Happy patients not necessarily healthy patients: study

Patient-pleasing doctors may not be so good for your health.

Patient-pleasing doctors may not be so good for your health.

That’s the conclusion of researchers at the University of California, Davis, after reviewing satisfaction ratings and other data on more than 50,000 patients nationwide.

They found that people who are the most satisfied with their doctors are more likely to be hospitalized, run up higher medical costs and have higher death rates than patients who are less satisfied with their care.

“Patient satisfaction is a widely emphasized indicator of health-care quality, but our study calls into question whether increased patient satisfaction, as currently measured and used, is a wise goal,’’ said Joshua Fenton, an assistant professor of family and community medicine and lead author of the study, published last week in the Archives of Internal Medicine.

Earlier research has shown that patient satisfaction strongly lines up with how much physicians fulfill patient expectations, Fenton said. One recent study, based on a set of commercial online reviews, found that most patients give their doctors good ratings, mainly on the basis of things like short waiting times and exams that aren’t too rushed.

Many patient-satisfaction surveys are run by health systems or insurance plans to evaluate physicians and set goals for improvement. Very low scores have been used to justify dropping physicians from a health plan, while higher scores can reap higher pay or bonuses.

Fenton said financial incentives based on keeping patients happy may make some doctors reluctant to bring up difficult topics like smoking, obesity or mental health.

And doctors may order tests or medicine for demanding or nervous patients even when they doubt there is any medical benefit or even new risks. “A better approach is to explain carefully why a test isn’t needed, but that takes time, which is in short supply during primary-care visits,’’ Fenton said.

Fenton and colleagues reviewed responses from federal surveys of adults’ use of, and costs paid for, medical services. Each respondent also completed questionnaires about their health status and experience with health providers, including how often providers listened to them carefully, were respectful and spent enough time with them. And they were asked to rate their health care on a scale of 0 to 10. Cases were also matched against the national death-certificate registry.

The results showed that patients who were most satisfied had greater odds — 12 per cent higher — of being admitted to the hospital and nine per cent higher total health costs.

They were also more likely to die: For every 100 people in the least-satisfied group who died over an average period of almost four years, 126 people died in the most-satisfied group.

Dr. Brenda Sirovich, a researcher at the VA Medical Center in White River Junction, Vt., writing in an accompanying commentary, said patients who have a strong sense of connection to the health-care system — and more satisfaction from it — may somehow be more vulnerable or frail, and thus more likely to be hospitalized or die.

Yet the more satisfied patients had better average physical and mental health at the start of the study than the less satisfied patients.

“We think it’s unlikely that more satisfied patients are somehow more sick . . . and more likely to die,’’ Fenton said. Sirovich agreed that it’s “believable — and cause for concern” that doctors ramp up care to please demanding patients.

“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,” she wrote.

Lee Bowman is a medical and science writer for Scripps Howard News Service. Contact Bowman at BowmanL@shns.com

Just Posted

WATCH: Red Deerians learn about The Power of One

Red Deerians should be empowered by their beliefs and fight racism in… Continue reading

Tens of thousands across the US march for gun control

WASHINGTON — Summoned by student survivors of the Florida school shooting, tens… Continue reading

Canyon Ski Resort season wraps up Sunday

Central Alberta skiers and snowboarders only have a couple more days to… Continue reading

Future space crunch is feared, as no new schools for Red Deer are in the budget

Only local modernization will be at Father Lacombe Catholic School in Lacombe

WATCH: Hundreds come to Red Deer Rebels Fan Fest

The Red Deer Rebels met with legions of their of fans just… Continue reading

Supreme Court rules former Stephen Harper aide guilty of influence peddling

OTTAWA — Canada’s highest court has upheld an influence peddling conviction against… Continue reading

2 killed, dozen hurt in French supermarket hostage-taking

PARIS — An armed man took hostages in a supermarket in southern… Continue reading

READER PHOTO: Red Deer students celebrate Canadian courage at Juno Beach

Teenagers from Red Deer’s Lindsay Thurber Comprehensive High School are learning about… Continue reading

UN report: Loss of plants, animals making a lonelier planet

WASHINGTON — New United Nations scientific reports diagnose that Earth is getting… Continue reading

Excavator frees dolphins trapped by pack ice in Newfoundland harbour

HEARTS DELIGHT, N.L. — A pod of dolphins trapped by pack ice… Continue reading

Structure fire destroys home in Mirror

A house in Mirror is completely damaged due to an overnight structure… Continue reading

Trudeau warns senators not to thwart will of Canadians on marijuana bill

OTTAWA — Prime Minister Justin Trudeau is reminding senators that his government… Continue reading

Most Read

Five-day delivery plus unlimited digital access for $185 for 260 issues (must live in delivery area to qualify) Unlimited Digital Access 99 cents for the first four weeks and then only $15 per month Five-day delivery plus unlimited digital access for $15 a month