Patient satisfaction is costly but maybe not so healthy

A satisfied patient is not a cheaper patient: however important such a finding may be in these budget-constrained times, that comes as little surprise. More unexpected is the finding that a satisfied patient is not necessarily a healthier patient -- that the patient happy with the medical attention he or she receives from a physician is more likely to die than the patient who grumbles about it. Yet both findings emerge from a study published “online first” on Monday in the Archives of Internal Medicine.

The authors -- four family medicine doctors at UC Davis -- suggest that in a healthcare marketplace in which Americans often choose their doctors in the same way they choose a plumber or an electrician, physicians may have gotten a little too eager to please their “customers.” More reliant than ever on patient-satisfaction scores and online reviews, doctors may be acceding to more patients’ requests for tests, treatments and medication that they’ve read about on the Internet or seen on TV.

That will certainly drive up costs. But for some patients, all that extra “care” may actually be harmful as well, hastening death.

The studied followed 51,946 Americans between 2000 and 2007, each for at least two years. In their first year of participation, participants were asked to rate how satisfied they were with the care they received from their physicians, as well as some health and biographical questions. In the second year, participants were asked to detail what medications they had been on in the past year, how often they had sought medical care in a clinic or doctor’s office or emergency department, and whether they had been admitted to a hospital for care. Researchers tracked a large subset of the participants for an average of 3 1/2 years to discern whether death rates bore any relationship to patient satisfaction.

Their findings: that compared to the least-satisfied patients, those who were most satisfied with their healthcare were on more prescription medications, made more doctor’s office visits and were more likely to have had one or more hospital stays, despite the fact they were in better overall physical and mental health. Also, despite the greater attention and all those prescription drugs they got, the highly satisfied were more likely to die in the few years after taking the survey than were those who pronounced themselves least satisfied with their physicians’ medical care.

The only type of care that the least satisfied were more likely to use was emergency department care. That could be because some of the malcontents may have delayed visiting their usual healthcare provider or didn’t have one.

Overall, the most satisfied patients incurred 8.8% more healthcare expenditures than did the least satisfied and spent some 9.1% more on prescription drugs than did the least satisfied. And yet, by the study’s end, the most satisfied patients were 26% more likely to have died than the least satisfied. And that surprising finding became even stronger when researchers stripped out the individuals from both groups who identified themselves as being in poor health or who suffered from three or more chronic diseases such as diabetes, emphysema or a heart condition.

In an invited commentary posted on Tuesday, Veterans Affairs physician Brenda Sirovich wrote that doctors have learned that they “will be rewarded for excess [treatment] and penalized if they risk not doing enough.” Insurance reimbursement structures, medical malpractice suits and the proliferation of websites that “grade” healthcare providers and guide consumers toward those that please have taught them that.

“Only if we commit to overcoming the widespread misconception that more care is necessarily better care, and to realigning the incentives that help nurture this belief,” can physicians, healthcare companies and patients drive down rising healthcare costs and reverse a trend of overtreatment, wrote Dr. Sirovich.