Medical research in 2012 concluded that patients who were highly satisfied with their doctors were more likely land in the hospital and 26 percent more likely to die than were people who were dissatisfied.
One contrarian doctor questioned the link, saying if it were true, “we should try to dissatisfy as many patients as possible – and that does not seem correct, does it?”
But many doctors are not happy when patients are asked how satisfied they are with the care they get, and use results of studies like the one noted above to support their position.
They complain that sometimes 2-3 percent of their pay depends on patient satisfaction surveys, and that the quickest way to raise their scores is to over-prescribe treatments such as antibiotics and painkillers. With this backdrop, a typical comment came from a doctor writing in Keystone Physician: “We must have the ability to deny treatment for a patient’s own good [without having our pay affected]. Patients aren’t the best judge of what is best for them.”
Many doctors, who may see thousands of patients a year, can offer with great glee at least one story to support this stance. For example, a befuddled elderly woman saw an advertisement for a drug that she then asked her doctor to prescribe – even though it was a treatment for prostate problems and women don’t have prostates. What isn’t clear is how common such experiences are.
What also isn’t clear is how often doctors back up a step and ask patients what problem they are trying to solve when they ask for a particular treatment. Some symptoms of urinary tract infections and prostate problems are similar; if the advertisement said it would treat those symptoms, perhaps it caught the woman’s attention because she had a bladder infection.
Or perhaps the woman is too easily confused by day-to-day activities. Instead of seizing on her mistake as hilarious proof that doctors should make all choices for patients, and that patients should not be asked about their experiences of care, perhaps the doctor might suggest that she be evaluated for mental functioning, and based on the results, suggest alternatives to the woman and her family to help protect her from harm.
Doctors offer each other “just joking” suggestions about how to game the system. For instance, if a doctor thinks a patient might give him a bad rating, he could report that the patient has a history of alcohol or substance abuse, because then that patient’s responses will be excluded from the survey results.
Such reactions seem to be more about preserving physician power and authority, partly by painting patients as unfailingly clueless, than they are about figuring out how to provide the best possible care.