Patient Questionnaire

Healthcare in the US is ranked lower than those from other developed countries. Affordability is still a great issue.

Background:  Healthcare reform initiated by the government and the private sector is emphasizing patient satisfaction, outcome and cost. This will lead to “Pay for Performance or Pay for Value.” Hence each hospital or a physician practice needs to have a policy to measure patient outcome, patient satisfaction (patient’s experience) and cost through appropriate practice guidelines. We are crafting a policy to help achieve this as well as creating a user-friendly questionnaire.

Objective: The aim of this policy is to improve the quality of care, improve patient satisfaction, reduce cost and simultaneously improve provider morale and reduce stress.


  1. Each and every patient to fill out a questionnaire upon discharge. If the patient stays in the hospital for longer than 1 week, the patient is to fill out a simplified questionnaire once a week.
  2. The patient or family member can fill out the questionnaire on “hard copy” or online.
  3. The patient satisfaction scores will be shared with the providers once in a quarter.
Does your Provider practice TPIU?
If so, nominate your Provider here.
Please be sure you ask all your questions to make certain that you understand what disease you have and what the treatment will be. The following sample questions are to help you to get started. Make a list of questions ahead of time and bring the list to the appointment. You may have other questions you and your family need to ask. Please do not be shy about asking them and getting the answers. It may be necessary for you to ask the same question more than once to make sure you get and understand the complete answer.
1. What caused my problem?
2. Please list the reason for the treatment you are proposing, the pros and cons of this treatment and all the possible side effects or complications that may happen.
3. If there are any alternative ways to treat me, please describe them as well as their pros and cons, including “no treatment.”
4. Could you give me an estimate of the length of hospital stay and recuperation period, the amount of time it takes for the usual patient to recover enough to fly a long distance?
5. Please give me enough details on the postoperative care including pain management in terms that a layman can understand.
6. Please tell me the number of such cases the surgeon has performed, the good and the bad outcome/the results, the side effects and complications, if any, the mortality rate, if any, the re-admission rate, if any.
7. Could you kindly give me a copy of the curriculum vitae (CV) of the surgeon and/or the responsible physician?
8. Please give me a copy of all my medical reports including doctors' notes and all tests results. If imaging studies were done, please give me the typed written report as well as an electronic copy of the images; for example, a disc or a flash drive or e-mail them to me.
9. If there are pathology reports, please give me a copy of the typed report.
10. Is there anything else you need or want to tell me and my family?