Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

We shouldn’t focus exclusively on patient satisfaction

Richard Young, MD
Policy
April 28, 2014
Share
Tweet
Share

“Patient-centered.”

It sounds so right, doesn’t it? Right up there with mothers and apple pie. If only family medicine were so simple.

A report by ABC News told the story of a doctor at a VA hospital in Kansas City who claims she was forced to leave her job because she tried to limit prescriptions for opioid pain medications to reasonable amounts. Patients complained, so she was canned.

She claimed that some patients received prescriptions for 900 narcotic pills a month. Some patients were “lethargic, not functional.” Patients who wouldn’t accept the gradual tapering of the narcotic doses would threaten her, “cussing, cursing, lashing out, complaining to the administration …”

In a separate announcement, the VA admitted there’s a problem with opioid prescribing nationwide and says it will improve the situation in part with “physician education.”

From a different environment comes stories of ER doctors prescribing Vicodin “goody bags” for patients complaining of any sort of pain. This approach decreased patient complaints and increased patient satisfaction scores, so hospital administrators were giddy.

These reports come in the midst of other findings that deaths from prescription drugs are now greater than deaths from heroin and cocaine combined.

The patient-centered medical home advocates have it wrong. They push for high patient satisfaction scores the way a retailer would obsess about customer satisfaction ratings. Unfortunately, my world in family medicine is so much more complex than running a Target.

We shouldn’t focus exclusively on patient satisfaction. We really need system-centered care by system-centered physicians. Most of the time this will correlate perfectly with patient satisfaction: patients who feel like they were listened to and that their physicians simply cared for them.

But at key moments, the highest form of family medicine is to piss off a few patients. Those who demand narcotics for iffy indications, demand antibiotics for colds, and demand MRIs for simple sprains are but just a few examples. This isn’t to suggest that the family physicians should be jerks about the encounters. There are polite and tactful ways to say no. But no matter how nicely it’s said, if a patient has made up his mind that he will not be satisfied until he gets his narcotic, he will leave the physician encounter not just dissatisfied, but often burning mad.

The PCMH pushers make no acknowledgment that these types of encounters occur and make no effort to reward ethical family physicians for making good decisions to protect patients from harm to themselves and protect the medical commons for everyone. In fact, they have created incentives for physicians to do the wrong thing.

This is one more reason the current PCMH model should be dumped into the trash heap of innovations that just don’t work.

Richard Young is a physician who blogs at American Health Scare.

ADVERTISEMENT

Prev

The Maryland approach to controlling health costs

April 28, 2014 Kevin 3
…
Next

Why patients cannot afford to have asthma or gout

April 28, 2014 Kevin 44
…

Tagged as: Pain Management, Primary Care

Post navigation

< Previous Post
The Maryland approach to controlling health costs
Next Post >
Why patients cannot afford to have asthma or gout

ADVERTISEMENT

More by Richard Young, MD

  • When medical protocol meets family concerns

    Richard Young, MD
  • Patients in Sweden received fewer post-op opioids. Why is that?

    Richard Young, MD
  • Medicine is too complex for computers to keep up with or understand

    Richard Young, MD

More in Policy

  • How the One Big Beautiful Bill could reshape your medical career

    Kara Pepper, MD
  • Why the U.S. Preventive Services Task Force is essential to saving lives

    J. Leonard Lichtenfeld, MD
  • Brooklyn hepatitis C cluster reveals hidden dangers in outpatient clinics

    Don Weiss, MD, MPH
  • Why nearly 800 U.S. hospitals are at risk of shutting down

    Harry Severance, MD
  • Innovation is moving too fast for health care workers to catch up

    Tiffiny Black, DM, MPA, MBA
  • How pediatricians can address the health problems raised in the MAHA child health report

    Joseph Barrocas, MD
  • Most Popular

  • Past Week

    • How hospitals can prepare for CMS’s new patient safety rule

      Kim Adelman, PhD | Conditions
    • Why primary care needs better dermatology training

      Alex Siauw | Conditions
    • Guilty until proven innocent? My experience with a state medical board.

      Jeffrey Hatef, Jr., MD | Physician
    • Why medical notes have become billing scripts instead of patient stories

      Sriman Swarup, MD, MBA | Tech
    • Physician practice ownership: risks, rewards, and reality

      Paul Morton, CFP | Finance
    • Few people realize this common infection can cause serious complications [PODCAST]

      The Podcast by KevinMD | Podcast
  • Past 6 Months

    • Why transgender health care needs urgent reform and inclusive practices

      Angela Rodriguez, MD | Conditions
    • COVID-19 was real: a doctor’s frontline account

      Randall S. Fong, MD | Conditions
    • Why primary care doctors are drowning in debt despite saving lives

      John Wei, MD | Physician
    • New student loan caps could shut low-income students out of medicine

      Tom Phan, MD | Physician
    • Confessions of a lipidologist in recovery: the infection we’ve ignored for 40 years

      Larry Kaskel, MD | Conditions
    • mRNA post vaccination syndrome: Is it real?

      Harry Oken, MD | Conditions
  • Recent Posts

    • Few people realize this common infection can cause serious complications [PODCAST]

      The Podcast by KevinMD | Podcast
    • Unity in primary care: Why I believe physicians and NPs/PAs must work together toward the same goal

      Jerina Gani, MD, MPH | Physician
    • My improbable survival of stage 4 cancer

      Kelly Curtin-Hallinan, DO | Conditions
    • How Filipino cultural values shape silence around mental health

      Victor Fu and Charmaigne Lopez | Education
    • Why leadership training in medicine needs to start with self-awareness

      Amelie Oshikoya, MD, MHA | Education
    • Federal shakeup of vaccine policy and the battle for public trust [PODCAST]

      American College of Physicians & The Podcast by KevinMD | Podcast

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 6 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

ADVERTISEMENT

  • Most Popular

  • Past Week

    • How hospitals can prepare for CMS’s new patient safety rule

      Kim Adelman, PhD | Conditions
    • Why primary care needs better dermatology training

      Alex Siauw | Conditions
    • Guilty until proven innocent? My experience with a state medical board.

      Jeffrey Hatef, Jr., MD | Physician
    • Why medical notes have become billing scripts instead of patient stories

      Sriman Swarup, MD, MBA | Tech
    • Physician practice ownership: risks, rewards, and reality

      Paul Morton, CFP | Finance
    • Few people realize this common infection can cause serious complications [PODCAST]

      The Podcast by KevinMD | Podcast
  • Past 6 Months

    • Why transgender health care needs urgent reform and inclusive practices

      Angela Rodriguez, MD | Conditions
    • COVID-19 was real: a doctor’s frontline account

      Randall S. Fong, MD | Conditions
    • Why primary care doctors are drowning in debt despite saving lives

      John Wei, MD | Physician
    • New student loan caps could shut low-income students out of medicine

      Tom Phan, MD | Physician
    • Confessions of a lipidologist in recovery: the infection we’ve ignored for 40 years

      Larry Kaskel, MD | Conditions
    • mRNA post vaccination syndrome: Is it real?

      Harry Oken, MD | Conditions
  • Recent Posts

    • Few people realize this common infection can cause serious complications [PODCAST]

      The Podcast by KevinMD | Podcast
    • Unity in primary care: Why I believe physicians and NPs/PAs must work together toward the same goal

      Jerina Gani, MD, MPH | Physician
    • My improbable survival of stage 4 cancer

      Kelly Curtin-Hallinan, DO | Conditions
    • How Filipino cultural values shape silence around mental health

      Victor Fu and Charmaigne Lopez | Education
    • Why leadership training in medicine needs to start with self-awareness

      Amelie Oshikoya, MD, MHA | Education
    • Federal shakeup of vaccine policy and the battle for public trust [PODCAST]

      American College of Physicians & The Podcast by KevinMD | Podcast

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

We shouldn’t focus exclusively on patient satisfaction
6 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...