The Ugly Truth About Patient Satisfaction

Years ago, the Disease Management Care Blog crossed swords with a clinic administrator who was unsatisfied with its Department's patient satisfaction metrics. The DMCB argued sometimes having to say "no" to patients' demands for easy cures, specialist referrals, sophisticated imaging studies or off-formulary drugs could result in low satisfaction rates. It was about then that the DMCB was informed that the patient satisfaction surveys were going to be tied to portion of its income.

Administrator: 1, DMCB: 0.

That's why years later, the DMCB feels partially redeemed by an interesting peer-reviewed publication that examines the lack of any relationship between patient satisfaction and patient centered care.  In case you think they're both the same, think again.

Writing in the July 11 issue of JAMA, authors Joel Kupfer and Edward Bond point out that the former is a consumerist concept that compares service or product delivery to customers' expectations, while the latter is a medical concept that uses patient values to guide medical decision making.

It's been long-known that exceeding expectations leads to customer loyalty which, in turn, leads to greater profits. That's one of the reasons why business-minded hospital administrators typically rely on satisfaction surveys as a key metric of success. Despite their wide use in health care settings, however, Drs. Kupfer and Bond find that "satisfaction" is a poorly researched concept that has little correlation with the important domains of quality, safety, effectiveness, efficiency or equitability. For example, it's possible for over-testing and over-prescribing to give patients the false impression of action and progress. In addition, because patients don't usually bear the full cost of medical care, their opinions don't have to reconcile price and product, like they would for a car or a bottle of shampoo.

What did the DMCB learn, other than, once again, it was right all along?

1. Building a patient centered medical care practice won't necessarily generate high patient satisfaction. Conversely, pursuing high satisfaction rates is not the same as initiating patient centered medical care.

2. "Patient satisfaction rates" are a Ver. 1.0 primitive window into one slice of patient experience that, by itself, ultimately offers little insight about overall quality.  Patients and their doctors deserve better.