Through three years of medical school, I’ve seen disgruntled physicians repeatedly slam the recent movement toward patient satisfaction. In our family medicine clinic, a copy of Dr. William Sonnenberg’s essay “Patient Satisfaction is Overrated” hangs on the door to remind attendings, residents, and students of the unfair pressure to keep patients happy despite their demand for antibiotics, imaging studies, or narcotics.
The only way to keep the patients satisfied, the argument goes, is to give in to unreasonable requests. “The mandate is simple,” the author suggests: “Never deny a request for an antibiotic, an opioid pain medication, a scan, or an admission.”
But the options are not simply give in to pressure or say “no” and lose patient trust. There is another path that is harder, takes more time, and is particularly challenging for young medical students and doctors: to improve communication.
“Patients aren’t the best judge of what is best for them,” Dr. Sonnenberg writes. This is true, but a physician’s calling includes not only judging what is best for patients, but also helping patients seek out accurate information, educating them, and developing the relationships and trust that ensures they understand the reasons for and against any treatment.
The author concludes with, “We should try to be kind to our patients and take time to understand them, but we must resist these misguided pressures and do the right thing. Sometimes patients have to be told ‘no,’ and the leadership in health care must understand this.”
This takes too narrow a view. Physicians must understand there is more than one way to say no. And going against patient wishes does not always lead to poor satisfaction.
A physician’s job requires — and patient satisfaction flows from — education, empowerment, and encouragement for patient decision-making within the health care delivery system. It’s explaining why his symptoms appear viral and explaining why antibiotics simply won’t help. It’s explaining that narcotics addiction is an illness in its own way, and there are other ways (e.g. rehab programs, exercise, counseling, withdrawal prophylaxis) to address the problem.
Patient satisfaction is linked to many other qualities a physician may possess, not just her prescription rates. It depends on her communication skills, the amount of time that her patients perceive she spends with them, and that she provides adequate explanations for the causes of pain or illnesses. Patient satisfaction and treatment compliance have been shown to relate directly to a physician’s empathic behavior. Improved communication is even linked to improved health outcomes. The pressure to keep patient-satisfaction levels high should not be seen as “misguided,” but as a call to arms to focus on a new skill set in an overburdened health care system. These surveys strive to keep doctors’ eyes on the patient rather than the computer.
There are ways to go against people’s wishes and still keep them happy. Kindness, respect, and understanding go a long way. Countless primary care physicians serve as the patient heroes who display these qualities. These are the role models for future physicians, and they must be acknowledged and celebrated. Health care leadership can put an emphasis on these qualities, seeking to strengthen the communication skills that define the patient-physician relationship.
This is admittedly no easy task. Personalities differ, and a doc will not get through to every one of his patients. A patient upset that he didn’t go home with amoxicillin may cause a good physician to receive a lower “score” than he deserves. But this can be mitigated or avoided by what doctors should be doing with every patient: seeking to improve creating intimate connections with diverse people. Physicians help patients understand their disease and treatment options as much as simply trying to treat them.
Doctors must see the new reality of the field of medicine not as creating perverse incentives away from proper treatment, but instead as an interpersonal challenge to connect with and educate all patients, including — especially — difficult ones.
In order to truly improve health care, the medical system must refocus on the relationships between doctors and patients, and less on doctors as intervention providers. Doctors exist for the patients, and to share some of life’s most intimate moments with them: life, death, birth, sickness, and recovery. To aid them when they need it most. To optimize their long-term health. To improve their quality of life, and to work to keep them healthy, educated, and satisfied. Patient satisfaction is underrated.
Justin Berk is a medical student.
