Focus on satisfaction: Too much autonomy?
Doctor-patient relationship may be harmed
Linking payment to patient satisfaction could have a profound impact on the doctor-patient relationship, argues James N. Kirkpatrick, MD, an assistant professor of medicine at the Hospital of the University of Pennsylvania who is affiliated with the University of Pennsylvania Department of Medical Ethics and Health Policy. "As part of the larger context of patient-centered medicine,' paying attention to patient satisfaction scores represents several things," he says. "One is another step away from the classical context of physician paternalism, and toward the paradigm of patient autonomy and patient empowerment."
At one point in time, doctors held all of the power and made all of the decisions, says Kirkpatrick, but decisions today are made more jointly. "Patients and physicians should work together to decide what to do," he says. In this context, he says, it may be helpful to rate physicians on communication skills, their bedside manner, and their ability to elicit patients' goals and expectations. "I'm not sure I like the idea of moving past that into a world where patients tell the doctors what to do, and the doctors had better do it, for fear of losing income from declining patient satisfaction scores," he says.
A "consumerist focus" in health care is the likely result, which is something that neither patients nor physicians really want, says Kirkpatrick. "I haven't met many patients who expect that our relationship will consist of them telling me what to do," he says, adding that physician training involves not only acquisition of knowledge and skills but also training in judgment. "That is the sort of thing that doesn't come out of a book, and the sort of thing that patients need from us."
The concern, says Kirkpatrick, is that the "pay for patient satisfaction" approach might stifle this part of the patient-physician relationship, which has negative public health implications. "It is already much easier, and less time-consuming, to write a patient a script for an antibiotic than to explain why they don't need it," he says. "If one adds on a potential financial penalty for making the patient dissatisfied, the choice becomes even easier. Patients seem to resonate with the idea of a pan scan' to find anything that could be wrong." It is difficult to explain to them that even the best of tests have a certain false-positive rate, potentially leading to unnecessary and potentially risky procedures and follow-up testing, let alone unnecessary expense, he explains.
"We already order lots of unnecessary tests in order to avoid lawsuits. We'll see lots more of this if our pay is docked because of disgruntled patients," says Kirkpatrick.
Patients answering satisfaction questionnaires may have a less positive view toward the provider after a tough discussion, adds Kirkpatrick, which may result in providers avoiding difficult end-of-life discussions.
"That said, a very positive upside may be increased time allowed for the patient encounter," he says. "If administrators see patient satisfaction scores rising when patients get to spend more time with physicians, they may allot more time for these encounters."
Source
- James N. Kirkpatrick, MD, Assistant Professor of Medicine at the Hospital of the University of Pennsylvania. Phone: (215) 662-7726. Email: [email protected].
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content