A recent study by Jerant and colleagues concluded that clinician denial of certain patient requests, such as referrals, pain medication, other new medications and laboratory testing, were associated with lower clinician satisfaction. Jerant also advocated that “in an era of patient satisfaction-driven compensation, the findings suggest the need to train clinicians to deal effectively with requests.”7
An overemphasis on patient satisfaction may have unintended adverse effects, such as promoting opioid addiction & overutilization of healthcare resources.
Satisfaction = Improved Outcomes?
Although patient satisfaction scores are meant to improve outcomes, there may be unexpected consequences. In a society with a healthcare system in which no incentives are based on patient satisfaction, medicine is practiced with the primary goal of decreasing morbidity and mortality. In a world where patients are asked to fill out surveys reflecting their satisfaction with staff members, practicing medicine becomes customer service driven, and patient satisfaction may be prioritized over evidence-based medicine. In the end, the patient may be the victim.
The critical difference between delivering healthcare services and other customer-based services is that in the latter, the individual requesting the service is the same one paying for it. In the former, the patients request services and insurances pay for those services. In this situation, some patients may overutilize resources. The role of the treating physician is to apply evidence-based medicine and decline inappropriate patient requests.
Clinic visits are now shorter, and physicians feel pressured to do more in less time while maintaining mutual respect with their patients. With the encouragement of patient involvement in decision making, patients feel they have more ownership of their health and may ask their physicians for more diagnostic testing or referrals. Some of those requests may be inappropriate because of the lack of a clear medical indication and overutilization of resources and time. Even when the request is not indicated, saying “no” may compromise the patient–provider relationship. But does saying “yes” to an inappropriate request do more harm than good?
The Centers for Medicare and Medicaid Services (CMS) link payment to achieving the triple aim initiative: better patient experiences, better health and lower cost.8 Prior studies have shown that physician refusal of opioid prescription requests was associated with worse patient satisfaction scores, so when it comes to chronic pain management, certain fields, such as pain management and rheumatology, will be heavily affected.7 As a result, their patient satisfaction scores may be relatively low compared with other subspecialties.
