Good care doesn’t equal good satisfaction scores

Do bad patient satisfaction scores mean that your doctor is not a good doctor? Not at all, if you’re a reasonable person.

One of the things that has always surprised me about how hospitals and other medical facilities behave is how they put a lot of weight on patient satisfaction. Don’t get me wrong, patient satisfaction is important because medicine is a business at the end of the day (here in the United States). However, patient satisfaction should not be the most important thing in rating the level of medical care they received. This is especially true in urgent and emergency care settings where patients only encounter a provider once or twice in their multiple visits. For patients to be satisfied, I believe that they need to have a personal relationship with their provider. When they don’t, one or two bad interactions can just ruin the whole thing.

And don’t get me started on patients who walk in demanding antibiotics for inexistent infections, painkillers for psychological pain, or erectile dysfunction medicine when they’re healthy and in their 20s.

So here’s a good article on why patient satisfaction is, well, problematic:

The Mask Your Doctor Hides Behind” at The Daily Beast

  1. For me, satisfaction is important, but that satisfaction is based upon the physician acting with me as a team, keeping me informed and if I make a request that is incorrect for the medical situation, corrects my error.

    But, for many institutions, consumerism has taken over. Where patient safety and effective treatment were paramount, patient satisfaction is now the rule. That makes it a customer-provider relationship, rather than a client-professional relationship. That results in lower quality of care, less than or even ineffective treatments (such as antibiotics for a viral infection) and McMedicine. Insurance companies contribute to that error as well, as in a consumerist environment, patients can be rushed through as quickly as possible. That results in incorrect diagnosis in some cases or worse, undiagnosed illness. In the latter cases, that triggers legal actions, the insurance companies then lobby for tort reform.
    In short, our health care system is eroding before our eyes, becoming a mass market endeavor, rather than individualized care that is truly required for each person.
    Fortunately, some medical professionals continue to give professional medical care, despite pressures of consumerism and insurance companies. Whether that will continue or even grow is anyone’s guess.

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    1. Correct. My wife find herself having to practice defensive medicine and being, quite frankly, abused by over-demanding patients. She’s been called all sorts of names by people who thought they knew better because they googled something. It’s funny to me that people come in to see a provider and claim to be more knowledgeable about medicine than said provider. If they’re so smart, then why do they need to see a licensed practitioner? Why not just heal themselves?

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      1. Remember, I’m a retired SF medic. My knowledge base is a bit larger than most military medics and most assuredly greater by far most patients.
        So, I tend to already have a diagnosis when I go to my physician, who checks and either agrees (the vast majority of the time) or disagrees (a mixed bag on who was right).
        I always follow the directions of the professional, as my physician and PA have far more specific and broader training than I did and with my current physician, she has far more experience than I do.
        But, for some things, I go because I don’t have the authority to write a prescription any longer (never wrote for myself anyway, even when I did write prescriptions (signed by doctor eventually)). Pity in some ways, as I still don’t have health insurance, so the physician is out of pocket and my blood pressure medication hasn’t changed in a decade (and my blood pressure is well controlled).
        Then, there’s the mystery.
        My wife had bilateral trigger finger in multiple fingers. Complicating the issue was previous carpal tunnel surgery and a positive rheumatoid factor *and* suspicion of lupus. She also has acanthosis nigricans.
        Neither doctor nor I could quite figure out what was going on, then he remarked that trigger finger could go with diabetes, but she wasn’t diabetic. Add in recent and rapid progression of presbyopia.
        Light bulb!
        Trigger finger and acanthosis nigricans have in common diabetes, which she has a weak family history of.
        Checking her glucose revealed likely diabetes, my requesting doctor request an A1C sealed the deal.
        Neither of us figured out the problem, but both of us as a team figured out something that could have had dire consequences for my wife.
        She didn’t tolerate metformin, so she was switched to glipizide. Less than stellar control was present and her presbyopia varied with glycemic control. So, she’s now on Onglyza with excellent glycemic control.
        Again, feedback to doctor, work together to resolve issues with glycemic control and side effects, in short teamwork. 🙂

        But then, that is being a well informed patient, not an idiot who is somewhat informed, uses non-medical and non-peer reviewed data and attempts to overrule the medical professional.

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