Deb Beaulieu

A friend of mine recently described a doctor's appointment in which he said he knew (before being told) that his condition was serious because the clinicians and staff were "really, really nice" to him. Their kindness was certainly appreciated, but what does it say, in the age of "patient experience," when gestures like sensitivity, thorough explanations or making phone calls on a patient's behalf lead patients to assume it can only mean they're on death's door?

It means that despite the study released this week revealing the dark side of "patient satisfaction," I'm sticking by everything I wrote about the topic last week or before.

While there may, in fact, be a correlation between patients who get a lot of attention from their physicians (which their satisfaction ratings show they appreciate), let's be clear that making patients happy doesn't cause their untimely death. Overtreatment, on the other hand, is bound to have consequences other than driving costs.

Nowhere in any patient satisfaction instruction I've read does anyone advise physicians to give patients everything they want (i.e., unnecessary tests, prescriptions or referrals), but it's not hard to see why this type of defensive decision-making may occur. Whenever a doctor says "no," he or she runs the risk of losing a patient to another who will say "yes."

And even if physicians understand the difference between customer service and medical decision-making, patients who complete satisfaction surveys may not recognize the distinction. As study authors indicated, when physicians' compensation is connected to satisfaction scores, it may be even tougher for doctors to make treatment decisions that may displease those  surveyed. But rather than giving up on asking patients for feedback, healthcare organizations might want to take this opportunity to take a hard look at the survey instruments they use to ensure they're written to assess the right things.

Meanwhile, the healthcare industry continues to work on ways to encourage physicians to make more evidence-based decisions. In theory, this means physicians will say "no" more often to discretionary care. At the same time, we can only hope that the system evolves to truly promote better coordination and communication among patients and providers rather than the path of least resistance. As with most things, strong communication can mean the difference between a patient being mildly disappointed versus being ticked off enough to leave a practice.

But while systems tinker with getting the incentives right, it's important to remember that, though it may not always feel like it, medicine is not a popularity contest. And at the end of the day, patients who think they know more about what treatments they need than those with medical degrees might be doing you a favor if they ultimately do find another doctor.

As for the rest of your patients, keep working on systems that make their interactions with your practice easier and more pleasant. Commit to constantly improving your service and communication skills. And for goodness sake, don't be afraid to show uncommon decency even when patients aren't all that ill. - Deb @PracticeMgt