Consumer Theory and Health Care

We have had previous posts dealing with both patient satisfaction and the notion of transparency in health care as a means of improving the health care system.  Both are for the most part useless and irrelevant.  We have also made reference to the research that this article in WSJ Capital Section (available to non-subscribers for 7 days) highlights and it further implicates the patient satisfaction efforts.  Just because patients are satisfied does not mean that they have received quality healthcare, the most recent evidence-based approach, or that they are even improved in their condition. 

As the author aptly points out "confusing high scores on patient-satisfaction surveys with high-quality medical care can be dangerous to your health."

Larry

Comments

[Hiten Dave' PT]

Patient satisfaction...Is'nt that what the Chiros excel in?! Patient's want instant gratification/pain relief and Chiros have brainwashed the public that....when you have back pain you think of Chiro! Tylenol and other OTC pain meds have been abused for years...How does EBM change public's perception and expectation of quick relief?

[Louie Puentedura]

I have to respectfully disagree with Larry when he writes that patient satisfaction is "for the most part useless and irrelevant". One of the things that I have come to appreciate (as a clinician) is that practicing with an evidence-based approach is not just about the latest research or only using treatment approaches/ techniques that have loads of scientific evidence. There are another 2 vital ingredients in the mix, namely the clinician's skill and experience and the patient's wants/ needs/ and yes, satisfaction.

Larry writes "Just because patients are satisfied does not mean that they have received quality healthcare, the most recent evidence-based approach, or that they are even improved in their condition" and I agree wholeheartedly. However, if a patient is dissatisfied (low satisfaction with their treatment) they are going to be much less likely to return to us (the evidence-based practitioners) as needed to receive the most recent evidence-based approach and achieve the improvement in their condition that they are hoping for.

[Larry Benz]

Louie: We might just have an honest disagreement and we are most likely just splitting hairs. Let me try and be a little more specific.

There is absolutely no research that supports the notion of satisfied patients returning. In fact, there is evidence that shows there is no relationship between satisfied patients and outcome. There is scant evidence that supports satisfied patients being more likely to be compliant with treatment which certainly appears to be a goal of having satisfied patients. When I say "worthless", I am mainly referring to the amount of work that it takes to collect and analyze data-it is time not well spent. Contrast this to the construct of patient loyalty which although is much harder to research, is much more meaningful and gets to the heart of what you are looking for-patients that will be advocates and will return (especially when the MD writes the script to their own or a different clinic than yours). Satisfied patients are apothetic, loyal patients are evangelists.

Larry

[Louie Puentedura]

Larry:
After reading your post, I see that we actually agree more than disagree, and we were actually splitting hairs.
My main point has been further raised in another blog http://blog.evidenceinmotion.com/evidence/2006/09/who_says_whats_.html and that was that we have to place some importance on patient values (satisfaction) because we're not going to be able to successfully offer our best evidence PT management unless the patient is a satisfied and motivated advocate for their own care and condition. As you so aptly put it, they become their own evangelists.
Thanks!

[Sean Hayes, PT]

Larry,
I agree with you 100%. I recently had a discussion with a PT who stated he had received wonderful pt satisfaction survey results. I had worked with him, and had first-hand experience of his "absentee" delivery of care; as well as the secretaries' careful selection of getting only outwardly satisfied patients to fill out the forms.
While it may not provide valid, reliable statistical data, if used properly, it can be a great "suggestion box" kind of tool if given to all or a RANDOM selection of pts.
When used properly, it can help us tweek various practices in our clinics that may create irritating situations for our patients.