Monday, April 20, 2015
Should Doctors Give Patients What They Want? (Part 1)
The question posed is a current concern in the medical field. Medicare devised a system where hospitals are reimbursed by a score of quality. 30% of this score is determined by patient satisfaction. Recently, New York City’s hospitals took this idea further and based their physicians’ salaries on patient satisfaction. This new format was intended to prevent doctors from being rude, not listening, spending little time with the patient, and not explaining things in detail to the patient, but it created a conflict of interest for the doctors giving care. Instead of providing the patients with care that will help them, the doctor ends up fulfilling patient requests to get paid.
A study surveying 52,000 patients found that “satisfied” patients paid 9% more and had a higher mortality rate, about 26%. This study shows that a higher level of patient satisfaction does not equal better care for the patient. The higher costs coincide with the doctor acquiescing to the demands of the patient. The patients demand a costly procedure or drug because they believe it will magically cure them of whatever afflicts them. The doctor, wanting to maintain a good rapport with the patient so he or she gets paid, orders the procedure or drug ending in more dollars spent on healthcare. It may result in the doctor appearing less rude, but this type of reimbursement program is a marketing ploy and in no way provides better care for the patient.
Sometimes there are nice ways to tell patients that they need to lose weight or stop smoking, but other times, situations aren't that easy. For many people, it is hard to differentiate between the disappointment of a message and the messenger delivering it. As a volunteer in Vanderbilt University Hospital, I see this type of shoot the messenger mentality a majority of the time. Many times a patient will ask me to get them food or water. Before I give the patients anything to eat or drink, I am required to consult the nurse or physician over them. Nine times out of ten, the nurse or physician will tell me that the patient cannot have anything because they are about to have a procedure done. As the messenger, I return to the patient and give them the bad news, and instantly, I am shot ... with angry looks. The patients then treat me differently afterwards most likely thinking I am mean for refusing their request. Withholding food and water from the patients might not be very pleasing to them, but in the end, it prevents them from having to remain in the emergency room longer. Materials in the stomach make reading x-rays and other types of scans difficult and also makes surgical procedures difficult to complete. So in order for the results to turn out well the patients would have to wait for their bodies to process the food and water. Even after explanation, some patients do not fully understand and still have disgruntled looks on their faces.
... to be continued.