Is Patient Satisfaction Dangerous?

Today’s Managing Health Care Costs Indicator is 6.4

This week’s issue of Forbes magazine has an article “Why Rating your Doctor is Bad for Your Health.”  Writer Kai Falkenberg points out that physicians hate to be judged by their patients, and tells a story of an ED physician who prescribes a inappropriately strong narcotic for minor pain because “my [patient satisfaction] scores last month were low.

She writes:

Many doctors, in order to get high ratings (and a higher salary), overprescribe and overtest, just to “satisfy” patients, who probably aren’t qualified to judge their care.   

She points out that the Affordable Care Act offers higher or lower hospital reimbursement based on patient satisfaction scores, and notes that hospitals across the country are seeking to improve patient experience, and often put physician bonuses at risk for patient satisfaction. 

Can that be a bad thing?

Falkenberg focuses on an article from Archives of Internal Medicine last year that showed

Adjusting for sociodemographics, insurance status, availability of a usual source of care, chronic disease burden, health status, and year 1 utilization and expenditures, respondents in the highest patient satisfaction quartile (relative to the lowest patient satisfaction quartile) had lower odds of any emergency department visit (adjusted odds ratio [aOR], 0.92; 95% CI, 0.84-1.00), higher odds of any inpatient admission (aOR, 1.12; 95% CI, 1.02-1.23), 8.8% (95% CI, 1.6%-16.6%) greater total expenditures, 9.1% (95% CI, 2.3%-16.4%) greater prescription drug expenditures, and higher mortality (adjusted hazard ratio, 1.26; 95% CI, 1.05-1.53).

That’s right. Higher patient satisfaction is associated with 9.1% higher costs and a 26% increase in mortality. 

BUT

The average age in that more expensive and higher mortality but very satisfied quartile was 6.4 years older than in the youngest and least satisfied quartile.   The study did adjust for age - but is it possible that the adjustment was suboptimal.

Note that the previous paragraph is corrected. I initially said there was no age adjustment, but there clearly is. I'm grateful to anonymous for pointing out my error.

Patient experience matters.   Doctors who think that patients will be more satisfied when they order unnecessary MRIs and harmful antibiotic prescriptions for viral infections are misleading themselves.  Even this Archives article has  references for articles demonstrating that patients could be highly satisfied by getting patient-centered care, as opposed to unnecessary procedures that run up the bills, and increase patient inconvenience and risk.

Patients deeply want to be listened to, and want their real needs ascertained and addressed.   We should measure patient satisfaction, and seek to improve it.   I’m confident that improving patient experiene doesn’t simply mean ordering unnecessary diagnostic tests and prescriptions!