Wednesday, September 21, 2016

Patient Satisfaction

As I did inpatient rounds today, I was struck by something new in the hospital.
Came across numerous phone/tablet charging docks near the elevators, family rooms etc.
These appeared new. All in the name of patient satisfaction.
The newer hot topic in USA Medicine.
That somehow, one of our jobs (as a doctor, clinic or medical system) was to satisfy the patient. Not that I would intentionally wish to dissatisfy them- however it's important to realize that patients are not customers or guests.
The doctor-patient relationship isn't one based on PR; this is not a service industry (though we are here to serve in a way).

So when systems or doctors start to get assessed based on patient satisfaction, this is where things may potentially go wrong. For some years now, more and more systems based their remuneration, at least in part, on how satisfied patients are. This is also becoming a metric for how insurors/Medicare reimburse providers. I know for me, part of my performance bonus is based on satisfaction scores.

The problem is, the patient sometimes not in the position to decide what's best for him or her medically. And may rate a doctor as such. Examples we see regularly:
- The patient who sees a GP for a viral upper respiratory infection- who leaves the clinic mad because he did not get antibiotics
- The patient who goes to the ER, wanting to leave with prescriptions for opiate medications
- The patient who does not want to be discharged despite being medically fit- because he "didn't feel like it yet". (While there are 10 patients in the ER waiting for inpatient beds)
- Closer to home- something I face weekly- the patient with normal testosterone or thyroid or growth hormone, wanting to be put on these hormonal agents for symptomatic benefit
- Or the inpatient I see who just got over his diabetic ketoacidosis, who is mad because he is on a diabetic diet, and feels that he should have unlimited amounts of carbs

Indeed, there are studies showing an inverse relationship- patient satisfaction scores are related to poorer outcomes- higher morbidity or mortality, longer hospitalization, higher cost of healthcare.

And if so why is there such a push to emphasize satisfaction scores? As Dr. Mayo once said, the needs of the patients come first. Not the wants of the patient.

Somehow, in the convulated world of politics and bureaucracy, we lost sight of what's more important. And so, the hospitals are spending more money installing iphone docking stations, provider bigger parking ramps, free valet parking, coming up with extravagant menus for patients. While nurses have a high rate of turnover because they are underpaid. Or the hospital tries to cut costs by forcing formulary medications on patients.