative of what centers choose to showcase on the Web.

Conclusions

Physician demeanor and quality of interaction with patients are pivotal in how laymen perceive good care, no less so than medical care per se. This inquiry can inform care providers and medical curricula, leading to an improvement in the perceived quality of care.

SUBMITTER: Miron-Shatz T

PROVIDER: S-EPMC5695918 | biostudies-literature |

REPOSITORIES: biostudies-literature

ACCESS DATA

Similar Datasets

Project description:INTRODUCTION:Patients who doctor shop for opioids are a vulnerable population that present a difficult dilemma for their health care providers regarding best methods of immediate treatment and how to manage their risk of harm from opioids. We aim to describe and compare opioid prescription patterns among high quantity prescription patients who doctor shopped, high quantity prescription patients who did not (doctor shopping eligible patients), and the remaining patients who received opioid prescriptions to guide population health policies for high risk opioid use patients. METHODS:We performed a cross-sectional descriptive analysis of opioid prescriptions during an 8-year period using California's de-identified Controlled Substance Utilization Review and Evaluation System (CURES) database from years 2008-2015. We identified the prevalence of patients who doctor shopped and depicted their opioid prescription patterns including prescriber characteristics, in comparison to the aforementioned groups. Doctor shopping was defined by patients who received greater than 6 or more prescriptions from at least 6 different prescribers within 6 months of time. RESULTS:Among the 3 million individuals who received an opioid prescription during the 8-year period, 1.3% met the doctor shopper definition. These patients received high levels of chronic opioids with 82% and 33% averaging greater than 20 and 100 morphine milligram equivalents (MME) daily, respectively, in comparison to 72% and 18% in the doctor shopping eligible group. Patients who doctor shopped received a significant proportion of their MME from 1 main prescriber (54%) and only received 2-5% of their total MME from episodic care providers, despite 88% receiving a prescription from these providers. CONCLUSIONS:Patients who doctor shop are at high risk of opioid use disorder but represent a small fraction of those with dangerous opioid use. Furthermore, these individuals do not receive substantial opioids from episodic providers, which challenges the utility of prescription reduction programs in curbing use among this population. These results suggest we re-evaluate physician roles in the care of these patients and focus on referral to treatment and harm reduction strategies.

Project description:BackgroundWhen being treated at a university-based hospital, a patient may encounter multiple levels of physicians, including trainees during a single emergency visit. Patients want to know the roles of their providers, but their understanding of the medical education hierarchy is poor.ObjectivesOur study explored patient understanding of commonly used physician and trainee titles as well as the factors that contribute to patient understanding in our emergency department patient population. Additionally, we evaluated a new badge buddy system that identifies medical personnel impacts patient's perceptions of providers. We examined how the increasing prevalence of medicine in media may change patient perceptions of the medical hierarchy.MethodsPatients pending discharge from the emergency room was assessed through a knowledge-based and opinion-based questionnaire. Questions quantified the percentage of patients who understood titles of their team.ResultsOf 423 patients who completed the study, 88% (N = 365) felt it was very important to know the level of training of their doctor when being treated in the emergency department. Seventy-four percent (N = 303) believed they knew the role of their care providers but the mean knowledge score was 4.7 of 8, suggesting a poor understanding of the medical training hierarchy. Younger patients and those who felt that knowing the level of training of their doctor was very important noticed the badge buddies more frequently (80.9%, P = .020 and 81%, P < .001).ConclusionsOur study found that patients had a poor understanding of the medical training hierarchy, but felt that it is important to know the level of training of their staff. The implementation of a badge buddy served this purpose for most patients, but was less effective for older patients. Further research may be needed to evaluate if a different intervention, such as a detailed video or teach-back techniques explaining the levels of medical training, would be more effective for a larger population of patients.

Project description:Letters to the Editor offer ways for readers to engage with authors' publications. Letters are the shortest manuscript for medical students to publish and medical-education journals are best suited. The UK Foundation Programme rewards medical students achieving PubMed ID publications and we hypothesise that this is a main motivation for medical students to submit Letters to the Editor. A review of 15 medical-education journals with an impact factor was conducted to identify numbers and percentages of Letters to the Editor by medical students between July 2018 and June 2020. Affiliation of medical students was collected. Our results show over two years, 299 letters were published by medical students equating to 45.9% of total letters. There was a 60% overall increase in letters by medical students published in the first 12 months compared to second 12 months. During this period overall numbers of letters published increased by 27%. 86% of the letters published by medical students over the two-year period were from UK medical schools. Five schools accounted for 60.5% of these letters. The three medical schools with highest numbers of letters published were King's College London, Imperial College London and University of Oxford for both 2018/19 and 2019/20. The increase in letters published overall with greater numbers published by students, may indicate greater awareness of Letters to the Editor as means of dissemination amongst medical students. UK medical schools published large numbers of letters, perhaps reflecting increasing importance to students of publications due to impacting on subsequent jobs. Results from our quantitative research revealing: large numbers of letters by medical students, increase in letters published from 2018/19 to 2019/20 and overrepresentation of UK medical students supports the hypothesis that medical students are publishing letters to achieve PubMed IDs. Further qualitative research is required to test our hypothesis.

Project description:BackgroundA comprehensive picture of how the US population engages in specialty care use is lacking, even though redesign models focused on specialty care are becoming more popular.ObjectiveTo describe the type of provider, primary care or specialist, most often seen by individuals, to test associations between type of provider most often seen and insurance coverage, and to test associations between the number of generalist and specialist visits and insurance coverage.DesignCross-sectional analysis of 2013-2016 Medicaid Expenditure Panel Survey. Logistic and negative binomial models were used in multivariate regression modeling.ParticipantsDepending on the analysis, the study samples include between 71,402 and 79,518 US residents.Main measuresIndividuals' provider type most often seen, primary care visits, and specialist visits were reported.Key resultsMore than half of the sample (55%) predominantly visited primary care providers (or generalists), and 36% predominantly visited specialists. Among individuals primarily visiting generalists, 80% visited only one type of primary care provider, and 24% also visited one or more specialists. Among individuals primarily visiting specialists, 48% visited only one type of specialist, and 47% did not visit any generalists in the year. Among Medicare enrollees, 50% predominantly visited specialists, and 40% predominantly visited generalists. Medicare enrollment was associated with greater odds of predominantly visiting specialists (p < 0.05), and Medicare-Medicaid enrollment and having no insurance were associated with lower odds of predominantly visiting specialists (p < 0.05). Medicare enrollment was associated with 13% more generalist visits and 35% more specialist visits, and Medicare-Medicaid enrollment was associated with 38% more generalist visits and 15% more specialist visits (all p < 0.05).ConclusionsGiven the overall frequency of specialty care use and the reliance on multiple specialists in any given year, particularly among Medicare enrollees, public payers are uniquely positioned to promote specialty care redesign and champion improved coordination between specialists.