My take: Colon cleansing, patient satisfaction

1) A reader writes: “I would really like it if you could blog about all the craziness involved with detoxification and cleansers.”

My take: I wrote about it a few years ago. For more, I’m going to defer to the woo-busting king, Orac.

2) A reader writes: “I’d like to hear your thoughts on this growing concept of healthcare customer service.”

My take: Physicians can certainly do a better job communicating with patients and improving the patient experience. Shorter wait times and improving access to the system would be two examples.

However, there are cases where what’s best for the patient may not always be congruent with good customer service. If a patient demands an unnecessary test or medication, should the physician acquiesce in the name of keeping the patient happy? How about the drug-seeking patient demanding narcotics?

More worrying is that compensation is increasingly linked to patient satisfaction scores. I can see some doctors caving in to questionable patient demands simply to keep their scores high, and maintaining their incomes.

Comments

Anonymous
“If a patient demands an unnecessary test or medication, should the physician acquiesce in the name of keeping the patient happy? How about the drug-seeking patient demanding narcotics? “
But that begs the question of whether the physician is correctly determining need for tests, pain relief, or even medication.
Physicians who don’t listen, (perhaps because they’ve”heard it all before”, or have anchored onto a general truth that doesn’t apply in an individual case – can do harm and should have a competing pressure to make the right choice.
You know full well some doctors have sticky ideas or conflicted interests with regard to treatment of a herd vs an individual, cost containment. They may be hassled and overworked, or simply lazy….taking the path of least resistance, avoiding paperwork or pain-in the-neck scrutiny of insurers, bosses, agencies, etc (and who may harbor unrealistic or baseless fears about scrutiny, to boot).
Unless the interest and satisfaction of the patient counts for something, it’s the patient who will end up getting the shaft. ( Or the catheterization instead of the preauth required stress test).
And though physicians sometimes forget, doctoring is about what is best for that one person. Not what is best for the “system”. Patients need to have a way to have their personal experiences factor into that increasingly overarching beast of a “systems” needs.
Stark Raving Med
Anonymous…
The problem with your argument is that you assume the interests of the system and the interests of the patients are mutually exclusive. This is not the case. What is in the interest of the system is often congruent with the interests of the individual. For example, the widespread use of antibiotics for viral illness was a response to patient demand for such treatment and doctors’ desire to satisfy the wants (not needs) of their patients. This has led to the epidemic of multidrug-resistant bacteria which has, in turn, seriously affected countless individual patients everywhere. The decision to offer a patient antibiotics when they truly do not need them, when magnified over the course of hundreds of thousands of patients over several years, can have profound repercussions on public health (the health system) which in turn affects us all. While it may be of no consequence for a single clinician to order a single chest xray unnecessarily, there are widespread consequences when this happens hundreds of times a day. If you don’t think you pay every time a physician acts to merely satisfy the capricious demands of his patients, you’re sadly mistaken.
Ian Furst http://www.waittimes.blogspot.com
Whie Coat had a major piece about his/her compensation being tied to customer satisfaction surverys. The problem is there variability is dependent on tangibles like wait time, pain, esthetics, interactions but there [mostly] not effected by quality. The physician is one small piece of the puzzle when it comes to the tangilbes of a health care experience but they are a major piece of it when it comes to quality. Tieing compensation to customer satisfaction survey’s might increase access and lower wait times but it encourages sub-optimal practices.
Anonymous
Ultimately, it is the physicians professional responsibility to resist allowing perverse incentives in a compensation program to degrade the quality of care. The existence of such incentives is as old as the medical profession itself and exists in every payment system in some form. That is why it is a “profession” that professes a set of ethics–why physicians swear to put the patients interest over their own in the care they recommend.
In capitated care, the incentive is to withhold care. In FFS care, it is to churn care. In traditional salaried systems, it is to be unavailable and do as little for your wage as possible. Patient satisfaction components is an attempt to counter this, which in turn creates it’s own perverse incentives.
It is the physician’s responsibility to keep the patient first regardless of the system, and if a system creates so much pressure to distort his behavior that he is unable to do so, to refuse to participate and provide his services though some other.
I have worked solo FFS, group FFS, capitated, salaried, and hourly wage, with and without patient satifaction bonuses–in the end the basic need for a commitment to professionalism over personal financial gail is the same. And I have watched a community of physicians move about through these same system–they ones who work put their patients behind their wallet do so consistently, easily shifting their care to match the dollar. The real doctors are consistent and do not change their professional behavior in response to changing compensation systems.
The administrators hate them. If you don’t worship Mammon, they have no hold on you.
Anonymous
This is nothing new. We’re already ordering billions of dollars in defensive medicine tests of little value other than the patient, the patient’s family, or your future malpractice trial attorney want it. After all, it’s the system’s money, not the patient’s or physician’s money being spent.
Patient satisfaction scores don’t introduce a new problem, they just exacerbate an existing problem.
Anonymous
A lot of pt satisfaction is based on getting what they want…and what they want may bear little resemblance to what is actually in their best interest, or what they need, or what the provider can actually deliver in that particular medical setting(urgent care vs ETR vs outpt clinic, etc.. This whole thing is replete with unrealistic demands and expectations. Doctors are delivering professional care… not a meal at Appleby’s..or buying something at Walmart. But that is how the business-types/consumers think about ‘satisfaction scores’. They are called patients (not customers) for a reason.

My take: Colon cleansing, patient satisfaction

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