I talked about patient satisfaction last week, but I thought I’d extend the theme one more week. A study in the Archives of Internal Medicine analyzed data from the National Medical Expenditure Panel Survey. This is where AHRQ (a federal agency) interviews a representative sample of Americans periodically to keep track of how and where they buy medical services, and how much they spend. This study is therefore observational, which means it can’t prove cause-and-effect, but we can still gain insight from its results.
This survey includes measures of patient satisfaction. The researchers found that “… higher patient satisfaction was associated with less emergency department use but with greater inpatient use, higher overall health care and prescription drug expenditures, and increased mortality.”
I still wonder what most benefits managers at large employers that still provide health insurance as a benefit expect me to do in certain situations. If a patient presents to me with acute low back pain and no other worrisome features suggesting severe pathology, but who demands an MRI, I just imagine some patient satisfaction zealot expecting me to reply in my best snobby French waiter voice, “Would you like the MRI with or without gadolinium?” (Gadolinium is an IV dye used in some MRI studies) If the patient then demands a bottle of 100 hydrocodone pills, I could imagine a conversation going like this:
Me: “Would you prefer the fives or 7.5s?”
Patient: “I want the tens.”
Me: “Excellent choice sir. My, you have exquisite taste in narcotics.”
OK, maybe this is a little over the top, but you get the idea. If we are ever to get healthcare costs under control – and achieve other important goals such as reducing deaths from prescription drugs – family physicians need to provide some patients with a large dose of dissatisfaction.
I just don’t see the government or private payers having our back on this, at least not in the current atmosphere of using simplistic standardized report cards the overlords are so fond of currently.