The patient is not always right

Patients are turning into customers or clients and, in many instances, citizen doctors and scientists, donating their DNA and money to the betterment of science and medicine via Internet platforms. In addition, satisfying patients has become big business with dollars and reputations riding on the results. A recent Hastings Center report questions the entire business.

Despite opinions to the contrary, most patients are not in a position to adequately evaluate the quality of care. In fact, most doctors struggle with what’s the right thing to do in many medical circumstances and whether the outcomes are appropriate or not. Patients are certainly in a position to evaluate the quality of service, experience,access, convenience and responsiveness. The evidence indicates that one is not related to the other and doing so can create a lot of problems:

1. Doctors do things to please patients, not do what is in their best interests.

2. Doctors and hospitals game the system , and in a sense, “teach to the test”

3. Doctors are offered perverse incentives to get rewarded

4. Vendors and consultants sell services to boost ratings that just perpetuate a faulty endeavor.

5. It creates a distraction from the real goal of getting better medical results at the expense of making patients happy.

6. The fact is that, in many instances, the patient does not know best. There are many preference sensitive conditions where shared decision making is necessary to agree on a treatment plan that fits with a patient’s beliefs or biases. However, in many instances, that is not the case and the patient trusts the doctor to treat them to the best of their knowledge and abilities. Medicine is an art. A small part  is based on science and probability.

7. Given how opaque medical care qualiity outcomes and pricing is, it is almost impossible for patients to judge quality of care. Instead they use non-quality value factors as a surrogate measure, like bedside manner. 

8. Tenure reviews, performance appraisals, promotion decisions and bonuses are  increasingly dependent on patient satisfaction surveys. Bosses have redefined “the good doctor”.

9. Qallity of service is not correlated to quality of care.

10. Given how doctors are recruited and trained, they are being held accountable for skills and attitudes that were not part of the job description  when they signed on. Few professionals can be all things to all clients.

All personal services businesses, whether they be lawyers, accountants, doctors or realtors assume not only the burden of quality of the deliverable to the customer, but also the responsibilty for marketing, customer service, personalized attention, “bedside manner” and alll the rest on the professional in question. 

For any one doctor to satisfy The Triple Aim is an unrealistic expectation and not consistent with how businesses become market leaders. Continuing to expect it just creates mischief. I’m sorry, but  the patient is not always right and, I’m sorry, but giving you antibiotiics for your cold or refilling your prescription because the doctor who originally recommended it does not answer their email  is not the right thing to do.