Blog | Thursday, April 5, 2012

On patient satisfaction and the consumer era of medicine

Archives of Internal Medicine is that free journal that keeps coming in my mail and occasionally surprises me with interesting articles. In March they published a study of patient satisfaction and its association with health care utilization, expenditures, and outcomes including death. There was also a great commentary which was equally if not more interesting.

Essentially, they found a statistically significant association between increased patient satisfaction and lower emergency department visits, higher odds of inpatient admission, greater total expenditures and higher mortality.

A few years ago when my wife was in nursing school she had professors that referred to patients as customers, which greatly surprised me and caught me off guard. I consider a customer to be someone who pays for a service or a good that somehow doesn't subject them to great discomfort or put their lives at risk (adrenaline junkies aside).

Having seen more than a few patients undergo 7+3 for AML it's hard to think of patients with leukemia as customers. We continue to hurtle toward a world in which physicians are judged on not necessarily their effectiveness as in preventing, diagnosing, and treating disease but in how many stars they received on a doctor rating website or on a post-discharge mail-in survey.

There are many important places for customer service in the health care system and as a multifaceted industry we should continue to find those places where we can really improve the customer care aspects of the service that we provide.

How do we balance expensive, technologically advanced care with cost effective care? How do we balance doing what's right for the customer and doing what's right for the patient's satisfaction? Will my salary be stipulated by how well my patients perceive their care, probably if not definitely? Should patients have the right to find a doctor that they perceive is taking "better care" or is a "better doctor?" How will patients as customers be able to judge if a physician is acting on their behalf to improve their morbidity and mortality versus acting to improve their patient's satisfaction score?

Internists are particular susceptible as "cognitive-risk-modulators." Prostate cancer screening is probably a classic example. An asymptomatic man comes into an office demanding a PSA to screen for prostate cancer. The customer service driven physician may say "Yes of course!" while a more evidenced-based physician would sway the patient away or may refuse. We know that the former situation is associated with an increase in harm but no difference in mortality, is associated with higher cost, and in this micro-vignette is probably associated with increased patient satisfaction.

Food for thought.

Justin Penn, MD, ACP Associate Member, attended medical school at the University of Washington School of Medicine and trained in internal medicine at the University of Rochester, where he is serving as Chief Resident. This post originally appeared at his blog, Musings of an Internist.