Null Hypothesis is True: “Attentive nurses, pain care” but what about quality of medical care?

            The article title wasn’t clear at first. I mean, it almost eludes to something that was going to be about bashing nurses. So I’ll further blur the lines with a picture with no meaning to the subject of the article. However, it does report on an interesting hospital/patient survey titled Patients as Consumers in the Market for Medicine: The Halo Effect of Hospitality. The hypothesis that there is a positive correlation between patient satisfaction and quality medical care is null and void. The null hypothesis is true.  

Patients’ ratings of hospitals and willingness to recommend them have almost no correlation to the quality of medical care provided or to patient survival rates, according to new Cornell University research.

            The actual study states that consumer-driven health care is often heralded as a new quality paradigm in medicine. Patient satisfaction has become a central dimension on which hospitals and doctors are evaluated. However, patients-as consumers face difficulties in judging the quality of their medical treatment. Among 3000 participants, they found that neither medical quality nor patient survival rates had an impact on patient satisfaction. They found:

Quiet rooms have a larger impact on patient satisfaction than medical quality, and communication with nurses affects satisfaction far more than the hospital-level risk of dying.

Interpersonal communication by nurses – such as their responsiveness and compassion (not their technical skill) – was a far bigger factor in patient satisfaction. Hospitality experiences create a halo effect of patient goodwill, while medical excellence and patient safety do not. Higher medical quality has a weak effect on patient satisfaction. In contrast, the quality of interaction with nurses has a positive effect size three or four times larger than medical quality.

Moreover, when hospitals face greater competition from other hospitals, patient satisfaction is higher but medical quality is lower.

            Today, patient satisfaction is becoming a central dimension on which hospitals and doctors are evaluated. The irony here is that patient satisfaction and quality medical care negatively correlate. Thus relying on patient satisfaction as a marker of quality care is null and void. 

References:

  1. https://www.painweek.org/media/news/attentive-nurses-pain-care-what-about-quality-medical-care
  2. https://academic.oup.com/sf/advance-article-abstract/doi/10.1093/sf/soaa007/5735232?redirectedFrom=fulltext
  3. https://web.stanford.edu/~cy10/public/Market_for_Medicine.pdf

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Robert Duprey MD

Robert P. Duprey Jr studied medicine as a 2nd career medical student who went to medical school in his 40’s after honorable discharge and ‘retirement’ from 25 years in the US Military (USCG & US Army). He was a registered nurse (RN) with specialty training as a psychiatric RN in the US Army for 15 years. During this time he also became a Master’s level psychotherapist in 2002. While on US Army active duty he also became a Psychiatric Nurse Practitioner while working full time in 2011. He served as a Psych NP on active duty, to include a combat tour in Iraq, until his ‘retirement’ in 2014 and moved to Philippines with his 3 children. At this time he started medical school overseas at Oceania University of Medicine based out of Samoa accredited by Philippine Accrediting Association of Schools, Colleges and Universities (PAASCU). He continued to work as a Psych NP throughout medical school to support his children and to not have to take out loans for medical school tuition. Originally from Rhode Island, he completed medical school clerkship rotations throughout the USA with a graduation in May 2019 earning the esteemed credential of MD. He has successfully completed USMLE Steps 1, 2CS, and 2CK. He will take Step 3 this September as he applies for Psychiatry Residency. Having been and RN, NP and now MD, he is a believer of Physician led multidisciplinary healthcare teams 

  1 comment for “Null Hypothesis is True: “Attentive nurses, pain care” but what about quality of medical care?

  1. Bridget Reidy
    February 28, 2020 at 3:48 pm

    QI at it’s best. Improve only what you can measure, even if it’s lower quality really.

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