Patient Satisfaction is not Patient-Centeredness

As a newly minted physician, I find myself besieged by data about how happy patients are with the care we deliver. Press Ganey, HCAPS, Consumer Reports, US News and World Report were merely the beginning. Now, physician reimbursement is tied to how happy patients are after facing and overcoming, at times, life-threatening illnesses in our hospitals. Given the financial incentive, hospitals across the country are seeking the aid of companies—e.g. Disney—well known for providing memorable, enjoyable escapes from reality through unparalleled customer service. I will readily admit that as the son of a physician who practiced a “Marcus Welby” style of medicine that existed more on television than in reality, I find it ironic that the medical community is now looking to the entertainment industry to guide our movement to improve the patient.

But is patient satisfaction synonymous with patient-centeredness that experts like Don Berwick desire? I contend that it doesn’t. I could bore you with the multiplicity of anecdotes that reveal a system fixated in certain segments on distraction from the care provided rather than developing innovative ways to make that care better. These actions make patients more comfortable, more empowered, and more informed but not necessarily healthier.

Recently, a nurse described to me the duties she completed in caring for her patients during a overnight shift. Four PB&J sandwiches prepared; 3 cups of grape juice delivered; 2 cups of coffee poured for visitors; 3 garbage cans emptied; 1 pillow fluffed; and 4 TV remotes fixed. Amidst this shift, she was also asked to provide an abundance of narcotics and sleeping aids.

She was measured not on the fundamental question of what have we have done today to make our patients healthier tomorrow. Instead, nurses and doctors are increasingly measured on things that are tied to metrics of patient satisfaction. Namely, how long are you in the patient’s room, how long does it take to deliver requested medications, and how accurately do we document the myriad of quality metrics that have variable support for improving care delivery (e.g. Have you given your patient a “golden ticket” to signify that you educated them about their new medications started on the current admission—performed at 2am!). The question in this scenario we don’t ask is the one that matters most: Is the patient getting better?

Now, is there a need for customer service to be a part of good, high quality patient care? Absolutely. Are the goals of patient-centeredness important? Yes. But our preeminent job as clinicians and as a healthcare system is to make people well—not just happy. A recent study found that, in fact, patient satisfaction scores are not linked to higher quality care. Moreover, this analysis showed that while higher patient satisfaction led to less ED use, it also led to higher costs, more inpatient admissions, and higher rates of mortality.

I’m not here to say that patient satisfaction is not important, only to say that I’d prefer to make patients happy and healthy. So, maybe we need to look to models other than the dream-world that is Disney.

Fenton, JJ, et al. Arch Intern Med. 2012; 172 (5): 405-411.

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Stanley Frencher, Jr. MD, MPH