Measurements Of Patient Satisfaction Research Articles

Qualitatively exploring the impact of a relationship-centered communication skills training program in improving patient perceptions of care.

To explore qualitative patient experience comments before and after a relationship-centered communication skills training to understand patient experience, program impact, and opportunities for improvement. Qualitative patient experience evaluation data was captured from January 2016 to December 2018 for 483 health care clinicians who participated in the skills training. A random sampling of available open-ended patient comments (N = 33,223) were selected pre-training (n = 668) and post-training (n = 566). Comments were coded for valence (negative/neutral/positive), generality versus specificity, and based on 12 communication behaviors reflective of training objectives. No significant difference was found in the valence of comments, or generality versus specificity of comments before and after the training. A significant decrease was present in perceived clinician concern. "Confidence in care provider" was the communication skill most frequently identified in comments both pre- and post-training. Perceptions of interactions largely remained the same following training. Key relationship-centered communication skills require further attention in future training efforts. Measurements of patient satisfaction and engagement may not adequately represent patient experience. This study identified areas for improvement in the training program and offers a model for utilizing patient experience qualitative data in understanding communication training impact.

Assessment of Consumer Satisfaction to Improve Quality of Services Provided in Tertiary Care Hospital of Uttar Pradesh- A Cross-sectional Study

Introduction: Satisfaction of the patient play a very important decisive factor for pay-for-performance metrics and it also replicates the type of care being provided. One of the major parameters to establish patient satisfaction is to measure success of services provided in hospital. Aim: To assess the quality of care in terms of patient’s satisfaction in a tertiary care hospital of Uttar Pradesh. Materials and Methods: A community based cross-sectional study was carried out among patients attending the Outpatient Department (OPD) at Varunarjun Medical College and Rohilkhand Hospital, Uttar Pradesh, India. Total 88 people (patients or attendants) were interviewed by using a predesigned and pretested semi-structured proforma, in Hindi language. The questionnaire contained questions related to an individual’s experience with the staff and environment of health system at the end of their outpatient visit. Data were analysed using Statistical Package for the Social Sciences (SPSS) version 20.0. Results: The majority 37 (42.0%) belonged to age group of 34-49 years, 58 (66%) were males, 36 (40.9%) educated upto high school and 45 (51.2%) belonged to general category. In the present study, regarding hospital informatory, 28 (31.8%) respondent found good direction indicators. Waiting period was less than half-an-hour reported by 47 (53.4%) patients. Sixty-three (71.5%) patients had opportunity to ask questions about their disease and treatment. Most of the respondent 50 (56.8%) said that hospital staff listened to their questions and problems. Statistically significant association was found in- between patient satisfaction and socio-demographic variable like age, gender, education and socio-economic status (p-value <0.05). Around 68 (77.2%) respondent were not satisfied with behaviour of hospital staff (nurses and paramedical staff) whereas only 35 (39.8%) respondent were satisfied with the behaviour of treating doctor. Conclusion: Among the different domains of measurements of patient satisfaction, only few were satisfied with doctor’s and paramedical staff. Doctor's time, behaviour of paramedical staff and poor quality of services were the main reasons for dissatisfaction among dissatisfied patients.

Assessment of Quality of Care Using Information on Patient Satisfaction at Adult Oncology Center of Tikur Anbessa Specialized Hospital, Ethiopia: A Cross-Sectional Study.

BackgroundCancer is one of the leading causes of morbidity and mortality in the world. It results in considerable mental, physical, and emotional stress for patients. Because of the nature and impact of the disease, and its treatment, measurements of patient satisfaction are important to bring to the attention of health-care providers in order to improve care.ObjectiveTo assess patient satisfaction at the adult oncology center of Tikur Anbessa Specialized Hospital, Ethiopia using the EORTC PATSAT-C33 tool.MethodsA facility-based cross-sectional study was conducted from January 2019 to May 2019. A consecutive sampling technique was employed to recruit a total of 384 study participants. Informed consent was obtained for each participant and data were collected using an interviewer-administered questionnaire. Ethical clearance and approval of the study protocol were obtained from the institutional ethics review board of the school of pharmacy. Descriptive statistics was used to summarize the data, while multivariate linear regression analysis was employed to explore factors affecting patient satisfaction. P<0.05 was considered as statistically significant.ResultsAmong a total of 384 study participants, the majority were female (65.9%) and the median age was 49 years. In most (65.9%) participants, the health-care service cost was covered by patients themselves; the majority of them were treated for gynecological malignancy (37.2%) and most received chemotherapy + surgery (37.2%). The mean score for the EORTC-PATSAT33 scales for overall satisfaction was 44.8 out of 100. Place of residence, gender, type of cancer, duration since treatment started, age and source of health-care costs were factors associated with patient satisfaction and all together explained 83% (adjusted R square=0.830, P<0.0001) of variance. Of these, residence (where patients came from) accounted for most (78.7%) of the variance (adjusted R square=0.787, P<0.0001).ConclusionThe mean overall satisfaction of patients with the services provided at the outpatient adult oncology center of TASH was significantly lower than previously reported in the world literature, which was >70. Hence, a concerted effort must be made to understand and improve patient satisfaction in oncology health-care services in Ethiopia.

Patient satisfaction about services obtained from a teaching hospital, Port Blair: A cross-sectional study.

Background:Periodic evaluation of health services delivered to the community is a part of total quality management of health care delivery system in developing countries.Objective:To assess the level of satisfaction among outdoor patients toward health care services available at teaching hospital, Port Blair.Methodology:The study included exit interview of 500 patients, sampled from 8 service delivery points of the health facility. Predesigned and pretested questionnaire based on PSQ-18 scale developed by Marshall and Hays was used as a study tool. Data entry was done in Microsoft excel sheet and analysis was done using IBM SPSS software version 21.Results:It has been observed that the majority of patients (62%) were from urban area. The highest number (32.40%) of respondents was in the age group of 30–39 years category. Mean satisfaction was the highest for communication (3.94 out of 5), followed by general satisfaction (3.69), technical quality (3.46), time spent with doctor (3.41), interpersonal manner (3.35), and least in accessibility and convenience (2.96).Conclusion:Our study showed a good level of satisfaction of patients with services obtained from the referral center. Among the different domains of measurements of patient satisfaction, only accessibility and convenience score was low. Findings of this study would serve as a baseline data for improving the quality of services and making them more clients centered.

A temporal analysis of opioid use, patient satisfaction, and pain scores in colorectal surgery patients

BackgroundRecent health care policy changes promote objective measurements of patient satisfaction with care provided during hospitalization. Acute postsurgical pain is a significant medical problem and strongly impacts patient experience and patient satisfaction. Multimodal analgesic pathways are used for acute pain management, but opioid medications remain a mainstay of treatment. Opioid use is increasing in the outpatient setting, but opioid use trends in the inpatient postsurgical setting are not well known. We hypothesized that use of opioid medications has increased over time along with decrease in postoperative pain scores and increase in pain-related patient satisfaction. MethodsIn this single-center study, we studied the trends and correlation in the average daily pain scores, opioid consumption, and patient satisfaction scores as measured by pain-related patient satisfaction questions in the Hospital Consumer Assessment of Healthcare Providers and System survey. Pain scores and opioid use data were obtained from electronic health records, vital signs monitoring, and medication databases. Adult patients who had nonemergent colorectal surgeries between January 2009 and December 2012 were included. ResultsWe found no significant trend in opioid use or pain-related patient satisfaction scores. There was an average annual increase of 0.3 (98.3% confidence interval, 0.2-0.4; P< .001) in average daily pain score from 2.8 ± 1.5 to 3.8 ± 1.5. The univariable associations between time-weighted pain score, average daily opioid dose, and pain-related patient satisfaction score were all highly significant. ConclusionIn this retrospective cohort study, opioid use and pain-related patient satisfaction scores were stable over time. Pain-related patient satisfaction scores were negatively associated with both pain score and opioid dose. The associations we report should not be considered evidence of a causal relationship.

First Canadian experience with robotic single-incision pyeloplasty: Comparison with multi-incision technique.

We compared the outcomes of single-incision, robot-assisted laparoscopic pyeloplasty vs. multiple-incision pyeloplasty using the da Vinci robotic system. We reviewed all consecutive robotic pyeloplasties by a single surgeon from January 2011 to August 2015. A total of 30 procedures were performed (16 single:14 multi-port). Two different single-port devices were compared: the GelPort (Applied Medical, Rancho Santa Margarita, CA) and the Intuitive single-site access port (Intuitive Surgical, Sunnyvale, CA). Patient demographics were similar between the two groups. Mean operating time was similar among the single and multi-port groups (225.2 min vs. 198.9 minutes [p=0.33]). There was no significant difference in length of hospital stay in either group (86.2 hr vs. 93.2 hr [p=0.76]). There was no difference in success rates or postoperative complications among groups. Single-port robotic pyeloplasty is non-inferior to multiple-incision robotic surgery in terms of operative times, hospitalization time, success rates, and complications. Verifying these results with larger cohorts is required prior to the wide adoption of this technique. Ongoing objective measurements of cosmesis and patient satisfaction are being evaluated.

Evaluation of satisfaction and durability after hemiarthroplasty and total shoulder arthroplasty in a cohort of patients aged 50 years or younger: an analysis of discordance of patient satisfaction and implant survival

Shoulder arthroplasty in individuals aged 50 years or younger reportedly leads to worse outcomes than in older patients. Current methods of determining survivorship may be inadequate and may not reflect actual patient definitions of satisfaction. The purpose of this study is to evaluate and contrast the survival of patient satisfaction and implant survival in the youngest reported patients undergoing either a primary hemiarthroplasty (HA) or total shoulder arthroplasty (TSA) using a third-generation stemmed prosthesis. Outcomes in 71 patients aged 50 years or younger who were treated with primary HA or TSA were evaluated for patient satisfaction and implant survival rates. Patient satisfaction survival was based on yes or no answers to 2 binary questions regarding willingness to undergo surgery again and whether surgery improved the patient's shoulder. The Kaplan-Meier patient satisfaction survival rates at 5 years were 71.6% (95% confidence interval [CI], 46%-87%) for HAs and 95% (95% CI, 81%-99%) for TSAs. Multivariable regression analysis implicated postoperative pain as the primary causative factor for failure of patient satisfaction in all patients. In contrast, the implant survival rates at 5years were 89% (95% CI, 69%-96%) for HAs and 95% (CI, 85%-100%) for TSAs. Patients aged 50 years or younger who undergo shoulder arthroplasty have declining rates of self-reported satisfaction despite high implant survival rates, and this finding highlights the discordance between patient satisfaction and implant survival. Primary TSA outperforms HA in both implant survival and patient satisfaction survival rates at short-term follow-up. Future studies and registries must incorporate measurements of patient satisfaction and not just revision rates to truly interpret outcomes.

Assessing patient satisfaction with medication related services in hospital settings: a cross-sectional questionnaire survey in China.

There are few prior studies on patient satisfaction with medication related services and the potential value of measurements of patient satisfaction to the development of pharmaceutical care service (PCS) strategies in China. The objectives of the current study were to assess patient satisfaction with medication-related services in Chinese tertiary hospitals, examine the possible impact of PCS on patient satisfaction, and form a development strategy to establish PCS strategy prioritization. Self administered questionnaires were distributed to 540 patients before discharge from units in 18 tertiary general hospitals in six cities. The participants assessed their satisfaction with the hospital's medication-related services based on a 7-point Likert-type scale. A comparative analysis between PCS and non-PCS pilot hospitals was conducted to evaluate the impact of PCS on patient satisfaction. 501 valid questionnaires were collected: 247 samples from PCS pilot hospitals (PCS group) and 254 from non-PCS pilot hospitals (non-PCS group). Factor analysis resulted in three factors (dimensions): "consideration and explanation", "discharge instruction", and "efficacy and finance". The "efficacy and finance" scores indicated relative satisfaction with this dimension (mean = 5.63 ± 1.36). However, the items "medication costs" and "other medical costs" were the lowest scored attributes (means = 4.98 ± 1.62 and 4.95 ± 1.63), indicating that most of the participants were dissatisfied with these financial attributes. The median score in the "consideration and explanation" dimension in the PCS group was 6.27, in comparison with 5.81 in the non-PCS group. This statistically significant difference (p < 0.01) demonstrates that the major impact of PCS on patient satisfaction is observed in the "consideration and explanation" dimension. This study revealed low patient satisfaction with the financial aspects of medication-related services, which must be improved to provide better inpatient hospital service. The clinical effectiveness of medication therapy at these 18 tertiary hospitals could meet patients' expectations, but PCS did not increase the level of patient satisfaction in the "efficacy and finance" dimension. Future PCS strategy in China should focus on improving the clinical and economic outcomes of medication-related services.

Angepasstes und standardisiertes Patientenmanagement bei der Behandlung der neovaskulären AMD im ambulanten Bereich einer Universitäts-Augenklinik

Visual results in treating neovascular age-related macular degeneration (AMD) using intravitreal injected anti-VEGF (IVT) clearly depend on injection frequency. Regarding to the European approval Ranibizumab has to be used only in cases of recurrent visual loss after the loading phase. In contrast monthly treatment--as also provided in the ANCHOR and MARINA studies--is generally allowed in Switzerland. However, it is commonly tried to reduce the injection frequency because of the particular cost situation in all health systems and of cause also due to the necessary strict monitoring and reinjection regimes, which raise management problems with increasing patient numbers. In this article the special treatment regimes of our University Eye Hospital is presented, in which a reduced injection frequency basically leads to the same increased and stable visual results as in ANCHOR and MARINA; however, needing significantly more injections as generally provided in other countries of Europe. The main focus for achieving this in a large number of patients is placed on re-structuring our outpatient flow for IVT patients with particular emphasis on patient separation and standardisation of treatment steps leading to significantly reduced time consumption per patient. Measurements of timing and patient satisfaction before and after restructuring underline its importance in order to be able to treat more patients at a high quality even in the future. The exceptional importance of spectral domain OCT measurements as the most important criterium for indicating re-treatment is illustrated.

Patient satisfaction with ambulance care services: Survey from two districts in southern Sweden

One of several quality indicators that are relevant to study is patient's satisfaction with health care in the ambulance services. Regular measurements of patient satisfaction in this field have not been carried out previously and a validated method of measurement is lacking. This study aimed to measure patient satisfaction with health care in the ambulance services in Region Skane, southern Sweden. Data collection was performed by a patient questionnaire, Davis Consumer Emergency Care Satisfaction Scale© (CECSS). The study was conducted in two of the region's ambulance districts, and 40 patients (20 informants from each of the two sites) were included in the study. Of the included patients 67% were women (n=27) and 33% men (n=13) with an average age of 65.6years (r=22-87). Informants average time of care in the ambulance was 31 min (r=12-75). A majority of the responses (93.1%) showed the most positive response option on each question position. The present study shows that patients within ambulance care in the region of southern Sweden were pleased with the care received and the competence of the ambulance staff, and the patients experienced a high level of psychological and physical sense of security.

Creation of a Novel Recuperative Pain Medicine Service to Optimize Postoperative Analgesia and Enhance Patient Satisfaction

Many patients have difficulty with pain control after transition from patient-controlled analgesia modalities to oral analgesics. The creation of a Recuperative Pain Medicine (RPM) service was intended to bridge this gap in pain management at the Hospital for Special Surgery. Specific goals were to improve patient and staff satisfaction with management of postoperative oral analgesics by improving clinical care, administrative policies, and patient and staff education. Primary outcome measures for improved satisfaction were Press Ganey surveys and staff surveys. From inception in Aug 2007 to Dec 2008, RPM has seen 6,305 patients for discharge planning and education and 997 patients for pain management consultation. Administrative and educational accomplishments have included creation of a patient "Helpline" for emergent phone questions regarding postdischarge home pain medications, a policy for prescribing pain medications for home discharge, patient education booklets, a pain management webpage on the Hospital for Special Surgery website, and direct education of staff. Press Ganey measurements of patient satisfaction increased from 87th percentile up to the 99th percentile among peer institutions since the implementation of RPM. Staff satisfaction was 92% positive regarding the RPM service's function and patient management. An RPM appears to be an effective means to optimize postoperative pain management after transition off patient-controlled analgesia devices. Further research is needed to ascertain the exact cost-benefit and potential impact on postoperative quality-of-life measurements.

Patient Satisfaction with private Physiotherapy for musculoskeletal Pain

BackgroundDespite emphasis on patient centred healthcare, healthcare professionals have been slow to use validated measurements of patient satisfaction in physiotherapy practice. The aim of this cross sectional survey was to measure patient satisfaction with private physiotherapy in Ireland, for patients with musculoskeletal pain, using a previously validated survey instrument.MethodsA multidimensional patient satisfaction questionnaire 'PTOPS', which assesses patient satisfaction with outpatient physiotherapy treatment, was translated from American English to European English, and relevant demographic and global satisfaction items were included. This was then circulated to patients with musculoskeletal pain (n = 240) for anonymous completion and return to the research team. Data were analysed using the Statistical Package for the Social Sciences (SPSS, v.12).ResultsIn total 55% (n = 131/240) of questionnaires were returned. Just over half of the respondents were male (53.4%, n = 70), with a mean age (SD) of 37.7 years (12.4), and had previous experience of physiotherapy (65.6%, n = 86). The most common site of musculoskeletal pain was spinal (51.5% n = 66). The mean (SD) number of treatments was 8.3 (8.3), at a mean total cost (SD) of €350.2 (€322.8). The 'PTOPS' questionnaire categorised and scored satisfaction items under four domains, Enhancer, Detractor, Location and Cost. The mean score (SD), optimum score, and scoring range for each domain were: 'Enhancer' 41.2 (3.8), 50, 10–50; 'Detractor' 19.4 (4.4), 10, 10–50; 'Location' 28.0 (4.1), 35, 7–35; 'Cost' 18.9 (2.8), 7, 7–35. "Overall satisfaction with physiotherapy experience" was scored on a five-point scale "excellent to poor", with a modal response of "Very Good" (42%; n = 55).ConclusionThis study measured patient satisfaction with private physiotherapy treatment for musculoskeletal pain in Ireland using a previously validated outcome measure and provides a template for future studies of this increasingly important topic. Results demonstrated high levels of satisfaction with all components of physiotherapy treatment, except cost, and provided valuable patient feedback regarding their physiotherapy treatment for musculoskeletal pain. Results can be used by physiotherapists to improve future patient experiences with a view to improving patient attendance and compliance with physiotherapy treatment protocols for patients with musculoskeletal pain.

Rehabilitation after Anterior Cruciate Ligament Reconstruction: A Prospective, Randomized, Double-Blind Comparison of Programs Administered over 2 Different Time Intervals

Background There are adverse effects associated with immobilization of the knee after anterior cruciate ligament reconstruction, yet very little is known about how much activity will promote adequate rehabilitation without permanently elongating the graft, producing graft failure, or creating damage to articular cartilage. Hypothesis Rehabilitation with either an accelerated or nonaccelerated program produces no difference in anterior-posterior knee laxity, clinical assessment, patient satisfaction, functional performance, and the synovial fluid biomarkers of articular cartilage metabolism. Study Design Randomized controlled clinical trial; Level of evidence, 1. Methods Twenty-five patients who tore their anterior cruciate ligament were enrolled and underwent anterior cruciate ligament reconstruction. Patients were randomized to accelerated rehabilitation or nonaccelerated rehabilitation. At the time of surgery and 3, 6, 12, and 24 months later, measurements of anterior-posterior knee laxity, clinical assessment, patient satisfaction, functional performance, and cartilage metabolism were completed. Results At the 2-year follow-up, there was no difference in the increase of anterior knee laxity relative to the baseline values that were obtained immediately after surgery between the 2 groups (2.2-mm vs 1.8-mm increase relative to the normal knee). The groups were similar in terms of clinical assessment, patient satisfaction, activity level, function, and response of the bio-markers. After 1 year of healing, synthesis of collagen and turnover of aggrecan remained elevated in both groups. Conclusion Anterior cruciate ligament reconstruction with a bone-patellar tendon-bone graft followed by either accelerated or nonaccelerated rehabilitation produces the same increase of anterior knee laxity. Both programs had the same effect in terms of clinical assessment, patient satisfaction, functional performance, and the biomarkers of articular cartilage metabolism. There is concern that the cartilage biomarkers remained elevated for an extended period.

Race/ethnicity and patient satisfaction. Using the appropriate method to test for perceived differences in care.

To determine whether an established patient satisfaction scale commonly used in the primary care setting is sufficiently sensitive to identify racial/ethnic differences in satisfaction that may exist; to compare a composite indicator of overall patient satisfaction with a 4-item satisfaction scale that measures only the quality of the direct physician-patient interaction. Real-time survey of patients during a primary care office visit. Private medical offices in a generally affluent area of northern California. Five hundred thirty-seven primary care patients selected at random from those entering a medical office. Patient satisfaction using 1) a composite, 9-item satisfaction scale (VSQ-9); and 2) a 4-item subset of that scale that measures only satisfaction with direct physician care. The 9-item, composite scale identified no significant difference in patient satisfaction between white and nonwhite patients, after controlling for patient demographics and other aspects of the visit. The 4-item, physician-specific scale indicated that nonwhite patients were less satisfied than white patients with their direct interaction with the physicians included in the study (P </=.01). Measurements of patient satisfaction that use multi-item, composite indicators should also include focused comparisons of satisfaction directly with the care provided by the physician. In measurements of patient satisfaction, patient race/ethnicity should be included as an explanatory variable. The results also confirm earlier findings that factors external to the direct physician-patient interaction can have substantial effects on patients' perceptions of that interaction.

Assessment of results of opponensplasty

One hundred and fifty-six opponensplasties carried out on 115 patients at Anandaban Hospital between 1987 and 1997 were reviewed. In most cases a flexor digitalis superficialis opponensplasty was performed. The outcome was assessed by measuring the finger to which the thumb could obtain a pinch grip, the gap between the thumb and little metacarpophalangeal joints, and the satisfaction of the patient. The objective assessments demonstrated excellent or good results in 89%. Good or fair patient satisfaction was obtained in 93%. Early complications were seen in seven cases (4%). Objective measurements of outcome and patient satisfaction were not always in agreement, indicating that objective measures do not adequately assess the success of surgery from the patient's perspective. We thus conclude that subjective measurements of results are an important measure of success and should be included in the evaluation of surgical results.

Dental implants in the atrophic maxilla: measurements of patients' satisfaction and treatment experience.

Maxillary bone reconstruction in combination with placement of dental implants is a treatment modality reported since 1980 for patients suffering from maxillary atrophy and difficulties with wearing removable prosthesis. This study reports on patient experience and satisfaction among 88 consecutive patients concerning surgical and prosthetic aspects of their treatment. A questionnaire was used to gather the data. Patient satisfaction was measured on a scale from 1 to 5 (1 = bad/few, 5 = very good/much). The satisfaction index with regard to the total treatment was 4.1 +/- 0.9. A total of 90% of the patients responded that they would go through the treatment again or recommend the treatment to a friend if necessary. The post-operative pain index scored 2.6 +/- 1.2. The acceptation of the post-operative pain at the crista iliaca was 86.1% and of the maxilla 89.9%. It is concluded that the results of measurements of patient satisfaction after maxillary bone reconstruction in combination with placement of dental implants were acceptable.

Measures and meanings: outcome measures in the management of sexually transmitted infections.

Applicable outcome measures in genitourinary medicine (GUM) include compliance with clinical standards of care, symptom control, cure rates of infections, decreased incidence of infections, lack of complications, increase in patients' knowledge or satisfaction, and number of partners treated. Measuring these may be easy in the short-term but result in information of limited usefulness. Longer-term outcomes may be more meaningful, but harder--or impossible--to obtain. Some outcome measures are affected by case mix, so differences between patients may be as much as or more relevant than the care received. Quantitative and qualitative measurements of patient satisfaction are straightforward to obtain and essential in examining care delivery, but may be unrelated to desired clinical outcomes for individuals or populations. Compliance with clinical standards is easy to measure, relatively independent of case mix, and useful if standards are evidence-based and validated. The role and applicability of outcome measures are discussed.

Rewarding Medicine: Good Doctors and Good Behavior

Many patients think that there are shortcomings in the ethical dimensions of patient care, and research supports their view. In this issue of Annals, Erde suggests that physicians' incomes should depend on patients' assessments of their ethical behavior in much the same way that waiters' incomes depend on patrons' tips. Although Erde's solution is satiric, the problem is a serious one. The experiences and perspectives of patients regarding their own illness are undervalued by physicians. A truly patient-centered care demands that physicians elicit, understand, and respond to patients' perspectives. Tying physicians' pay to measurements of patient satisfaction is unlikely to dramatically improve the ethical quality of patient care as long as attention to the patient's perspective is seen as peripheral to "good medical care." Rather than relying on a single, easy "fix," we must re-examine all of professional development and practice. We need to choose persons for medical careers who will find patient-centered care rewarding; we need to provide such persons with training and socialization that underscores the value of personalized medicine; and we need to build institutions and systems that facilitate and reinforce patient-centered practice. The best ways to achieve these objectives are as yet unclear, but if we, as physicians, are offended by Erde's "modest proposal," then we must respond by proposing and implementing our own ideas about how patient care can become more humane.