Beyond surveys and payments, better physician–patient communication, trust lead to improved care delivery

The words “patient satisfaction” elicit a wide variety of emotions in emergency physicians. Some immediately become angry and feel like the entire concept has been foisted upon them by hospital administrators only interested in market share and the bottom line. Some feel victimized by the move on the part of the federal government and third-party payers to tie payment to quality and patients’ perceptions of their experience. Others feel that the push for patient satisfaction leads to physicians acquiescing to patients and giving them whatever they ask for, including opiate medication prescriptions or advanced imaging studies such as CTs or MRIs, when those prescriptions and diagnostic studies are truly not in patients’ best interests. For some, it is not the concept of patient satisfaction but rather how it is measured and then used as a quality metric to judge physicians that creates concern. However, others believe that patient satisfaction and clinical quality are intimately interdependent and so patient satisfaction is part and parcel of being an outstanding physician.

All of the above feelings have merit and should be addressed by our specialty as we continue to promote excellence in what we do. I have heard my colleagues say the following:

“Clinical quality is the real deal; this customer service stuff is the fluff stuff.”

“I am an excellent physician, highly trained and skilled at procedures; I can move patients; and my RVUs are among the highest in my group—why do I have to pay attention to this?”

“These patient-satisfaction surveys are poorly devised, do not measure quality, and are not statistically valid.”

“My patients are different. We are a different kind of hospital (inner city with angry patients/suburban hospital with patients with high expectations/trauma center with a lot of homeless and drug-seeking patients) and should not be measured as others are.”

What does the literature say about the connection between patients’ perceptions of care and clinical outcomes? In a study published in the Archives of Internal Medicine in 2012 titled “The Cost of Satisfaction,” the authors concluded, “In a nationally representative sample, higher patient satisfaction was associated with less emergency department use but with greater inpatient use, higher overall healthcare and prescription drug expenditures, and increased mortality.”¹

This article has been used by naysayers of patient satisfaction to suggest that the entire concept is misguided, and some quote a Forbes article based on that study published online in January 2013, “Why Rating Your Doctor Is Bad for Your Health.”² The conclusion is that physicians are paying more attention to satisfying their patients than to treating them in an evidence-based manner and consequently their care costs more and they die more. This study, however, has serious methodological flaws: 1) They studied patient satisfaction only in the year 2000 (year 0) and never in the years when they studied cost and outcomes. 2) Prescription drug expenditures and hospital visits and admissions (cost) were studied only in 2001 (year 1) and never again, and mortality was studied in years 2001–2006 (years 1–6), during which years they never studied patient satisfaction or cost. Their conclusions have no legitimacy.