Patient satisfaction surveys, risks of being a satisfied patient

Are You a Satisfied Patient?

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Are You a Satisfied Patient?

The title of an editorial caught my eye this week. It was "Patient Satisfaction Is
Overrated. Why, I wondered, would
physicians feel that patients need not be satisfied with their care?

After reading the article I could understand why the author
feels the way he does. It is because
physician behavior is being adversely influenced by companies that perform
federally mandated patient satisfaction surveys.

I am one of the few remaining independent physicians in the
United States. Today, the overwhelming majority of physicians
are employed by hospitals or other large corporations. Nearly two-thirds are on incentive programs
that are tied to patient satisfaction surveys.
For many physicians this means giving patients what they want rather
than doing what will provide the best outcome.

In an attempt to boost their satisfaction ratings physicians
admit to over-prescribing antibiotics and narcotics, ordering unnecessary tests
and procedures, and admitting patients to the hospital when there is no medical
reason to do so. Physicians also report
that they are much less likely to comment on patients' unhealthy behaviors as
they fear advising a parent not to smoke around their asthmatic child or
recommending a better diet will result in a lower patient satisfaction

There is a cost to achieving high patient satisfaction
scores. It is estimated that the
financial burden of over prescribing drugs, running unnecessary lab tests, and
performing unwarranted procedures was over $226 billion in 2011.

There is a personal cost as well. Using data from nearly
52,000 adults, researchers at UC Davis found that the most satisfied patients
spent the most on health care and prescription drugs. They were 12% more likely
to be admitted to the hospital and accounted for 9% more in total health care
costs. Since medications and medical procedures place people at risk of serious
adverse reactions or complications it is not surprising that the most satisfied
patients were also the ones most likely to die. (Fenton
JJ, Jerant AF, Bertakis KD, Franks P. The cost of satisfaction: a national
study of patient satisfaction, health care utilization, expenditures, and
mortality. Arch Intern Med. 2012;172:405-411.)

Nearly as important as patient satisfaction ratings in
determining physician incentive bonuses is the doctor's ability to keep patient
encounters brief. I cannot help but
think that physicians are choosing to take the route of least resistance by
prescribing drugs and ordering tests requested of them rather than taking the
time necessary to explain why doing so is not in a person's best interest.

Physician ratings are just another symptom of the dysfunctional system that is euphemistically called "health care. Governmental and other third-parties have
destroyed the relationship between physicians and patients that was in better
times one of intimacy and mutual trust.
I believe that this was done intentionally. This
is an excerpt from my article Is Your Personal
Physician "Burned Out"?

"The system has also been instrumental in removing the sense
of meaning that physicians derive from their work. The system refuses to
recognize doctors as physicians and chooses to refer to them as "health care
providers. The designation has more than semantic significance.
Webster's Ninth New Collegiate Dictionary defines a
physician as "A person skilled in the art of healing; specifically:
a doctor of medicine. One exerting a remedial or salutary influence. It defines a provider as one that provides.
A physician is an artist whose very presence can exert a healing effect. A provider is a technician performing those duties the system
requires. A physician has a calling; a provider has a job. A physician cares; a provider goes through the motions.
Is it any wonder that people who enter medicine with a
sincere desire to help relieve the suffering of others have difficulty finding meaning in carrying out the dictates of an impersonal system dedicated to its own interests rather than those of hurting individuals? Is it surprising that they become cynical as they find themselves under constant scrutiny by third parties who are charged with modifying their behavior?
It has been over thirteen years since I opted out of the system. In doing so I reduced my workload to less than a third of what the system demanded. I regained my autonomy; I'm free to make recommendations based
solely upon what I believe to be in the best interest of the person consulting me. I eliminated over ninety percent of my administrative burdens. Most importantly, I became a physician again rather than a health care provider. As a result I'm reminded every day how rewarding and meaningful helping sick
people become well can be."

I feel sorry for doctors who have chosen to be providers
rather than physicians. I feel worse for
those who come to them seeking care and advice and who receive useless prescriptions and platitudes instead.
Unfortunately, that is the state of medical treatment in the United
States today.