How to balance patient satisfaction and quality care

"In essence, we want physicians to care about satisfaction, but not too much," Joshua J. Fenton, M.D., MPH, of the University of California, Davis, recently told Medscape in an interview following up on his team's 2012 widely cited study indicating that highly satisfied patients had higher hospital admissions, higher drug expenditures and were even 26 percent more likely to die.

The study has garnered both support and criticism during the two years since its publication in the Archives of Internal Medicine. With the opportunity to clear up misunderstandings in how the findings have been interpreted and offer current insights, Fenton made the following points:

  • In most settings, technical quality of healthcare is invisible to patients, and therefore has a weak relationship with patient satisfaction. "For example, in preventive healthcare, there might be an unadjusted relationship between patient satisfaction and receiving an appropriate cancer screening test," Fenton said, "but when you adjust for patient characteristics and other confounding factors, that relationship is no longer present."

  • Any incentive, if weighed too heavily, can become perverse, so "excellent" satisfaction at every encounter may not be an effective goal. "When difficult issues are raised, such as a patient's ability to drive, a possible substance abuse issue, or perhaps poor exercise habits, patients may have an affective response that leads to lower satisfaction," he said. "Yet compensation schemes that unduly award maximum satisfaction would discourage these important conversations."

  • Physicians in the bottom 20th percentile of satisfaction scores may need communication training. Physicians scoring well below their peers may likely be making "simple communication missteps" that can be easily corrected with the help of a trusted supervisor, colleague or consultant, Fenton said. "On the other hand, if a physician's satisfaction scores are in the middle of the bell curve for his or her peers and this physician is doing his or her best to communicate with respect, empathy, and care, then we have no compelling evidence to force that physician to change," he concluded.

To learn more:
- read the article from Medscape