Original Research

Is Patient Satisfaction the Same Immediately After the First Visit Compared to Two Weeks Later?

Journal of Clinical Outcomes Management. 2019 March;26(2):61-67

References

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Discussion

Patient satisfaction is considered a quality measure^1-8 and is typically measured directly after an in-person visit. This study tested differences in patient satisfaction and perceived empathy immediately after the initial visit compared to 2 weeks later. In addition, we assessed whether change in disability was independently associated with change in satisfaction and empathy after the initial visit compared to 2 weeks later.

We acknowledge some study limitations. First, we only measured satisfaction based on 1 visit rather than multiple visits over time. It might be that satisfaction ratings differ when the physician-patient relationship is more established. However, we found overall high satisfaction ratings and a well-established relationship might not add to this finding. Second, surgeons were aware of the study and its purpose, which might have resulted in subconsciously altering the behavior to improve satisfaction. The effect of people acting differently as a result of being observed is called the Hawthorne effect.¹⁹ Third, we only used 1 simple ordinal measure to assess patient satisfaction with the surgeon. There is a wide variety of satisfaction measures,²⁰ though the focus of this study was not to test the best possible satisfaction measure but to assess changes in satisfaction over time and its predictors. The simple 11-point ordinal satisfaction measure has proved reliable.⁶ Fourth, 35% of patients did not make a second rating. This is not unusual for phone or email studies. Our response rate was relatively high compared to other studies in our field,¹⁸ perhaps because the time to the second assessment was only 2 weeks and all people were available for follow-up by phone. Fifth, we analyzed 4 surgeons as 1 group and 3 offices as 1 group since we did not enroll enough patients per surgeon and office for individual analysis. However, multilevel linear analysis takes surgeon specific factors into account within that group.

The finding that satisfaction with the surgeon after 2 weeks was significantly lower on bivariate analysis compared to immediately after the initial visit is different from a study that found small increases in satisfaction after 2 weeks and 3 months,¹ but comparable to another study in our field.²¹ Although significant, we believe the decrease in satisfaction is probably not clinically relevant. It might also be that satisfaction at follow-up is lower than measured, but that the least satisfied people did not respond on the follow-up survey.

We found no significant change in perceived empathy after 2 weeks. Since empathy is a strong driver of satisfaction,^2,4-7 we did not expect to find differing results for empathy and for satisfaction over time. Both satisfaction and empathy seem to be relatively durable measures with current measurement tools.

The finding that change in disability was neither independently associated with change in satisfaction nor change in empathy is consistent with prior research.^2,3,21 We cannot adequately study the impact of changes since we did not find an important change in either satisfaction or empathy over time. Jackson et al found higher satisfaction ratings over time in patients who had an increase in physical function and a decrease in symptoms.¹ They also found that met expectations was associated with higher satisfaction immediately after the visit, after 2 weeks, and after 3 months.¹ We feel that met expectations and fewer symptoms and limitations are likely highly co-linear with satisfaction. We therefore may not be able to learn much about one from the others.

The slight change we found in satisfaction with the surgeon among Latino patients was significantly less than the change among white patients. This suggests Latino patients might have a more stable opinion over time (a cultural phenomenon), or it might be spurious given the small number of Latino patients included in the study. The same can be said for the finding that race/ethnicity other than white or Latino was independently associated with greater change in empathy. Providing email as the preferred mode of contact was found to be independently associated with less change in perceived empathy compared to follow-up by phone. We had a 100% success rate for our follow-ups by phone. Our findings suggest that patients might more easily switch ratings on an 11-point ordinal scale than on a 5-item Likert scale. However, both measures are often rated at the ceiling of the scale.^2,21