Do you ever go to a website to see the satisfaction score your doctor or hospital is getting? If their score is below 4.5 would you stop seeing them? Some pundits expect patients to check out websites with quality ratings such as www.healthgrades.com and www.drscore.com to help them shop for doctors and hospitals similar to a purchase of a dryer or a car.
Posting satisfaction scores may be beneficial in some instances. Businesses like these measurements because it helps them feel like it helps them receive quality care when they purchase health insurance for their employees. In general, businesses like to measure things so this process is well within their comfort zone. Of course there is a complete lack of transparency of how a website generates its scores.
When I’m teaching my family medicine residents, we discuss the tension between the science of medicine and patient expectations. I’ll frequently couch the discussion by saying, “Sometimes you need to wear your scientist hat; sometimes you need to wear your customer service hat.” A common scenario is a patient who is convinced she needs a test, even if the science of medicine says she doesn’t. Most patients are respectful of their doctor’s opinion on the matter, but their attitude is often that they won’t be happy unless they get their MRI.
Imagine I saw an otherwise healthy patient who had been coughing up a little bit of green stuff (the Latin term) for a few days. He wants antibiotics and won’t be happy unless I write the prescription, or even better give him free samples. His vital signs are normal and his lungs are clear, which means he doesn’t have pneumonia. A reasonable diagnosis in this scenario is that he has bronchitis.
The scientific reality is antibiotics don’t really work for bronchitis, which is caused by viruses that aren’t killed by antibiotics. I can offer some symptomatic relief for the cough, but nothing works well for coughs either. The National Institutes of Health doesn’t fund research on new drugs to relieve coughs. It isn’t a sexy problem, and coughing or bronchitis doesn’t have a powerful advocacy group with celebrity spokespeople testifying in front of Congress pleading for more research dollars.
The science of medicine concludes that the average case of bronchitis lasts three weeks and pretty much nothing will change that. If your lungs don’t want something in them, you’re coughing it up, and it takes about three weeks for you respiratory system to heal the damage after the viral invaders are eliminated.
I’ve talked to respected family physician colleagues who practice in the same high-income zip codes where urgent care centers have sprung up like mushrooms. These family physicians know that if they don’t dispense antibiotics like M&Ms, their patients/customers will just go down the street to the urgent care center to get what they want. These patients expect the healthcare system to be kind of like a big medical ATM machine that dispenses whatever they want whenever they want it.
A few years ago, one of my senior residents worked at one of these urgent care centers — we call them doc-in-the-boxes — and he appropriately took the time to educate a patient with a minor cold why she didn’t need antibiotics. When the patient got home she called the urgent care center and complained. The medical director called the resident the next day and fired him over the phone.
Some of my residents still work at these centers. They tolerate it by just accepting they have to “sell my soul” during their shift.
Back to my bronchitis patient, if I educate him on the self-limited nature of bronchitis and decline to write a prescription for antibiotics, what grade should I receive on my doctor quality report card? Will you give me an A for being an excellent physician scientist who took the time to educate my patient about his illness and helped the greater society by preventing the spread of antibiotic-resistant bacteria? Or will you give me an F because I didn’t give the customer what he wanted?
To put it another way, would you rather your doctor be a compassionate scientist or a McDonald’s employee?