Such patient satisfaction data are playing an increasing role in a number of important healthcare decisions. For one thing, physicians can be hired, fired, promoted, and compensated based in part on their patient satisfaction scores. Increasingly, these scores also determine how hospitals are ranked and paid. The Center of Medicare and Medicaid Services has been publishing this data and has begun distributing funds to hospitals based in part on patient satisfaction.
From one perspective, the effort to take patient satisfaction into account in allocating healthcare dollars is a welcome change. For many years, private and public health payers compensated physicians and hospitals based almost solely on the quantity of care they provided, essentially ignoring quality. The more patients they cared for and the more they did for each patient, the more revenue they generated. Now quality, defined in part by patient satisfaction, is playing a greater role.
Though attending more carefully to patients should strike any physician as a good idea, such perceptions are not always reliable. For one thing, a patient’s assessment of a physician visit or hospitalization can be colored by a variety of factors not under the control of either. For example, a patient frustrated by the difficulty or expense of parking may assign lower scores to every aspect of a hospitalization, including the quality of care provided by the physician.
In some cases, patient perceptions may prove downright misleading. Tony practiced medicine in a poor community. A high percentage of his patients complained of pain, and many were known to visit a variety of emergency rooms on a regular basis, seeking prescriptions for powerful pain relieving drugs, a pattern often referred to as “drug-seeking behavior.” We need to be careful about applying such a potentially derogatory term to any group of patients, but the problem is well known in the field.
In one study of drug-seeking behavior, 178 patients made a total of 2,486 emergency room visits in a single year, nearly 14 visits per patient. When asked why they were returning so frequently for more pain relievers, many replied that their medication had been lost or stolen, or that they have used up their supply. Nearly 30 percent rated the severity of their pain as 10 out of 10, and nearly 15 percent explicitly requested a particular medication by name. These include narcotics, benzodiazepines, and muscle relaxants.
This problem is widespread. A colleague recently cared for a suburban housewife from one of the nicest parts of town. She was both well-educated and well-off, and everything about her radiated health and success. When asked what medications she was taking, she mentioned a well-known narcotic pain reliever. When asked who had prescribed the medication, she replied, “No one.” When asked where she was obtaining it, she replied “Oh, just a person in the neighborhood.”