In a surprising new study published in the Archives of Internal Medicine, patients who rated themselves as most satisfied with their doctors not only incurred 8.8 percent higher health expenses in a two-year period but were also 26 percent more likely to die shortly thereafter than those who rated themselves as less satisfied. In addition, the analysis of 51,946 patients' surveys revealed that although satisfied patients were less likely to visit emergency departments, they had more inpatient admissions.
According to researchers Joshua J. Fenton from the Department of Family and Community Medicine and Center for Healthcare Policy and Research, University of California, Davis, in Sacramento, and colleagues, the results point to the downside of putting too much emphasis on always giving patients what they want, which may include unnecessary services and prescriptions.
"Practicing physicians have learned--from reimbursement systems, the medical liability environment, and clinical performance scorekeepers--that they will be rewarded for excess and penalized if they risk not doing enough," wrote Brenda Sirovich from the Department of Veterans Affairs Medical Center in White River Junction, Vt., in an accompanying invited commentary. "It is time that we, as a profession and as a society, take responsibility for controlling this unrestrained system, by working to overcome the widespread misconception that more care is necessarily better care and to realign the incentives that help nurture this belief."
More immediately, the takeaway for physicians may be that despite the benefits of patient satisfaction in keeping patients loyal and engaged, it's important that service not be confused with medical decision-making. In other words, there is probably no downside to offering convenient hours or streamlining a practice's phone systems, for example, but when it comes to deciding medical treatments, the "customer" is not always right.