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

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