En Route to File 13

Monday, November 01, 2010

After my recent, unexpected stay in the hospital, it finally arrived. No. Not the bill, although that's what I thought the envelope from the hospital contained. What had arrived was, instead, a piece of bureaucratic, meddlesome ... nonsense ... called a Press-Ganey questionnaire. Although I'd heard of these before, it didn't click right away when I opened the envelope to find the polite letter asking me for my "confidential" input in the form of filling out and sending in the enclosed questionnaire.

I was, at first, delighted that there might be a way to express my appreciation for the people who probably saved my life in the course of their normal work day. They also were able to tell me the very next day that I am actually quite healthy and that avoiding similar episodes in the future will be ridiculously easy. I do dread the bill, but in light of the alternative, I'll pay it with a smile -- or however many smiles it takes.

The first few questions were pretty run-of the mill: Did I have a roommate? Was it my first stay at that hospital? That sort of thing. Then I got to this one: "Did someone explain your extended life support (e.g., living will, advance directives, etc.) options?"

First of all, I was so wiped that day that if someone told me the sky is blue, I'm not sure I would have necessarily remembered clearly enough to answer "yes" or "no" -- my only choices on the survey form -- to a query as to whether I was given that information. Second, being told such a thing was completely unwarranted in my case, given that I was unconscious while actually in danger, and that by the time I was conscious and awake enough to handle such a weighty issue, it was plain that I really didn't need such counseling, anyway. So I already have a question that I am unable to answer truthfully and that I should have been able to opt out of anyway -- because there is no objective reason to provide such counseling to every patient.

Given that another question was, "Did someone give you information about the Patient's Bill of Rights?" I have a pretty good feeling about what the "right" answers are. Since medical care is not a "right," there are legal remedies against malpractice in place already, and I was much more interested in sleeping that day, I would regard a "yes" (that I remembered) as a definite black mark against my hospital. So, on top of the survey being impossible for me to answer honestly, its criteria for good hospital care are, at least in some ways, wrong.

These issues extended to the multiple choice section of the questionnaire. Since I was -- I think -- unconscious, asleep, or undergoing emergent procedures while being admitted to the hospital, I have no way of, say, rating the courtesy of the person who admitted me on a scale of 1-5 and nothing to report on the comment line reserved for me to "describe a good or bad experience."

"Noise level around the room." This is a hospital, not a cemetery. I understand that, but how many other people do? Trying to rest was, I imagine, like attempting to meditate in Grand Central Station, but so what? They were making sure nothing goofy and dangerous was happening to me, so I'll give them a pass.

And questions on food?!?! I ordered something I thought was impossible to screw up -- and it was still awful. It was edible and I was alive, so I found it amusing. I refuse lie about this or to add a manufactured, ninny-complaint to a pile of much more important worries for that hospital.

I could go on about the questions I am not really qualified or inclined to answer on a scale of 1-5, like "skill of physician." I'm alive and in great shape: "very good" isn't good enough as far as I'm concerned.

But enough of that. I think a word from the receiving end of this lunacy is in order about now:

... a rep from the company came to present their survey findings to the hospital. First, he introduced his company by mentioning that it was founded by "Doctors Press and Ganey". I looked up "doctors" Press and Ganey and they, in fact,are not real doctors but PhDs in statistics and cultural anthropology. Nice to be lied to right out of the box. ... I was in awe of the audacity of the rep, standing in front of a group of doctors and making the following statement (one of many winners): "Patient privacy is important. On your survey patients said the privacy in the ER was lacking. Let me tell you how you can fix this for NOTHING! When you pull the curtain to separate the beds, say 'I'm doing this for your privacy', and your scores will, I guarantee, improve!" In other words: privacy is a problem; instead of ACTUALLY making the ER more private, PRETEND that it is more private and the PERCEPTION will improve. Fix perception, not the actual problem. ... This is the essence of Press-Ganey.
And that hypocrisy is evident on the very form! Two lines at the end, marked "(optional)" permit you to give your name and contact information or opt out. In a sense, though, it is already too late to opt out, if you fill out the survey truthfully (to the extent that's even possible). Among the first things the survey will say about you are the following:
  • Room Number
  • Duration of Stay
  • Date of Discharge
  • Sex
  • Age
This combination is more than enough to identify you already, if combined with hospital records. While I suspect that there may be laws in place to prevent a patient from being identified in this way under ordinary circumstances, I wonder whether they will remain in effect under ObamaCare. I also wonder whether filling out this absurd and impossible form -- or something worse -- will remain optional or even minimally "private" for long.

On a personal level, I found this survey patronizing to the patient. I suspected it to be unjust to medical professionals as well, and confirmed this suspicion at a medical blog:
Even though the kind of 'protection' we pay for with JCAHO and Press-Gainey has nothing to do with physical harm, doctors and hospitals have become dependent on getting good scores so they can advertise their "five star rating" or whatever, and individual ER groups often base bonus pay on a physician's Press-Gainey scores. These scores and the methods used to obtain them are NOT TRANSPARENT, and have the science of statistics behind them to be sure, but really, how much sense does it make to ask patients whether they received good care? First off, if you are answering the survey, you lived! Awesome. Secondly, it is an unfortunate axiom of the ER that if you are not really sick you are probably going to wait a long time and why the hell would you then want to fill out a survey telling someone how great your experience was?
And the waiting time for the not-so-sick is not actually the fault of the hospital, anyway.

-- CAV


Vigilis said...

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Excellent, Gus!

Small grumble: It is unclear whether or not you are suggesting the current avalability of medical malpractice torts makes a patient bill of rights redundant rather than vice versa.

Gus Van Horn said...

Unclear to me is whether you are equating a legitimate legal remedy with a manufactured "right."

If I sell you a defective generator, you ought to have legal recourse. That is a far cry from saying at the outset that I owe you a generator for free if you simply show up at my store in need of one.