Thursday, June 26, 2014

Are we taking patient satisfaction too far?

"Patient satisfaction" has become quite the buzzword for us in the medical care field.  Of course we want our patients to be healthy, and if possible we would also like them to be happy.  However, sometimes the two are mutually exclusive, or at least mutually elusive.  Patient satisfaction is even starting to be factored into how we're paid- starting last year, Medicare started making incentive payments to hospitals based on how they did on surveys.  Some doctors are even having part of their salary based on how they score in surveys.

On the surface, this sounds like a pretty good idea, right?  If someone is satisfied, they must have gotten good care.

Not so fast.  Press-Ganey is the largest company involved in making patient satisfaction surveys.  But even they admit that the response rate on surveys is so low that it does not produce meaningful results.  Even more disturbing is that physicians who are a minority race are more likely to receive low scores.

And the worst part of this whole thing?  Patients who are more satisfied have worse outcomes.  They have more hospitalizations, more health care expenses, and a higher death rate!    If you think about it, it's easy to see why.  A patient wants a stress test, just to "make sure" his heart is OK.  It's not indicated, as he has no cardiac risk factors and no chest pain.  If he doesn't get it, he's unsatisfied.  If he does get it, he's happy.  But what if the stress test is positive?  Then he gets a cardiac catheterization- a procedure with definite risks.  The cath is normal.  So, now this patient has added at least $10,000 to the nation's health care tab.  He had a risky procedure.  Luckily, there was no permanent harm done.  The patient is satisfied, and thinks, "I'm so glad we made sure everything was okay!"  But in reality, he received bad, expensive, and risky medical care.

Anyway, this is what has triggered this little rant of mine.  It's an article on NPR written by an emergency physician, detailing a patient's experience.  In a nutshell, the patient had a heart attack at a restaurant.  He refused an ambulance and his wife drove him to the ER.  Once there, he received exemplary, fast care.  He had an EKG within 3 minutes, an immediate diagnosis of a heart attack and was taken to the cath lab.  In 22 minutes, the clogged artery in his heart was opened with a balloon a stent was placed.  The patient recovered perfectly- so perfectly, in fact, that he was back at work and exercising again in 2 weeks.

But the story doesn't end there.  The patient and his wife then lodged a complaint with the hospital that there was no communication and he didn't even know that he had a heart attack until his second day in the hospital.

Well.  I have to say that I find this pretty hard to believe.  The husband signed a consent.  Unfortunately, the anesthesia given can often cause amnesia for the events preceding it.  As for the wife, I would venture to say that given the panic of the situation her recall might not be that great.

In my experience, when I was doing hospital medicine, I would always introduce myself to patients.  I'd see them, examine them, and review the plan with them. And often, a few hours later, a nurse would page me and ask when I was coming to see the patient.  I'd already seen the patient, but they  thought that I was the nurse or a therapist, even though I had introduced myself.  Or they just forgot the visit all together.  A hospital is a disorienting place to be, and that can be made worse by medications and illness.

But let's say that in this particular case of the heart attack patient, the patient and his wife are correct.  The ER staff didn't explain to them what was happening.  They treated the disease only.  But was their sin so bad?  Seconds count in a heart attack.  Every second wasted is more dead heart muscle.  This story makes me wonder if we've gotten so used to the every day miracles that modern medicine performs that we have forgotten how things used to be.  Heart disease deaths in the United States peaked in 1968.  Since then, we've added 6.6 years of life expectancy, and 70% of this increase is due to a decrease in heart disease.  The estimate is that 1.7 million lives are saved in the USA annually that would otherwise be lost to heart disease.  1.7 million.

I'm sorry the patient and his wife were unhappy.  But, I have to say, I also think they are terribly ungrateful, and I'm more sorry for the doctors and nurses who had to deal with the inevitable fall out from the complaint.  They busted their butts and saved that patient's life, and for their amazing efforts they were called on the carpet.

For me, personally, if it comes down to a life-or-death situation, I want a doctor who can kick ass, not kiss ass.  Niceties and hand-holding be damned.

6 comments:

  1. I agree completely. I've met some people who will never be happy with the care they get. I realize that the medical world can be overwhelming, but this people pleasing thing is ridiculous. Patients need to ask questions if they don't understand. They need to read the paperwork they're given, including consent forms. Sometimes it feels like the "doctor knows best" is just an excuse so that people don't have to take any responsibility for understanding their healthcare.

    It floors me how much people don't know about what's happened to them, I sometimes want to shake them and ask if they were there at the time. "You never told me that", when I discussed it and gave it to them in writing. "I had a CT scan of my stomach and it was normal," and you find that they had a MRI of their brain and they had a stroke. "My doctor isn't even doing anything about my blood pressure" and they're on lisinopril with a normal BP. Even more amazing is that I've seen patients forget they've had a colonoscopy - truly, how do you forget that prep?

    I hope the hospital administration realizes what a crock of fecal material that man's complaint is, and recognize the staff for the good work they did. I hope someone shows him a copy of his consent form and says, "Well, you did sign this."

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    1. Thanks for your comment. I have to agree, some people are never happy with their care. I must admit, when I see a new patient who has nothing but complaints about multiple previous doctors, I am very hesitant to accept them as a patient, as I know I will eventually be the newest addition to their list of terrible doctors.

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  2. Any wonder why I won't simply pick another doctor per the insurance company's restrictions?

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  3. I do hospital admissions. We had a pt admitted to the hospital brought in by ambulance, unresponsive. The next day she refused to sign her consent to treat, complaining about all the "tests she'd already had" that she hadn't consented to. Turns out she'd had a stroke, the docs and those "tests" saved her but she couldn't care less about that!

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  4. Here is a question. My family physician misdiagnosed me and sent me to the wrong specialist. I have the cost of that session plus a longer wait to see the right person. The problem was a simple one not requiring high tech equipment. How is feedback provided and acted upon so the family physician will correct that kind of error?

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