Some of the best doctors have the worst patient satisfaction scores. According to a recent article in Forbesnotes, "doctors get good at being what people need them to be. But it slowly transforms doctors into something they couldn’t have foreseen—a sort of Stepford doctor—pleasing everyone with their perfect smile and agreeable demeanor, hoping that their patient satisfaction survey will be favorable, no matter the cost."
In fact according to researchers at UC Davis, the most satisfied patients are 12 percent more likely to be hospitalized and 26 percent more likely to die,. “Overtreatment is a silent killer,” wrote Dr. William Sonnenberg in his recent Medscapearticle, Patient Satisfaction is Overrated. “We can over-treat and over-prescribe. The patients will be happy, give us good ratings, yet be worse off.”
“The mandate is simple,” wrote Dr. Sonnenberg. “Never deny a request for an antibiotic, an opioid pain medication, a scan, or an admission.” Soinstead of better care and cheaper care, satisfaction scoring is making patients sicker and driving up costs. Indeed, the UC Davis researchers found the most satisfied patients account for 9 percent more in total health-care costs—and that does not include the excess monies wasted on trying to please the rest.
“The most ethical doctors are ousted and the most servile are raised high. In this world, doctors are forced to violate their sacred oaths to keep their jobs. In this world,once-proud physicians are over-prescribing and over-ordering, grinning and pretending, stepping and fetching.”
This applies to end-of-life care as well. Doctors often are afraid of the patient’s family and go to extreme measures to provide costly futile care to the dying patient. Fear of lawsuits has prevented more conservative treatment. The decision to use life prolonging treatment is a personal one. It is always important for the dying patient to be involved in this decision. The epiphany for doctors comes when they really see a person experiencing an illness, rather than a patient in some stage of a disease process. In my book, Soul Service: A Hospice Guide to theEmotional and Spiritual Care to the Dying (Balboa Press, 2013) we explore a more holistic perspective to the death experience. For further information please visit www.soulservice.info
At MD Anderson’s Integrative Medicine Center, the holistic approach to treatment is starting to become a reality. There you will find medical doctors working to incorporate the social, mind-spirit and physical aspects of healthcare. Dr. Richard T.Lee, and Dr. Gabriel Lopez, provide advice to patients who wish to incorporate integrative therapies into their conventional cancer care.
“Cancer and its treatments can have major effects on the patient and those who are close to the patient. The Integrative Medicine Center works cooperatively with the primary oncology team to build comprehensive and integrative care plans that are personalized, evidence-based and safe to improve health, quality of life and clinical outcomes.”
Acupuncture,massage, music therapy, meditation, nutrition consultation and health psychology are all employed in this approach to treating the whole person. When these different forms of complementary care can be used and the treating physician is not afraid to provide ethical and quality patient care,disregarding patient satisfaction surveys in favor of good care, then excellent medicine will be practiced and the familiar doctors creed “ first do no harm” will be practiced.