Blog | Friday, October 17, 2014

The very real-world limits of patient satisfaction

Everyone involved in health care, and particularly hospital care, has witnessed a sea change over the last decade. Things that were never even thought about, let alone formally taught to frontline doctors and nurses, have now come to the forefront. Chief among these is the drive towards improving patient satisfaction and delivering a more optimal hospital experience.

True, a large part of this is due to federal incentives and tying reimbursements to patient satisfaction scores. Whatever the motivation, a lot of this focus was in fact long overdue. As one of my own personal areas of interest, I really believe that health care must always strive to be more customer service oriented with a focus on keeping our patients as comfortable, informed and satisfied as possible. Being sick is horrible enough for anyone without feeling like you’re being treated badly or with disrespect.

I’ve written a lot about the things we can do to improve care, like spending more time with our patients, being clear on wait times, allowing them to get a good night’s sleep, and even giving them more palatable food to eat. Yet sometimes I fear that the patient satisfaction movement is going a bit too far and not realizing where to draw the line. Interestingly studies are now also showing that patient satisfaction isn’t necessarily correlated with good care, including a recent study published in JAMA.

My own experience is that the vast majority of patients are pleasant, motivated, listen to the doctors’ advice, while also asking very reasonable questions or expressing legitimate concerns. But let’s look at a few everyday real-world hospital scenarios where keeping patients happy and granting their wishes definitely isn’t the best thing:
• The patient who has a narcotic dependence who is demanding additional pain medications (often when already over-sedated)
• A patient who is insisting on a treatment or discharge plan that you know goes against your better judgment and is not safe
• A patient who has a misunderstanding of a clinical situation and is drawing the wrong conclusions, or seems unreasonable in their complaints

These are just 3 examples that will be familiar to all those practicing at the front lines. It’s important that the new generation of doctors and nurses doesn’t have “patient satisfaction at all costs” drummed into them so much that they are reduced to yes-men professionals. As much as we strive to improve communication skills or the comfort of hospitals in a patient-centered environment, it simply isn’t always the case that the doctor and patient are completely equal partners. Just as the job of a teacher isn’t to please their students, the job of a doctor isn’t to always please their patients. Ironically I’ve found that patients tend to appreciate and respect an educated, authoritative well-intentioned “no” over an insincere “yes,” especially over the long-term.

In hospitals we are already in a work environment that is among the most compassionate and understanding. All doctors and nurses will also be familiar with the angry relative who storms into the hospital demanding immediately to speak with the physician. Just think what would happen if someone ever aggressively walked into a bank and demanded immediately to speak with the bank manager in a raised voice? Security would probably promptly escort them out. But health care is an emotional arena, and we make allowances and are always accommodating (as we should be).

In the new patient-centered health care of the future, the worst-case scenario would be for doctors to be fearful of a patient being able to pull up his or her iPhone and threaten them with a bad online review if their wishes are not immediately granted, or scared to tell a patient that they need to lose weight because it might offend them. That shouldn’t be the health care satisfaction of the future. Doctors must never be afraid to stand by their principles and clinical judgment. Patients are ultimately the ones who will lose out if that happens.

Suneel Dhand, MD, ACP Member, is a practicing physician in Massachusetts. He has published numerous articles in clinical medicine, covering a wide range of specialty areas including; pulmonology, cardiology, endocrinology, hematology, and infectious disease. He has also authored chapters in the prestigious "5-Minute Clinical Consult" medical textbook. His other clinical interests include quality improvement, hospital safety, hospital utilization, and the use of technology in health care. This post originally appeared at his blog.