I was listening to a physician friend of mine a while back complaining about how the focus on patient satisfaction scores was forcing him to prescribe antibiotics and refer for procedures that would not otherwise be indicated.
Because he was afraid.
Of a piece of paper.
In fact, apparently, he is not the only one speaking up on this. Do a google search.
Quite frankly, I have very little patience for this sort of thing.
Are patient satisfaction scores always fair?
I have been dinged because a patient didn’t like how much their MRI cost. Not my fault. That is an insurance benefits problem that I have no control over. Or there was the time someone wanted large quantities of a controlled substance I don’t ever write for prescribed to them for a questionable diagnosis. They didn’t like me saying no very much. At all.
I could go on.
To say that I don’t care what patients think of me is not really true. I care very deeply. Every negative survey really bothers me. I will tell you why.
Because I feel like a failure.
There is still art in the practice of medicine.
The art is earning trust.
I have people from time to time who are upset that I do not write antibiotics for their two days of upper respiratory symptoms.
More often they are appreciative when I explain that antibiotics won’t help them get better at this stage and that inappropriate use means that they or someone that they love may develop an infection down the road that we cannot treat with ANY antibiotics. We work together to treat their symptoms while their body fights off the infection, knowing that antibiotics are available if needed down the road.
Generally, patients respond very well to explanations.
For a doctor to say that they feel trapped by a patient satisfaction survey suggests they are are not really trying.
That being said, physicians who argue otherwise like to point to a fascinating article, The Cost of Satisfaction: A National Study of Patient Satisfaction, Health Care Utilization, Expenditures, and Mortality.
“Conclusion: In a nationally representative sample, higher patient satisfaction was associated with less emergency department use but with greater inpatient use, higher overall health care and prescription drug expenditures, and increased mortality.”
Translated: If you are happy with your doctor, you are spending more on your care and are more likely to die.
Does that just mean we are all pansies? Do we believe patients are too stupid to understand? Are we pushovers who really think patients just want us to give them what they want?
Is that what patients want?
If we ALL use evidence based medicine, if we all consistently educate our patients to change their expectations about their care, can’t we improve care, costs, and patient satisfaction?
Maybe I am just being naive.