An interesting article in Medscape tells us something which most doctors already know: patient satisfaction does not always equate to quality healthcare - in fact, if this study is correct, the most satisfied patients are also the ones who "have the highest mortality rate and the highest hospital admission and healthcare expenditure rates".
In case you can't access the article, here are some abstracts:
"[A]n overemphasis on patient satisfaction could have unintended adverse effects on health care utilization, expenditures, and outcomes," write Joshua J. Fenton...
The prospective cohort study followed-up 51,946 respondents to the 2000 through 2007 Medical Expenditure Panel Survey (MEPS) and included 2 consecutive annual surveys for each patient. ... Mortality outcomes during a mean follow-up of 3.9 years were available for a subset of 36,428 respondents.
Patient satisfaction was assessed with the Consumer Assessment of Health Plans Survey; specifically, with 4 items pertaining to physician communication (which is strongly correlated with global satisfaction) and a fifth item that allowed patients to rate their care from all physicians and healthcare providers.After adjusting for sociodemographics, health behaviors, healthcare access, propensity to use healthcare, and health status, the authors determined that the odds of any ED visit were lower among patients in the more satisfied quartiles (adjusted odds ratio [aOR], 0.92; 95% confidence interval [CI], 0.84 - 1.00; P = .06), whereas the odds of inpatient admission were higher among the most satisfied patients (aOR, 1.12; 95% CI, 1.02 - 1.23; P = .02).
Similarly, patients who were the most satisfied had 8.8% more health expenditures (95% CI, 1.6% - 16.6%; P = .02) in the second year, as well as 9.1% more drug expenditures (95% CI, 2.3% - 16.4%; P = .01) and a 26% greater mortality risk (adjusted hazard ratio, 1.26; 95% CI, 1.05 - 1.53; P = .02), compared with patients who were least satisfied.
... the authors... suggest a possible explanation for the findings.
"Physicians whose compensation is more strongly linked with patient satisfaction are more likely to deliver discretionary services," they write, adding that "discretionary services may lead to iatrogenic harm via overtreatment, labeling, or other causal pathways."
"The authors infer that efforts to cater to patient satisfaction may be ill guided," writes Brenda Sirovich, MD... "There is, however, reason to question the validity of the inference," she continued. "[T]he likelihood of an unmeasured confounder remains high. One nomination is that a patient's strong sense of connection to the health care system, related perhaps to (unmeasured) vulnerability or frailty, might predict more satisfaction, hospitalization, and death.
"And yet, the inference is entirely believable — and cause for concern," she adds.
"Practicing physicians have learned — from reimbursement systems, the medical liability environment, and clinical performance scorekeepers — that they will be rewarded for excess and penalized if they risk not doing enough.... It is time that we, as a profession and as a society, take responsibility for controlling this unrestrained system, by working to overcome the widespread misconception that more care is necessarily better care and to realign the incentives that help nurture this belief."
The authors of this blog will not be surprised at all by these findings - in fact, some have warned against such a phenomenon. Fact is, healthcare is a confidence goods, and what you want (or think you want), what makes you feel good, is oftentimes not what *is* good for you.
Until patients and payers (the "scorekeepers") alike wise up to the fact that it is not the criteria they set but the ones the clinicians set which are likely to have real health outcome significance, and until they are willing to incentivise clinicians for doing what the clinicians *know* and not they (the "customers") *think* is right, the situation will persist.