Saturday, February 1, 2014

Patient satisfaction, physician satisfaction, over prescribing, over testing

As physicians we are dedicated to providing the best care for our patients. Of course, 'best' can be defined in at least two ways. One definition of 'best' is the care that results in the maximal durable improvement in comfort and function for the patient with the least risk to the patient's health. Another definition of 'best' is the care that results in the highest degree of of the patient satisfaction, as measured by questionnaires. Companies have been formed to measure patient satisfaction, and the results are now being tied to physician compensation.

A recent article in Forbes has pointed out that these two definitions may at times be in conflict, and that incentivizing patient satisfaction may lead to unintended consequences.  For example, a physician may decide that the patient is best served by not ordering an MRI or a CT scan, but the patient is unsatisfied because 'a full evaluation' was not performed. As another example, the physician finds there is no evidence to support the prescribing of antibiotics for a viral illness, but the patient will only be satisfied by such a prescription. Or, as a final example, the physician may believe that the ongoing prescription of narcotic pain medication is likely to be hazardous to the patient's health and safety, yet the patient is unsatisfied without it. Often it is simpler for the physician to just do what the patient requests rather than explaining the logic for withholding the test or the prescription. The peril is that failing to satisfy the patient may have negative consequences for the physician even though the care is consistent with 'best practice' as indicated by the published evidence.

Our view is that we need to do both - provide evidence-based care and also take the time to explain why we are doing what we're doing. Patients also need to recognize that their desires for tests and medications and even surgery may need to be tempered by evidence on the value of these interventions.

Here is a bit more on satisfaction by the Stones.

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