post by Bill Gardner
There is an important study in the Archives of Internal Medicine by Joshua Fenton and his colleagues that reports that
In a nationally representative sample, higher patient satisfaction was associated with less emergency department use but with greater inpatient use, higher overall health care and prescription drug expenditures, and increased mortality.
The national sample was over 50,000 patients from the Medical Expenditure Panel Survey (MEPS). This is a household survey, meaning that the results are representative of the nation as a whole, rather than being driven primarily by those who received care. Respondents' satisfaction was measured by a composite score based on
4 items pertaining to physician communication, specifically how often in the past 12 months patients' physicians or other health care providers performed the following: (1) listened carefully, (2) explained things in a way that was easy to understand, (3) showed respect for what they had to say, and (4) spent enough time with them... [and] a fifth item in which patients rated their health care from all physicians and other health care providers on a scale of 0 to 10.
To my knowledge, there is universal concensus that these are qualities that we want in our health care. And it has been hoped that by promoting better patient-doctor communication, more patients will get the care they want, avoid care that they do not want, and live healthier lives.
What the investigators did was to split the survey respondents into four groups based on their overall satisfaction, and then look at their use of health care and survival in the next year. They found that patients who were most satisfied with their medical care in year 1 had 8.8% greater year 2 total health care expenditures and 9.1% greater prescription drug expenditures compared to those who were least satisfied, after adjusting for demographic characteristics and measures of year 1 health. In addition, "relative to the least satisfied patients at baseline, the most satisfied patients had a 26% greater mortality risk. (emphasis added)"
It is not surprising that those who were more satisfied with care would use more of it. It is completely uncool, however, that this extra care appeared to be killing them, and that -- lambs to the slaughter? -- they nevertheless seemed to believe that they were getting better care.
This study reinforces widespread concerns that patients believe that they need and will benefit from aggressive care, but they would in many cases be better off with less care. And it raises serious questions about whether we should be striving to improve patients' satisfaction with care. The alternative is to focus exclusively on improving health outcomes.