I recently presented at a conference. I was making the case for gathering patient feedback at the point-of-service. The benefit is that information captured at the point-of-service is not dated. It’s not stale. It’s timely and relevant. It makes no sense for patients to identify problems that presented days or weeks ago. Memories fade. I can’t even remember what I had for lunch the previous day. (Well, OK, I had a Greek Salad).

If you ask patients for feedback down the road, by email, letter, or phone, you typically get nothing. Minimal to no response.

The audience was receptive.

One person pushed back. He argued that asking patients for feedback in the office created “undue influence.” The patients would feel pressure to please and the information would be overly optimistic and valueless.

I explained the eMerit system is not asking for glowing praise. It asks for honest feedback. What worked. What didn’t. How can the practice be made better. Further, eMerit’s default setting is anonymity. If a patient chooses to give their name, great. But absent an affirmative step, only a pseudonym is tied to the review. The doctor would not know who the patient is, or even if the patient completed a survey.

I do concede that if the doctor or staff is sitting across from a patient, tapping a pencil while they complete a survey, then, yes, that could influence the outcome. But, who does that?

More importantly, doctors and patients have to manage a range of conflict of interests. And, it seems to work just fine the vast majority of times.

How about this one?

If a patient sees the doctor to discuss surgery versus conservative options, the patient understands the surgeon will be paid more for operating. Does the doctor have to explicitly disclose how much he will be paid with either option? Of course not. It’s assumed the doctor will behave like an adult and put the patients’ interest first, and the patient will make an informed decision.

Is it ever abused? Yes. With just under 1 million doctors in the US, some cannot resist the impulse to treat the patient as a cash cow. But, the majority of doctors comport themselves ethically –  with integrity.

And, if you develop a strong reputation of putting a patient’s interest first, you likely will have a stronger, economically successful practice.

Back to answering the original question about undue influence. How doctors interact with patients determines whether they are treating their patients with respect or whether they are tainting the relationship with undue influence. It has nothing to do with whether a practice asks for feedback at the point-of-service or somewhere else.

What do you think?

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