For anyone who has read articles about the negative aspects of patient experience and satisfaction, such as The Atlantic piece The Problem With Satisfied Patients or the op-ed Death by Patient Experience in the ER, embracing patient experience may seem absurd. As medicine has slowly evolved from paternalism to mutual autonomy or shared-decision making, more and more feel that the pendulum has swung too far. They fear that healthcare now too closely resembles a service industry. Patient experience or “satisfaction” is interpreted to mean “the customer is always right.” You may have heard Burger King’s slogan of “Have It Your Way” (or “You Can’t Have It Your Way”) thrown around jokingly. Having read the aforementioned articles, one would be forgiven for assuming that patient experience efforts will result in mutually assured destruction: poor care for patients and high levels of burn-out for physicians.
Regardless of your opinion on whether modern healthcare is evolving into a service industry, patient experience is fundamental to the patient-physician relationship. Moreover, its origins predate the move from paternalism to mutual autonomy. Consider the painting ‘The Doctor’ by Sir Luke Fildes. It was commissioned by Sir Henry Tate in 1890, and the subject was that of Sir Fildes’ choosing.
The painting depicts a general practitioner holding vigil over a sick child, who lies on a bed made from two chairs pushed together in the home of an impoverished English family. The child’s mother sits with her head on a table, perhaps weeping or praying. The father stands next to her in the shadows, with his hand on her shoulder as he watches the physician. There is little focus on the medicine, although a small bottle is visible on the table next to the physician. It is unclear what illness affects the child, and whether he will recover or an inevitable death nears. Instead, the focus is on the physician and the patient, illuminated by a lamp and the light coming through the window.
It is believed that Sir Fildes was inspired by the compassion and devotion of the physician that cared for his 1-year-old son Philip, who died on Christmas morning in 1877. The painting was very well received, and it has been considered by many to represent the ideal physician. Mitchell Banks, a surgeon of the time, said of the painting:
“What do we not owe to Mr. Fildes for showing to the world the typical doctor, as we would all like him to be shown- an honest man and a gentle man, doing his best to relieve suffering? A library of books written in our honour would not do what this picture has done and will do for the medical profession in making the hearts of our fellow-men warm to us with confidence and affection.”
Thus ‘The Doctor’, one of the most iconic medical paintings, not only reflects the ideal patient-physician relationship, but it was inspired by a real patient experience. It was painted by a parent who was part of the patient experience. And it represents the reason that we too spend the holidays away from our own family and at the bedside of those who need us most, doing our best to relieve suffering and heal. You’ve trained to hone your craft; how you share it is the experience for both you and the patient. It is the patient experience and the “physician experience” that forms the basis of the patient-physician relationship.
Could it be that our frustration with patient experience efforts is actually our frustration with the physician experience? Perhaps we intuitively understand the importance of communication needs, emotional needs, competent care needs, waiting needs, physical and environmental needs, but often feel constrained by inadequacies in the US healthcare system? The US healthcare system, particularly during this fourth wave of COVID-19, feels like it is at the breaking point. We want patients to be seen quickly, but sometimes we don’t have the staff. We want to communicate well and provide emotional support with our patients and their families, but we frequently don’t have the time. We don’t want patients in the hallways, but we don’t have empty rooms to put them in. That’s not to say you’ll get along with every patient you meet. Even with abundant resources, there will be negative patient and physician experiences. But surely you didn’t go into medicine with the assumption that you would enjoy every patient encounter.
So let me make two proposals. First, ask the question: “Why don’t I have the resources I need to provide a great patient experience and physician experience?” Continue to work on the things that you can control, but keep asking that question. Sometimes you won’t get an answer. Sometimes you will get an answer that you don’t like. But keep asking. That question may lead you from department leadership all the way to the highest levels of our government. When the dust from this pandemic settles, keep asking that question.
Second, when you hear the words ‘patient experience’, don’t think of a Press-Ganey patient satisfaction survey. Instead, think of your own experiences with the healthcare system as a patient or the loved one of a patient; consider what the patient is experiencing when you are in the room with the patient; remember the Facebook posts by multitudes of other physicians who are overwhelmed by the healthcare system; and reflect on the experiences of the physician, the patient, and the parents in the painting The Doctor.
Finally, to all of our physicians on the frontlines of this pandemic, I see you. To the physicians in the academic and urban hospitals, I see you trying to hold the weight of Indiana’s healthcare system on your backs like Atlas, taking in those with the greatest need from your own community and other communities. To the physicians in the suburbs, I see you trying to help other smaller hospitals while also seeking help, stuck in what feels like a gridlocked state. To the rural and critical access physicians, I see you alone on the dark nights as hospitals near and far shut their doors and you struggle to lift up your sickest patients in a sea of patients, saying “Help them.” I see our graduates and faculty from across the state uniting to hold Indiana’s healthcare system together, and I am proud to stand alongside you.
-Courtney Soley, MD
If you choose to dive deeper into medical art history by reading the below citations, as I hope you will, please start with the first citation.