In modern medicine, the patient is the customer. Medical services are customer services. Measures of patient – nay, customer – satisfaction are tied to reimbursement and, by association, contracts and employment. We’ve often remarked this perceived or overt emphasis on satisfaction is an incentive for bad medicine – specifically the “Where’s my Z-pack variety?”, and this is one of the few studies to actually show such an effect.
These authors reviewed three years of data from their direct-to-consumer telemedicine program and assessed the correlation between receiving a 5-star patient rating and various physician-related features. There were 85 physicians included across 8,437 patient visits for respiratory tract complaints, mostly sinusitis, but also pharyngitis, bronchitis, and “other” categories. While adjusted ORs showed a variety of small associations with 5-star service just barely clearing statistical significance, there were clear ORs favoring those who gave out candy. Antibiotics were provided in 66% of all visits, and the aOR for a 5-star rating was 3.23 (2.67-3.91) as compared to no antibiotic, and a non-antibiotic prescription bestowed an aOR of 2.21 (1.80-2.71). No other aOR exceeded 1.30, except the “free coupon” visits at 1.58 (1.31-1.90). They also noted it was not possible to be in the 90th percentile for patient satisfaction unless you were basically in the top half of antibiotic prescribing.
There were a couple physicians who were above the 50th percentile for patient satisfaction while maintaining some semblance of antibiotic stewardship. The authors do not provide any qualitative evaluation of those physicians but – thank you good sirs, please share your wisdom with us all.
“Association Between Antibiotic Prescribing for Respiratory Tract Infections and Patient Satisfaction in Direct-to-Consumer Telemedicine”
https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2705078