How well did your urologist do for you?

A new report in the journal JAMA Surgery has suggested that urologists who see fewer patients tend to get higher satisfaction ratings than those with higher-volume practices. A commentary on this new research letter by Murphy et al. has already been published by Reuters.

The “New” Prostate Cancer InfoLink hastens to point out that these data do not necessarily mean that the urologists getting lower satisfaction ratings are necessarily worse urologists, but it may well be that they don’t fully appreciate the importance and value of good communication with their patients.

We should also point out that:

  • The satisfaction scores used to compile the data used in the reported research came from four websites:,, and, and may have been affected by all sorts of factors other than the skills and experience of the urologist.
  • The data are based exclusively on 665 urologists who were practicing in the state of California in 2014 and who were accepting Medicare patients.
  • 600/665 of the urologists (90.2 percent) were male.
  • 84/665 of the urologists (12.6 percent) worked in academic settings (where there was a residency program for urologists in training)
  • 581/665 of the urologists (87.4 percent) worked in non-academic, community-based practices.
  • The urologists were being evaluated on their ability to treat a whole spectrum of urological disorders and not just prostate cancer.

We are early in the days of being able to use web-based satisfaction scores like these to make judgements about just how “good” or less “good” physicians in general (and urologists in particular) may be as  providers of health care-related customer services. We would all be wise not too read too much into the data provided by Murphy et al. However, here are some of the core study findings:

  • The average (median) number of Medicare patients seen by the 665 urologists in 2014 was 423.
  • There was a significant trend toward higher satisfaction ratings for the urologists who saw fewer Medicare patients.
  • Based on a scale of 1 (low) through 5 (high),
    • Academic urologists averaged a score of 4.2 on the various patient satisfaction web sites in the study.
    • Non-academic, community-based urologists averaged a score of 3.7.
    • Male and female urologists had comparable satisfaction scores.
  • For every 100 patients seen during the course of the year, average patient satisfaction scores dropped by 0.04 points.

Quoted in the Reuters’ report on this study, the lead author, Dr. Murphy, indicated that their data “suggest that doctors need to spend some time talking to their patients”. He went on to point out that when treatment — whether surgical or non-surgical — leads to complications patients are likely to feel better about the experience when they feel as though their doctor is actually listening to them:

Patients want someone who communicates well and listens in those unfortunate and frightening moments

Murphy is reported to have said, and we would entirely agree with that assessment.

On the other hand, an  individual urologist who was not involved with the study noted that “specialists, especially in urology where surgery is often involved, may only interact with patients a few times and have limited opportunities to build a relationship” and that

To the patient, it is often a completely alien, frightening experience so the patient may get the absolute highest quality of care, but the experience may be perceived as poor. They may leave feeling like they were not treated well — perhaps the doctor swooped in and swooped out, did not engage them like they are used to.

We would point out that the physician who simply “swoops in and swoops out” like this not doing himself or his patients any favors, and he may well be setting himself up for a poor consequent perception by the patients and his family members. Good communication is — and should be — at the very heart of good medical practice. Medicine is still, and probably always will be, not only a profession that requires great skill and training but also a customer service activity that requires the ability to educate, inform, and build trust between the practitioner and his or her patients.


5 Responses

  1. My urologists spent plenty of time. Unfortunately for all (especially the other patients sitting in the waiting room) the early time was wasted, spent before I was ready to learn more than the basics.

    Going over surgical procedures and concerns, then radiology methods and concerns, before I decided not to have treatment at all was a waste. Appreciate the time, dedication, and skill, not the inefficiency.

    I would happily trade the first half of their time for a good nurse practitioner who is scheduling in larger blocks. I actually have more confidence the urologist is focused on the details of my individual case when they are familiar with what the focus of the NP and my final discussions reached.

    This country really needs a better flow chart.

  2. Forwarded to my local urologists.

  3. My story (my dilemma): My doctor had a 16 year old girl and a 17 year old boy high school interns that reside in the neighborhood looking over patient records (with full access to all records) working in his office for the summer, when I went to see him. I consider this to be a privacy and confidentiality issue/violation. My doctor referred me out to his urologist friend because of a high PSA test. I will refer to the urologist as Doctor “A”; he used old and dangerous testing technology (18 core blind biopsies), his nurse seemed to have a mental defect exhibiting arrogant, rude, strange, abusive behavior and was intent on inflicting psychological harm to me. Shortly after my Dr. “A” visits ended, his nurse was no longer employed at his office and no person in that office would refer to her employment or her existence. I now believe this nurse was under the influence of drugs because of drug abuse being common among nurses (easy access to drugs). I was diagnosed with prostate cancer by Dr. “A”. I refused Dr. “A” surgery and hormone therapy recommendation because of the imminent side effects and his unprofessional (sadistic) nurse behavior, so Dr. “A” referred me to Dr “T”. Dr. “T” was outside of my insurance network; however his office manager stated she was willing to work with my insurance, offered me a doctor consultation and would accept any insurance payment as a full payment. When I arrived in his office the waiting room was empty and Dr. “T” had a large staff. Dr. “T” used older conventional technology (old equipment, 9 week radiotherapy), offered me overtreatment, hormone therapy, bone scan (unnecessary procedures and testes). One week after my consultation with Dr. “T” I received an $850 bill, in conflict with what was agreed upon with his office manager. After a recommendation from an acquaintance, I called clinic “O” and met with the nurse. She offered me treatments with a verbal guarantee of “no side effects from the SBRT radiation”. However this nurse could not answer any of my basic questions lacked any credibility and sounded like an unscrupulous used car salesmen. Most of these office visits caused me multiple problems with office workers processing paperwork for tests, insurance forms and billing, etc. Two of these doctors offered me an unnecessary bone scan. Two of these doctors recommended unnecessary hormone therapy ADT (overtreatment) for my organ confined cancer. After I absolutely and utterly refused hormone therapy, both doctors admitted it probably would not help me in my final outcome because of the computer estimate run on me with my organ confined cancer. Having no newer treatments (laser, etc) available to me at that time, I decided on SBRT treatment with Dr. “K”, he could answer my questions and had new equipment. Before my treatment could start I was referred to “W” lab for an MRI. “W” lab had a trainee assisting and it took over 3 hours to complete my MRI. 2 days later after receiving my MRI report, I examined it and it had my name and some other patient history information. I wasted 2 stressful days verifying it was the correct MRI of me and not some other prostate patients MRI before my treatment could start. I did receive treatment from Dr. “K”. I did have a relatively fast and noninvasive treatment (SBRT), resulting in several months of fatigue, a large PSA bounce 18 months later. I feel this entire ordeal aged me and I’m not sure what the future will bring? I also no longer trust modern medicine, doctors, nurses, etc. Modern medicine seems to be more of a gamble then a science. I have wasted hundreds of hours and thousands of dollars. I feel modern medicine has violated my confidentiality, abused and failed me (and others) due to the lack of guidelines and regulation, still approved obsolete technology, better unapproved treatments, exploitation, greed, apathy and incompetence. Hindsight is 20/20. If I could do it over again, I would also consider no PSA testing and treatment or traveling for newer treatments from a competent provider if practical and available. I believe if I did take the two doctors recommendations and received unnecessary hormone therapy in addition to the radiotherapy my quality of life (QOL) would have been severely impacted for years or permanently and could possibly have resulting in my early death.

    “First, do no harm”, unless you can make a lot of money and get away with it: I was harmed physically and verbally by Dr. “A” 18 core blind biopsy and verbally abused by his sadistic nurse. I was potentially exploited and financially harmed ($850) by Dr. “T” and offered unnecessary testing and overtreatment. Clinic “O” nurse attempted to misinform and deceive me about the treatment outcome of “SBRT treatment with no long term side effects”. I was harmed by “W” lab by mistakes and incompetence. I did also have numerous other billing and paperwork problems probably due to mistakes and apathy. I was also harmed by the release of my cancer files by my state cancer registry or SEER as explained above. A few office staff were incapable of completing some very simple tasks like filling out lab work request or insurance forms. At least 40% (probably substantially more, 50% to 60%) of the health care workers I came into contact with did or attempted to do some form of harm to me or provide substandard care, attempted excessive testing and treatment, mistakes, billing overcharges, blind biopsy, false statements, deception, misinformation, apathy and abusive behavior¬¬¬, as explained in this text. I have also observed several medical facilities do not require workers to wear name tags and when asked for a name most will give a first name only; this may also be a factor in health care workers not acting in an ethical manner. To me, it seems that this prostate cancer nightmare maze was intended for maximum physical, psychological, financial harm, to be of questionable benefit and maximum profit for doctors. My prostate cancer experience has been one of the worst events that have happened to me in my lifetime. Also seeking testing and treatment is one of the biggest mistakes I have ever made. I specifically hold responsible modern medicine for not protecting patients from predatory doctors, substandard technology and a lack of regulations that would protect patients. I would have probably been better off going to a Voodoo or witch doctor. I would have saved thousands of dollars, time, had no side effects, no paperwork, more confidentiality and privacy. Less neglect and abuse. I probably would have received better advice. I could have received a nice amulet or a good luck charm to protect against sorcery and magic (conventional testing and treatment) and evil medicine men (predatory doctors, incompetent or abusive staff).

  4. I don’t know my urologist’s case load, but he gave me his full, unhurried attention. He explained his recommended treatment, based on my age and family history. His assistant even placed the call I asked for to the doctor I wanted for a second opinion; which did agree with his recommendation. I had IMRT radiation plus ADT. This occurred in 2004, so you can seeI am very happy with the outcome.

  5. Dear Tugboat.

    Good. The problem is that many urologists don’t seem to offer quite the same level of care and attention as your urologist provided to you!

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