Another article pulled out of the mainstream media – and one that highlights an issue many are familiar with: patient satisfaction. There isn’t an ED out there whose medical director doesn’t know their patient satisfaction scores, whether Press-Ganey or their own evaluations, and many EPs compensation (or employment) is tied to their patient satisfaction. And, we’ve argued time and time again that patient satisfaction has nothing to do with high-quality care, and that it’s insulting to degrade medical practice to customer service.
Now, this prospective cohort study of 36,428 patients from Archives demonstrates an association between patient satisfaction with their primary care physician and worse health outcomes. They used the “Consumer Assessment of Health Plans Survey”, which included four items of interest to the authors: whether the physician listened carefully, explained things well, showed respect, and spent enough time with the patient. There was also a fifth overall item of general health care rating for all their physician visits from the past year.
For a huge data set with a lot of granularity, the authors, unfortunately, don’t report the unadjusted mortality – which seems like it would be appropriate, when the major selling point is that mortality difference. But, in any event, a few of the interesting adjusted associations:
– Black race was more likely to be satisfied with their physicians. (1.17)
– College graduates were less likely to be satisfied with their physicians. (0.78)
– Public insurance was more likely to be satisfied with their physicians. (1.14)
– Those in poor health were more likely to be satisfied with their physicians. (1.33)
That last item – the poor health – could potentially explain all the mortality difference. They report unadjusted percentages for the rest of their measures, in addition to the adjusted OR, and then their main results come out: more satisfied patients are less likely to show up in the ED, more likely to be admitted, consumed slightly more healthcare dollars, and had slightly more prescription drug expenditures. And, then, finally, the 1.26 increased hazard ratio for mortality. Interestingly enough, when patients who have self-reported poor health and more than three chronic diseases are removed, the hazard ratio increases to 1.44.
So, satisfied patients in fairly good health, on whom more healthcare dollars are being expended, have significantly worse outcomes? There must be more to this story than just patient satisfaction – which, unfortunately, seems to be all the lay press focuses on.
“The Cost of Satisfaction”