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Surveys of patients’ experiences are increasingly commonplace in healthcare. They are used to address a range of purposes, from driving quality improvements and informing patients to providing data for performance assessment of organisations. Making best use of such surveys requires an understanding of their design, sampling, administration, and analysis. This chapter addresses these issues, beginning with a brief discussion of the history of patient experience research. Patient experience surveys emerged as a reaction to patient satisfaction surveys. They are principally quantitative methods for collecting highly structured data, typically from relatively large numbers of people in order to provide statistically reliable results. They have been used in a wide range of settings (primary to tertiary care, many conditions etc) and for different purposes (eg QI, payment, international use, performance assessment, etc.). Surveys are extremely scalable: once a questionnaire and methodology exists they can easily be deployed to small or large numbers of people with only marginal cost increases. Thus they are a popular means of collecting locally representative data on a national basis. In general, though, surveys only tell us about what we have asked, and hence it is important to ensure that they are designed and used appropriately. Good, well designed surveys can be of considerable value for measuring and improving healthcare services: in this chapter we set out the key considerations around ensuring survey quality.

The escalation of anti-abortion violence and killing of abortion providers and clinic staff in the early 1990s raised tensions within the abortion provider community. Frustrated with what they perceived as inadequate support, NAF members began to leave the organization and established the November Gang and the National Coalition of Abortion Providers. Much smaller than NAF and made up of mostly independent clinics, both the November Gang and NCAP encouraged more open conversations about the difficult questions in abortion care such as the role of violence and fetal death. Members of the November Gang also introduced head and heart counselling to offer women greater support as they dealt with the increasing stigmatization of abortion. The development of intact D&E and debate of the so-called partial birth abortion ban further increased tensions in the abortion provider community as abortion providers and their supporters disagreed over whether and how to defend intact D&E procedures. When the US Supreme Court decision upheld the ban of intact D&E in its decision Gonzales v. Carhart, anti-abortion activists had, for the first time, successfully banned an abortion procedure. Despite these developments, patients continued to affirm their right to choose abortion.

The epilogue offers a brief overview of the history of legal abortion from the early 1970s to the 2000s. If patients and abortion providers could discuss their experience with abortion in positive terms in the 1970s, by the 1980s anti-abortion activism had stigmatized abortion. The fetus had been redefined as a baby and abortion as murder. Patients and abortion providers lost the space to talk in positive terms about their abortion experience. Despite the stigma attached to abortion care, however, abortion providers continued to argue that providing abortion services was moral and patients asserted their right to choose abortion and articulated their sense of relief.

Electroconvulsive therapy (ECT) is an effective medical treatment for severe and persistent psychiatric disorders. It relieves de pressed mood and thoughts of suicide, as well as mania, acute psychosis, delirium, and stupor. It is usually applied when medications have given limited relief or their side effects are intolerable. Electroconvulsive therapy is similar to a surgical treatment. It requires the specialized skills of a psychiatrist, an anesthesiologist, and nurses. The patient receives a short-acting anesthetic. While the patient is asleep, the physician, following a prescribed procedure, induces an epileptic seizure in the brain. By making sure that the patient’s lungs are filled with oxygen, the physician precludes the gasping and difficult breathing that accompany a spontaneous epileptic fit. By relaxing the patient’s muscles with chemicals and by inserting a mouth guard (not unlike those used in sports), the physician prevents the tongue biting, fractures, and injuries that occasionally occur in epilepsy. The patient is asleep, and so experiences neither the painful effects of the stimulus nor the discomforts of the seizure. The physiological functions of the body, such as breathing, heart rate, blood pressure, blood oxygen concentration, and degree of motor relaxation, are monitored, and anything out of the ordinary is immediately treated. Electroconvulsive therapy relieves symptoms more quickly than do psychotropic drugs. A common course of ECT consists of two or three treatments a week for two to seven weeks. To sustain the recovery, weekly or biweekly continuation treatments, either ECT or medications, are often administered for four to six months. If the illness recurs, ECT is prescribed for longer periods. The duration and course of ECT are similar to those of the psychotropic medicines frequently used for the same conditions. Electroconvulsive therapy has been used safely to treat emotional disorders in patients of all ages, from children to the elderly, in people with debilitating physical illnesses, and in pregnant women. Emotional disorders may be of short or long duration; they may be manifest as a single episode or as a recurring event. Electroconvulsive treatment is an option when the emotional disorder is acute in onset; when changes in mood, thought, and motor activities are pronounced; when the cause is believed to be biochemical or physiological; when the condition is so severe that it interferes with the patient’s daily life; or when other treatments have failed.