The Cost Of A Satisfied Customer

First Internal Medicine - Diagnosis

The Cost Of A Satisfied Customer

Patient Knows Best…

Visits to the doctor can frequently be nerve-wracking and uncomfortable. The uncertainty, the sterile environment, the outdated magazine selection. More often than not, though, the doctor has only one priority; your health.

However, many times, patients complain about having a cold, impersonal or rushed experiences at the doctor’s office or hospital. While having a satisfying and thorough appointment when being treated is a preference for many healthcare recipients, it does not always convert to better practice. It could be quite the opposite, as it turns out.

A recent 2-year study of over 50,000 participants found that higher patient satisfaction was associated with a greater chance of being admitted to a hospital, paying higher prescription drug and healthcare costs and even having a higher frequency of death.

These findings suggest that, in an effort to make their patients happy and satisfied with a given diagnosis, doctors may not be providing the most efficient care possible. This can be manifested in the practice of prescribing medications, tests, screenings and treatments that the patient sees as being necessary or would like to try, even if they may not prove vital to their overall well-being. In many cases, all this accomplishes is a much higher cost for the patient due to excessive testing and failsafe reassurances, with no measurable health benefits in the end.

In the age of the internet and self-diagnosis through website’s like WebMD and Wikipedia, patients can regularly approach their personal healthcare with a “the customer is always right” attitude. And while this may prove advantageous when deciding salad toppings or what temperature a steak should be cooked (the answer is always medium-rare by the way, always), when the health of a patient is on the line, it is important to remember that the doctor knows best. Physician and healthcare professionals are highly skilled and knowledgeable, having spent years training in their respective fields, and always aim to give the best, most effective care possible to their patients. The last thing we want is for a patient to not be satisfied with his or her experience, but your health must come first.

False-Positives Can Lead To True-Negatives

Healthcare satisfaction is not only dictated by a doctor’s willingness to appease a patient’s treatment request. There are sometimes more subconscious conditions at play.

Take for example the case of Joseph Epstein, the subject of a self-written New Yorker article titled “A Healthy Man’s Nightmare.” The piece highlights Mr. Epstein’s path from an active and healthy literature professor in his early 60’s to his diagnosis with low “good cholesterol,” or HDL, during a routine physical exam on his birthday. As a result of this diagnosis, Epstein was immediately given a stress test in order to ascertain his stress levels, a test that likely had no effect on next steps for treatment. In the months that followed, Epstein eventually underwent and survived a coronary artery bypass surgery, a highly intensive, invasive and complex procedure.

Now, typically having to endure a comprehensive and risky medical procedure with long lasting side effects would not be described as a “satisfying” experience. But was Mr. Epstein stratified? You bet. He attributed his satisfaction to his physicians’ thoroughness and perhaps meticulous efforts. And this should not come as a surprise. Satisfaction with seemingly adverse outcomes of potentially excessive medical care appears to be the norm. Numerous studies have found that patients are consistently highly satisfied with one of the most common downsides of medical care; false-positive test results.

Furthermore, this kind of false-positive test satisfaction only tends to put in motion a pattern of behavior in which patients are more likely to undergo the same, and perhaps more, testing in the future, writing off the negative effects (high costs, extended treatment time, etc.) as simply being the price for achieving a positive outcome, i.e. “effective” treatment and cures.

A Two-Way Street

Over testing and excessive treatment is not just a reassurance for the patient, but can also bolster and protect a physician’s position in the patient-doctor relationship. Say a physician orders a patient to undergo a screening that may or may not have an outcome on an overall diagnosis, but in the end will not bring negative feedback. The doctor only stands to benefit from such a practice. If the test comes back normal, the patient is reassured, or, if the test comes back “positive,” the physician can celebrate with the patient who has overcome a “disease” that was proven by a false-positive test. The physician is left feeling satisfied with a job well done, and supported in his decision to conduct the test, thus likely continuing to do so moving forward.

Sometimes, Less Is More

In the last 30 years, thyroid cancer diagnoses have tripled, mostly due to the abundance of very small cancers that are now detectable. The vast majority of these cases represent what is called pseudo-disease, meaning they will never cause any sort of measurable symptom during a patient’s lifetime. While the treatment of such pseudo-diseases can result in adverse health effects, the take away by the patient is that the vigilance of their medical team may have been life-saving.

Again, this only reinforces the desire to continue such excessive treatments, especially when the incentive for the physician to do so is so strong, considering the presence of reimbursement systems, the medical liability environment and performance scorekeepers who could potentially penalize physicians who are found to be not thorough enough in their treatments and diagnoses. All this despite the fact that a recent survey suggests that nearly half of US primary care physicians believed that their own patients were receiving too much medical care.

One Goal In Mind

Quality healthcare is always first and foremost in the priorities of any medical professional. By studying, acknowledging and spreading awareness of excessive or unnecessary medical treatments we all stand to benefit. Doctors will no longer feel the pressure or need to conduct such tests and treatments and, more importantly, patients will receive the best, most effective and efficient care possible at a lower cost to them.

So do not hesitate to talk with your doctor about suggested procedures. An open dialog is what we strive for and could result in a happier, healthier more satisfying life. In the end, it’s your health that matters most to us.

–Igor Huzicka, MD