Tuesday, February 14, 2012

Patient satisfaction and reality

Christmas came early for us skeptics this year. In a landmark study, certainly one of the most interesting and thought-provoking of the year-to-date, researchers from the University of California-Davis found that the more satisfied patients were with their physicians, the higher their hospital admission rates, prescription costs and total costs were. And patients with the highest level of satisfaction with their doctors had higher mortality rates compared to those patients least satisfied with their doctors.

The prospective cohort study included almost 52,000 patients. The full text of the paper can be viewed here. I won’t bore you with the details of how it was done except to say it looks scientifically legitimate.

The study’s authors say, “Patients typically bring expectations to medical encounters, often making specific requests of physicians, and satisfaction correlates with the extent to which physicians fulfill patient expectations. Patient requests have also been shown to have a powerful influence on physician prescribing behavior, and our findings suggest that patient satisfaction may be particularly strongly linked with prescription drug expenditures.”

Translation. What they mean is that doctors who do what their patients want receive higher satisfaction scores. This may also include admitting patients sooner rather than later, which could account for the fact that patients who were more satisfied had lower rates of emergency department visits.

So it seems patient satisfaction may not be the great “quality metric” that it is touted to be. The study concludes, “an overemphasis on patient satisfaction could have unintended adverse effects on health care utilization, expenditures, and outcomes.”

Due to something called "copyright law," I will resist the urge to quote the whole paper. I suggest you read it and judge for yourself.

13 comments:

Diksha Chakravarti said...

This makes very interesting reading - what are your views on how this very parameter works within the complementary healthcare field? I'd be grateful for information on research into this if you can provide any...

Skeptical Scalpel said...

Thanks for commenting. I am not aware of any patient satisfaction research in complementary medicine. There is very little scientific research of any kind in complementary medicine.

dentist Costa Mesa said...

Complementary medicine is a group of diagnostic and therapeutic disciplines that are used together with conventional medicine. An example of a complementary therapy is using aromatherapy to help lessen a patient's discomfort following surgery.

Skeptical Scalpel said...

Dear dentist,

I am aware of what the definition of complementary medicine is. I was simply pointing out that there minimal good published research on it.

Libby said...

These results remind me of what Jerome Cooper, MD wrote in "How Doctor's Think". It's been awhile since I've read it but one area that he spoke about is the doctor's attitude towards the patient. If they really liked the patient they find/found it hard to tell bad news to them, sometimes to the patient's detriment.
I could be flippant and say we should hate our doctors but I think it is both side's responsibility to respect each other. Patients need to not pressure their doctor into giving them something that isn't needed and doctors need to aware of their feelings towards patients (good & bad) and not let the patient pressure them into things that are not needed or wise.
Thanks for posting this.

Skeptical Scalpel said...

Libby, thanks for the thoughtful comment.

Unknown said...

I wonder if this applies to patient satisfaction with MDs only, or with the entire healthcare experience. I am currently reading the book, "If Disney Ran Your Hospital...", and as an RN, I can (anecdotally) attest to the impact of simple interventions to increase patient satisfaction. One of the major points of the book is that after safety, courtesy should be prioritized above efficiency. This of course does not mean that efficiency should be thrown out with the bathwater.

For example, many nurses become so focused on giving medications within the "30 minute window" (yes, this CAN be important, but it probably doesn't matter if the Colace is RIGHT at 1700...) that they neglect or simply forget a patient's request for another blanket. Similarly, I've seen nurses obsessed with not falling behind on charting that they postpone medicating a patient for pain by 30 minutes. That's an eternity when one is in pain.

It seems to me that patients are often more focused on their overall experience than if their MD ordered everything that they wanted. A compassionate nursing staff that validates a patient's concerns & emotions can mitigate a great deal of frustration & anger. This is, of course, an assertion limited to inpatient care.

Just my humble 2 cents, interested to hear your take.

-Jennilee

Skeptical Scalpel said...

Thanks for the interesting perspective from the nursing point of view.

The paper I reviewed focused only on the MD component of patient satisfaction. My guess would be that the inverse relationship between patient satisfaction and outcomes would be the same for nurses, hospitals and insurers.

Anonymous said...

I think this study should be reviewed very closely by every hospital administrator, especially hospital marketing departments which like to use "customer satisfaction" as one of their barometers of good care. As a rehabilitation medicine physician treating worker's compensation patients on a daily basis, I constantly have to tell patients (when they have sufficiently recovered) that they may return to work. They often complain and tell their companies that I have given poor care. I also am in a position to refuse giving opioids to patients which is also met with much disdain frequently.

Patient Follow Up said...

A very fine article and exceptional blog. Is there any way I can subscribe to new articles, you know like acquiring them on email or something like that.

Skeptical Scalpel said...

I'm glad you like the blog.

Look just under "Popular Posts" in the upper right of this site. You will see "Follow by Email." Insert your address and you will be notified every time I post a new blog.

Thanks.

Anonymous said...

I was dumbfounded when the hospital told us our reimbursembent/pay would be tied, to some degree, to patient satisfaction. I asked if it was also tied to infection rate, complications, length of stay, etc, and they said no. Crazy!

Skeptical Scalpel said...

Yes, it is crazy. Just be nice and give the patients whatever they want.

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