While doctors strive to make their patients happy, the growing trend in healthcare toward “pay-for-performance” underscores the need to achieve patient satisfaction in the practice of medicine. Among other benefits, improved medication adherence and overall better outcomes are associated with patients' satisfaction with their physicians (Citation1,2). A variety of factors affect how patients perceive their doctors, and it is difficult to know where one stands without asking. When patient satisfaction is measured, however, it can be difficult to get an unbiased response.
The “Heisenberg Uncertainty Principle” is a concept that may help to understand the principles at work in determining patient satisfaction. This principle, first described in 1927 by Werner Heisenberg, relates that the exact position and momentum of a particle cannot both be accurately measured at the same time, and it can be understood by examining how the position and momentum of an electron are measured. Similar to the way billiard balls change direction when they bounce off one another, the kinetic energy in photons causes the electron to change its momentum when they collide. A high-energy photon with a very short wavelength will allow the position of the electron to be measured accurately, but the high energy of the photon greatly changes the electron's momentum. To get an accurate assessment of momentum, a very-low-energy photon with a long wavelength could be used, but then the position of the electron could not be closely determined. No matter how accurate the instruments, no matter how high quality the experimental methods, nature's intrinsic mechanics and wave properties do not allow for simultaneous precise measurement of a particle's momentum and position.
There is perhaps a similar principle at work in measuring patient satisfaction and how patients perceive physicians. Patients value doctors who are friendly and caring; these factors are the ones most closely tied to patient satisfaction (Citation3). When physicians ask patients for their feedback, patients perceive this as demonstrations of care, respect and concern. Requesting their opinion augments patients' perceptions that doctors care about doing what is best for their patients, thus patients respond positively to this effort and report higher satisfaction with their physicians.
The tools used to assess patient satisfaction affect responses to questions about how patients perceive their doctors. Just as photons change the position or momentum of electrons, surveys or direct physician questioning introduce new energy into the patient–physician interaction and alter patients' views. Photons are also affected by the electrons with which they collide in the same way that physicians who actively seek feedback from patients are likely aware that they are under a microscope and therefore change their own behavior toward patients. While physicians already strive to provide accurate diagnoses and treatments, they should also work to deliver what patients perceive as great medical experiences. Recognizing that patients will be reporting their impressions likely reminds physicians to remain attentive to the little things that make people feel appreciated and cared for.
Although the principle that measurements are inherently biased by the measuring process may have been disappointing to Heisenberg in the context of quantum physics, it should be welcomed by the medical community. Physicians should strive to be high-energy photons who reap patient feedback and, by doing so, change their own behavior and their patients' perceptions for the better. With quality care being the common goal, patient satisfaction will increase as physicians display concern for their patients in this regard. The medical community thanks Heisenberg for conceptualizing this inherent bias. By measuring patients' perceptions, we change and increase patient satisfaction, evidence that this bias can be put to good use.
Acknowledgement
We are indebted to dermatology residents training to make the future of Dermatology better than ever. Author Contributions: Dr. Steven R. Feldman and Ms. Candace Glenn had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: Feldman, Glenn. Acquisition of data: N/A. Analysis and interpretation of data: N/A. Drafting of the manuscript: Glenn, Feldman. Critical revision of the manuscript for important intellectual content: Glenn, Feldman. Statistical analysis: N/A Obtained funding: N/A. Administrative, technical, or material support: Glenn, Feldman. Study supervision: Feldman. Financial Disclosure: The Center for Dermatology Research is supported by an unrestricted educational grant from Galderma Laboratories, L.P. Dr. Feldman has received consulting, speaking, and/or grant support from Galderma Laboratories, L.P., GSK/Stiefel, Abbott Labs, Leo, Centocor, Amgen, Astellas, Coria, and Aventis Pharmaceuticals, has received stock options from Photomedex, and holds stock in www.DrScore.com. Ms. Glenn has no relevant financial interests to report.
Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.
References
- Kaplan SH, Greenfield S, Ware JE Jr. Assessing the effects of physician-patient interactions on the outcomes of chronic disease. Med Care. 1989;27:S110–S127.
- Kirsner RS, Federman DG. Patient satisfaction. quality of care from the patients' perspective. Arch Dermatol. 1997;133:1427–1431.
- Uhas AA, Camacho FT, Feldman SR, Balkrishnan R. The relationship between physician friendliness and caring, and patient satisfaction. Patient. 2008;1:91–96.