Why Patient Satisfaction Surveys Need Context
In my present job I do try to not only satisfy my patients but also make them happy. Why? Because my patients pay me a monthly fee to be their doctor (and I genuinely want to be a good doctor). The job is great and I am one year into it and I can truly say that my direct primary care business is a success. I am happier than I have ever been being a doctor. I bring this up because I recently read about a survey of a million patients in 7800 practices in England showing that “patients were least satisfied with family doctors who were frugal with antibiotic prescriptions.” Even better, the amount of antibiotic prescriptions a practice gave out was a leading predictor of its patient satisfaction ranking. All this was published in the British Journal of General Practice. This is no surprise to me but it is a great reason that OTHER practices cannot use quality metrics like patient satisfaction surveys. It forces doctors to use inappropriate antibiotics or other medications. So how does this relate to me? Well, I think that I give LESS antibiotics than I ever have given in my career. The reasons are many:
- I can truly spend time listening and examining a patient, which makes my diagnosis more accurate
- I know my patients and they trust me
- If the infection is viral I spend a lot of time educating them on why antibiotics won’t work and may actually hurt them and their own good bacteria (microbiome)
- I spend time going over the best OTC products for symptom control
- They have my cell number and email to get in touch with me if symptoms change
- I email all my patients when a new viral URI seems to be hitting the local community so they don’t even need to come in
The key metric above is time. I have it and other doctors don’t. In summary, patient satisfaction means everything to me as patients will leave if they don’t like my practice. Time = patient satisfaction. For employed docs, who have no time. using these surveys as a way to bonus doctors is a mistake and leads to bad care.
Great post! Machine medicine is properly called a religion, not a science, because it guides future behavior based on belief in certain myths. One of the things it does NOT each is a simple evidence-based approach to medicine, so obvious that it doesn’t need a randomized, double-blinded study.
You do something. You look for an effect. The effects of interest are changes in symptoms and signs that suggest an improvement in underlying disease. This takes time. It takes exactly the amount of time needed to understand the change in the patient’s condition.
Machine medicine assures patients that for every symptom, there is a purchase to be made. For the common cold, something must be purchased. Many of these things are useless; a few are harmful. To write a prescription for a placebo antibiotic is the same as punching your time-card in machine medicine.
To look for a change, one must be patient, and to watch when the condition calls for watching, requires experience and bravery. All of these are actively discouraged in the market myth that is “modern medicine.” We believe that medicine was nothing before antibiotics, antipsychotics, antidepressants, all these things. We forget that these things allowed the advance of medicine – they did not substitute for medical care, but rather change the playing field. In every case, the patient still needed to be SEEN.
It is not simply jargon to say that we SEE a patient. People seek to be understood. They are told that they can be sold a nostrum that will chill their ills. I find that if someone sees their suffering, and exerts one’s professional skill to alleviate it, that is healing.