Up@dawn 2.0

Wednesday, April 22, 2015

Should Doctors Give Patients What They Want? Part 3

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.


Should Doctors Give Patients What They Want? Part 2

Many times patients think that physicians don’t listen to them, but physicians are some of the best listeners I have known.  There have been times when I have shadowed doctors, and patients will attempt to tell long winded stories that do not aid in treating their malady.  The doctor will cut them short in a polite way and attempt to get to the bottom of the problem at hand.  It may seem like the doctor does not care for the patient’s story, and that may be the case, but most of the time the doctor has many other patients that are also waiting.  In an effort to spread his or her time evenly between all of the patients, the doctor must cut the patient short and not “listen.”  If the reimbursement program were to come into effect, it would create a catch twenty-two.  If the doctor spends more time with one patient, then other patients will be angry for having to wait.  If the doctor spends less time with one patient to tend to others, then that patient will feel unsatisfied.

The doctor should make an effort to explain certain procedures and medicines to the patient, but also, the patient should realize that they will not have the same understanding as the physician.  The physician is the expert in the room.  In the field of oncology, many patients don’t fully understand the tolls that chemotherapy takes on their bodies.  In a study concerning a patient’s knowledge, over 60% of lung cancer patients and over 70% of colon cancer patients did not realize that chemotherapy was not curative.  Another finding suggested that the more patients understood their situations, the more they disliked their care provider.  The more the patients are educated, the more they realize how much they do not know resulting in feelings of dissatisfaction.  If oncologists were to educate all of their patients, these findings suggest that these physicians would have some of the lowest satisfaction scores for doing a better job.

Part 3

One last factor that I read in an article from The New Yorker linked a doctor’s appearance to patient satisfaction.  The article quoted Daniel Kahneman by saying, “If we think a baseball pitcher is handsome and athletic … we are likely to rate him better at throwing the ball, too.”  Kahneman was referring to the halo effect.  The halo effect is a type of confirmation bias where positive feelings about one trait of a person, their attractiveness, clouds judgement about other traits.  This would be great for attractive doctors but terrible for their less aesthetically pleasing counterparts.  It seems unfair for pay to be based off of attractiveness level, and that is a possible outcome.

I agree with the efforts of the proposed system.  I think the patients should feel happy with their care, but I don’t think their overall medical care should be handicapped.  Also, if many other factors such as the halo effect are able to cause bias or illegitimate care, I do not think it should be enacted as a reimbursement program.  Another type of program devised to better physicians should be created in its place.  What do you think would be a better solution?

1 comment:

  1. Well, the best solution would be to enroll everyone in a critical thinking course while they're young. Then, when facing illness in later life they may be slightly less susceptible to confirmation bias and the halo effect!