Sunday, November 01, 2015

Patient Satisfaction

There is much talk about the importance of patient satisfaction. Of how some hospitals and physicians are reimbursed in part based on how satisfied patients are, the much-hated Press-Ganey surveys. After all, we do want our patients satisfied, don't we?
Do we?
Proponents say, patients are clients, customers. Keeping them happy should be a priority.
But is this truly the relationship physicians and patients should have? After all, in situations like this, the 'customer' isn't always right; the patient doesn't have the background knowledge to know that's best for him or her. Studies have shown that higher patient satisfaction is associated with more adverse outcomes.
I'm sure this is a struggle all physicians across all specialties face. I hear this coming from ER and primary care colleagues of how patients leave disappointed if they are not prescribed antibiotics for a viral syndrome, or opiates for pain.
This week alone I encountered three situations myself where patients left obviously disappointed and upset.
Two patients with no background of thyroid problems who were upset because I would not prescribe thyroid hormone treatment for their fatigue and inability to lose weight despite claiming to be on a diet and exercising. One already had a TSH that was undetectable while on exogenous Levothyroxine, refusing to discontinue treatment.
Another patient, a woman, who left upset because I would not prescribe Testosterone treatment for her dry skin! Because according to her extensive research (on Google) skin dryness if from Testosterone deficiency; after all if a person makes too much, you get oily skin, acne, right?
I have to say, a part of me blames the referring physician. It gets my blood boiling, wondering where how the heck these people got their medical degrees. It's not surprising that a patient leaves unhappily, when your GP promises that this hormone specialist will fix your problems, and gives you the impression that your troubles are indeed from a hormonal imbalance. And then you wait 2 months to see this person, who then says no to treatment but bills you for the visit.
So, no. I do wish to try to satisfy my patients, but my view is a patient is not a customer in the classic sense; he/she does not have the medical background to really know what's best for his or her health.
As how my patient ominously ended my session with her after I counselled her on the risks of unnecessary hormonal treatment: "I'd rather have a stroke than continue to be fat..."
Is this going to be the future of healthcare?