Medical Mystery: Why Are More Satisfied Patients Actually Worse Off?

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medical billsThis post originally appeared on MainStreet.

Some doctors’ compensation is pegged to patient satisfaction, and patient satisfaction is an often-used indicator of high-quality health care.

That said, a new study shows that patients who are most satisfied with their doctors have 8.8% higher total expenditures, 9.1% greater prescription drug expenditures and higher mortality numbers (126 patients versus 100 patients of the least satisfied over nearly four years).

In essence: the more you compensate your doctor, the more satisfied you will be and the greater risk you run in your treatment.

Joshua Fenton, assistant professor in the UC Davis Department of Family and Community Medicine and lead author of the study, which was published in the Archives of Internal Medicine, questions whether a patient satisfaction survey “as currently measured and used, is a wise goal in and of itself.”

The problem, says Fenton, is that doctors may order tests and prescribe medications or other treatments that are not necessary, increasing risks for patients without providing benefits. Explaining why a treatment or test is not necessary takes time, which doctors don’t have much of, and doctors may be reluctant to bring up issues that make their patients uncomfortable, such as substance abuse, mental health and smoking, which may then go unaddressed, he says.

More than 50,000 adults nationwide were surveyed for this study.

The “study generates some interesting hypotheses, and opens some interesting discussion, but it adds no ‘knowledge,’” says Stuart Spitalnic, a Newport Hospital emergency room physician and former Brown University emergency medicine faculty member. He says that “the history of this kind of research shows that nearly all of these associations, when appropriately studied, either prove to be wrong, or the effect size vanishes to the point where the conclusion is clinically irrelevant.”

Fenton also noted that a cause and effect relationship could not be established from the survey.

The UC Davis researchers will next explore why the more satisfied patients tend to be hospitalized more frequently as well as why prescription costs are higher in this group.

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