Last week’s column described some research that concluded that satisfied patients end up in worse shape than dissatisfied ones, a curious result that some doctors have latched onto to suggest that patient satisfaction is not relevant to good care.
The questions that the researchers used focused on doctor-patient communication. For example, did the doctor listen carefully, explain things clearly, show respect for patients’ comments, and spend enough time with them?
Those sound perfectly reasonable. But consider another set:
Did the doctor ask how your symptoms were interfering with your ability to lead the life you want?
Did it turn out that the first diagnosis you were given was correct?
Did the doctor help you compare benefits and risks of each treatment option?
Did the doctor explain how much improvement you could reasonably expect, given your condition and the treatment(s) chosen?
Did you understand clearly the next steps to be taken, who was to take them (you, the doctor, or others), and when they needed to be taken?
Did the doctor explain how soon you should start to feel better?
Did your doctor explain steps the professionals would take and steps you could take to reduce the risk of preventable side effects and complications of hospital treatment (such as bed sores, new infections, delirium, and drug dosing errors)?
In short, it would be useful to think of “patient satisfaction” as a bigger question than simply, in effect, “Does the doctor have a constructive bedside manner?”
If you go to a computer store to buy a laptop, fly on an airplane to get to the east coast, or invest a lot of time and money to get a college education, it’s useful to know if the employees listen to you. But you’re probably more interested in knowing if the computer they sell you will work for the purpose you bought it for, if you and your luggage are highly likely to get to the location you intend, and if your life is likely to improve as the result of getting that degree.
Guarantees are hard to come by in any of these cases – you play a role in getting results from your computer, unexpected weather changes may mean that your flight gets redirected, and a college degree is only part of the equation when people work to improve their lives.
The situation is similar in health care. Guarantees are hard to come by. Many factors come into play. But it would be good to know if the deck is stacked for or against you by having research that goes beyond, “Did the doctor show respect for patients’ comments?” and the like, to focus on whether the results improved patients’ ability to lead the lives they want.