Patient Satisfaction (1 Viewer)

[Terminalxylem]

To build upon the "Doing your own research" thread, I'll introduce a related topic: patient satisfaction.

Intuitively, it's important to advocate and be involved in shared decision making with one's healthcare provider. Presumably, this leads to an optimal patient:clinician relationship. As others have stated, doctors work for patients, not the other way around.

But how does patient satisfaction impact care? What makes patients satisfied?

An interesting study on this topic.

While most health care quality metrics assess care processes and health outcomes, patient experience or satisfaction is considered a complementary measure of health care quality. Patient satisfaction data may empower consumers to compare health plans and physicians, and both the Centers for Medicare & Medicaid Services and the National Committee on Quality Assurance require participating health plans to publicly report patient satisfaction data. Health plans use patient satisfaction surveys to evaluate physicians and to determine incentive compensation, and consumer-oriented Web sites often report patient satisfaction ratings as the sole physician comparator.

Satisfied patients are more adherent to physician recommendations and more loyal to physicians, but research suggests a tenuous link between patient satisfaction and health care quality and outcomes. Among a vulnerable older population, patient satisfaction had no association with the technical quality of geriatric care, and evidence suggests that satisfaction has little or no correlation with Health Plan Employer Data and Information Set quality metrics.

In addition, patients often request discretionary services that are of little or no medical benefit, and physicians frequently accede to these requests, which is associated with higher patient satisfaction. Physicians whose compensation is more strongly linked with patient satisfaction are more likely to deliver discretionary services, such as advanced imaging for acute low back pain.

Although benefits of discretionary care are by definition limited or absent, discretionary services may lead to iatrogenic harm via overtreatment, labeling, or other causal pathways. In a national Medicare sample, health care intensity varied widely among patients across US regions, despite similar illness burdens. Within 3 chronic illness cohorts, greater health care intensity was associated with increased patient satisfaction with some aspects of care but also with higher mortality and without improvement in the quality of care.Discretionary care has been similarly associated with added risks and costs in other studies.

The associations among patient satisfaction, health care intensity, and outcomes have not been studied within a national sample that includes adults of all ages. Therefore, we used Medical Expenditure Panel Survey (MEPS) data to assess the relationship between patient satisfaction and health care utilization, expenditures, and mortality in a nationally representative sample.

Results Adjusting for sociodemographics, insurance status, availability of a usual source of care, chronic disease burden, health status, and year 1 utilization and expenditures, respondents in the highest patient satisfaction quartile (relative to the lowest patient satisfaction quartile) had lower odds of any emergency department visit (adjusted odds ratio [aOR], 0.92; 95% CI, 0.84-1.00), higher odds of any inpatient admission (aOR, 1.12; 95% CI, 1.02-1.23), 8.8% (95% CI, 1.6%-16.6%) greater total expenditures, 9.1% (95% CI, 2.3%-16.4%) greater prescription drug expenditures, and higher mortality (adjusted hazard ratio, 1.26; 95% CI, 1.05-1.53).

Conclusion In a nationally representative sample, higher patient satisfaction was associated with less emergency department use but with greater inpatient use, higher overall health care and prescription drug expenditures, and increased mortality.

tl;dr In ~52K outpatients followed over a 4 year period, those with the highest healthcare satisfaction had greater total expenditures, were hospitalized more, and 26% more likely to die, in comparison to the least satisfied.

As an aside, the number of deaths in this study was relatively low, but the mortality difference was statistically significant, and aligns with other, related research findings.

Thoughts?

 

[Joe Bryant]

To build upon the "Doing your own research" thread, I'll introduce a related topic: patient satisfaction.

Intuitively, it's important to advocate and be involved in shared decision making with one's healthcare provider. Presumably, this leads to an optimal patient:clinician relationship. As others have stated, doctors work for patients, not the other way around.

But how does patient satisfaction impact care? What makes patients satisfied?

An interesting study on this topic.

While most health care quality metrics assess care processes and health outcomes, patient experience or satisfaction is considered a complementary measure of health care quality. Patient satisfaction data may empower consumers to compare health plans and physicians, and both the Centers for Medicare & Medicaid Services and the National Committee on Quality Assurance require participating health plans to publicly report patient satisfaction data. Health plans use patient satisfaction surveys to evaluate physicians and to determine incentive compensation, and consumer-oriented Web sites often report patient satisfaction ratings as the sole physician comparator.

Satisfied patients are more adherent to physician recommendations and more loyal to physicians, but research suggests a tenuous link between patient satisfaction and health care quality and outcomes. Among a vulnerable older population, patient satisfaction had no association with the technical quality of geriatric care, and evidence suggests that satisfaction has little or no correlation with Health Plan Employer Data and Information Set quality metrics.

In addition, patients often request discretionary services that are of little or no medical benefit, and physicians frequently accede to these requests, which is associated with higher patient satisfaction. Physicians whose compensation is more strongly linked with patient satisfaction are more likely to deliver discretionary services, such as advanced imaging for acute low back pain.

Although benefits of discretionary care are by definition limited or absent, discretionary services may lead to iatrogenic harm via overtreatment, labeling, or other causal pathways. In a national Medicare sample, health care intensity varied widely among patients across US regions, despite similar illness burdens. Within 3 chronic illness cohorts, greater health care intensity was associated with increased patient satisfaction with some aspects of care but also with higher mortality and without improvement in the quality of care.Discretionary care has been similarly associated with added risks and costs in other studies.

The associations among patient satisfaction, health care intensity, and outcomes have not been studied within a national sample that includes adults of all ages. Therefore, we used Medical Expenditure Panel Survey (MEPS) data to assess the relationship between patient satisfaction and health care utilization, expenditures, and mortality in a nationally representative sample.

Results Adjusting for sociodemographics, insurance status, availability of a usual source of care, chronic disease burden, health status, and year 1 utilization and expenditures, respondents in the highest patient satisfaction quartile (relative to the lowest patient satisfaction quartile) had lower odds of any emergency department visit (adjusted odds ratio [aOR], 0.92; 95% CI, 0.84-1.00), higher odds of any inpatient admission (aOR, 1.12; 95% CI, 1.02-1.23), 8.8% (95% CI, 1.6%-16.6%) greater total expenditures, 9.1% (95% CI, 2.3%-16.4%) greater prescription drug expenditures, and higher mortality (adjusted hazard ratio, 1.26; 95% CI, 1.05-1.53).

Conclusion In a nationally representative sample, higher patient satisfaction was associated with less emergency department use but with greater inpatient use, higher overall health care and prescription drug expenditures, and increased mortality.

tl;dr In ~52K outpatients followed over a 4 year period, those with the highest healthcare satisfaction had greater total expenditures, were hospitalized more, and 26% more likely to die, in comparison to the least satisfied.

As an aside, the number of deaths in this study was relatively low, but the mortality difference was statistically significant, and aligns with other, related research findings.

Thoughts?

Thanks. Am I right to think you're asking it seems odd that the most satisfied spent more and were more likely to die?

I'd agree that seems odd. But maybe it's one of those stats things where there's more to the story? Like people felt like they got great care after a serious (and expensive) surgery that was also dealing with a more life threatening issue?

 

[Pip's Invitation]

This is one reason why the drug and device companies advertise as aggressively as they do.

 

[fatness]

tl;dr In ~52K outpatients followed over a 4 year period, those with the highest healthcare satisfaction had greater total expenditures, were hospitalized more, and 26% more likely to die, in comparison to the least satisfied.

That sounds odd at first, but it may not be. Patients in the "more satisfied" group may be patients who are overall less healthy, making them more in need of health care and more thankful for the care they receive.

In other words, does their health lead to them being more satisfied, or does being more satisfied lead to worse health?

 

[The Longtime Lurker]

tl;dr In ~52K outpatients followed over a 4 year period, those with the highest healthcare satisfaction had greater total expenditures, were hospitalized more, and 26% more likely to die, in comparison to the least satisfied.

Sounds like the former were possibly less healthy with greater healthcare needs from the reported outcomes, more inclined to favor pharmaceutical/surgical treatment vs lifestyle modification due to poor health and happier to have long term intervention that gives relief?

Do healthier people that seek care for aging, unforseen illness, silent conditions that don't recover to 100% of their former selves, but don't need ongoing care take it out on healthcare with low satisfaction?

 

[D_House]

According to the OP, the authors accounted for the confounders below:

Adjusting for sociodemographics, insurance status, availability of a usual source of care, chronic disease burden, health status, and year 1 utilization and expenditures,

 

[Nipsey]

Here's a study that says patient satisfaction is associated with lower mortality rates in heart patients.

Another that says hospitals with higher patient satisfaction had significantly lower mortality rates.

 

[Ilov80s]

My dad worked his entire career in the hosptial system, eventually as a Food and Beverage director for several years at a very large city hospital. They did a lot of surveys/studies at the hospital. One thing that he said came up over and over was the patients most satisfied with their stay and least likely to seek litigation, complain, etc. were the ones who felt satisfied with their relationships/interactions with staff. From the doctor down to the food runner who brough their lunch, if they felt welcomed, heard and treated warmly than they were very likely to have a positive view of the experience even if their health wasn't improved during the stay. The biggest factor in wanting to sue, complain, etc. wasn't ineffective care but actually feeling like they were treated poorly, weren't listened to.

 

[Terminalxylem]

tl;dr In ~52K outpatients followed over a 4 year period, those with the highest healthcare satisfaction had greater total expenditures, were hospitalized more, and 26% more likely to die, in comparison to the least satisfied.

That sounds odd at first, but it may not be. Patients in the "more satisfied" group may be patients who are overall less healthy, making them more in need of health care and more thankful for the care they receive.

In other words, does their health lead to them being more satisfied, or does being more satisfied lead to worse health?

The study groups were similar in regard to major confounders.

Adjusting for sociodemographics, insurance status, availability of a usual source of care, chronic disease burden, health status, and year 1 utilization and expenditures, respondents in the highest patient satisfaction quartile (relative to the lowest patient satisfaction quartile) had lower odds of any emergency department visit (adjusted odds ratio [aOR], 0.92; 95% CI, 0.84-1.00), higher odds of any inpatient admission (aOR, 1.12; 95% CI, 1.02-1.23), 8.8% (95% CI, 1.6%-16.6%) greater total expenditures, 9.1% (95% CI, 2.3%-16.4%) greater prescription drug expenditures, and higher mortality (adjusted hazard ratio, 1.26; 95% CI, 1.05-1.53).

ETA Thanks @D_House

 

[Terminalxylem]

In addition, patients often request discretionary services that are of little or no medical benefit, and physicians frequently accede to these requests, which is associated with higher patient satisfaction. Physicians whose compensation is more strongly linked with patient satisfaction are more likely to deliver discretionary services, such as advanced imaging for acute low back pain.

Although benefits of discretionary care are by definition limited or absent, discretionary services may lead to iatrogenic harm via overtreatment, labeling, or other causal pathways.

Yes, it is counterintuitive. The bolded may suggest part of the mechanism, per the study investigators. I’m sure there’s a lot more to it, but this is one (of many) problems associated with treating medicine like other businesses, imo.

I’ve mentioned this phenomenon repeatedly, in threads where people talk about frustrations not getting the tests/treatment they want, or conversely, satisfaction with “VIP care.”

 

[Terminalxylem]

Here's a study that says patient satisfaction is associated with lower mortality rates in heart patients.

Another that says hospitals with higher patient satisfaction had significantly lower mortality rates.

Thanks, but those studies are making a different point entirely.

The study I posted looked at outpatients screened prospectively over several years, recording their satisfaction scores over time, relative to healthcare utilization and mortality.

The heart study looked at patients hospitalized for acute heat attacks, and correlated inpatient satisfaction to survival. The second study is similar, looking at patients hospitalized for surgery. Among other outcomes, the most satisfied patients died less.

So, being satisfied with the care you receive for an acute, serious illness is good, as is being pleased after surgery. But liking the relationship with your outpatient doctors may not be.

This begs chicken-or-the-egg questions, as well as suggesting pleasing patients, as customers, may not always be right. And we may be providing healthcare of dubious benefit.

 

[Chaos34]

how'd they poll dead people?

 

[Nipsey]

Here's a study that says patient satisfaction is associated with lower mortality rates in heart patients.

Another that says hospitals with higher patient satisfaction had significantly lower mortality rates.

Thanks, but those studies are making a different point entirely.

The study I posted looked at outpatients screened prospectively over several years, recording their satisfaction scores over time, relative to healthcare utilization and mortality.

The heart study looked at patients hospitalized for acute heat attacks, and correlated inpatient satisfaction to survival. The second study is similar, looking at patients hospitalized for surgery. Among other outcomes, the most satisfied patients died less.

So, being satisfied with the care you receive for an acute, serious illness is good, as is being pleased after surgery. But liking the relationship with your outpatient doctors may not be.

This begs chicken-or-the-egg questions, as well as suggesting pleasing patients, as customers, may not always be right. And we may be providing healthcare of dubious benefit.

Fair point about outpatient versus hospitalization but at the end of the day all three studies focus on patient satisfaction. To me it seems like you’re choosing to highlight one narrow, selective study because it backs up your narrative from the other thread.

 

[Terminalxylem]

My dad worked his entire career in the hosptial system, eventually as a Food and Beverage director for several years at a very large city hospital. They did a lot of surveys/studies at the hospital. One thing that he said came up over and over was the patients most satisfied with their stay and least likely to seek litigation, complain, etc. were the ones who felt satisfied with their relationships/interactions with staff. From the doctor down to the food runner who brough their lunch, if they felt welcomed, heard and treated warmly than they were very likely to have a positive view of the experience even if their health wasn't improved during the stay. The biggest factor in wanting to sue, complain, etc. wasn't ineffective care but actually feeling like they were treated poorly, weren't listened to.

Yes, litigation risk is one reason (among several) hospitals have pushed patient satisfaction as a quality metric. It's catering to patients as "customers". And of course patient satisfaction is important, but unclear if it drives better outcomes in all settings, and increases healthcare utilization.

 

[Terminalxylem]

Here's a study that says patient satisfaction is associated with lower mortality rates in heart patients.

Another that says hospitals with higher patient satisfaction had significantly lower mortality rates.

Thanks, but those studies are making a different point entirely.

The study I posted looked at outpatients screened prospectively over several years, recording their satisfaction scores over time, relative to healthcare utilization and mortality.

The heart study looked at patients hospitalized for acute heat attacks, and correlated inpatient satisfaction to survival. The second study is similar, looking at patients hospitalized for surgery. Among other outcomes, the most satisfied patients died less.

So, being satisfied with the care you receive for an acute, serious illness is good, as is being pleased after surgery. But liking the relationship with your outpatient doctors may not be.

This begs chicken-or-the-egg questions, as well as suggesting pleasing patients, as customers, may not always be right. And we may be providing healthcare of dubious benefit.

Fair point about outpatient versus hospitalization but at the end of the day all three studies focus on patient satisfaction. To me it seems like you’re choosing to highlight one narrow, selective study because it backs up your narrative from the other thread.

No, I think the difference is critically important. Details and study design matter, which underscores the need to scrutinize research data carefully.

In this instance, I'll argue my study is far more generalizable, with better design to investigate the relationship between patient satisfaction and future outcomes.

 

[Terminalxylem]

how'd they poll dead people?

Survivorship bias definitely applies, but is a bigger problem in retrospective chart reviews, versus prospective studies, like the one I cited.

 

[Peggy]

Here's a study that says patient satisfaction is associated with lower mortality rates in heart patients.

Another that says hospitals with higher patient satisfaction had significantly lower mortality rates.

Thanks, but those studies are making a different point entirely.

The study I posted looked at outpatients screened prospectively over several years, recording their satisfaction scores over time, relative to healthcare utilization and mortality.

The heart study looked at patients hospitalized for acute heat attacks, and correlated inpatient satisfaction to survival. The second study is similar, looking at patients hospitalized for surgery. Among other outcomes, the most satisfied patients died less.

So, being satisfied with the care you receive for an acute, serious illness is good, as is being pleased after surgery. But liking the relationship with your outpatient doctors may not be.

This begs chicken-or-the-egg questions, as well as suggesting pleasing patients, as customers, may not always be right. And we may be providing healthcare of dubious benefit.

Fair point about outpatient versus hospitalization but at the end of the day all three studies focus on patient satisfaction. To me it seems like you’re choosing to highlight one narrow, selective study because it backs up your narrative from the other thread.

Abandoned thread when it doesn't go your way, then try again.

 

[Nipsey]

Here's a study that says patient satisfaction is associated with lower mortality rates in heart patients.

Another that says hospitals with higher patient satisfaction had significantly lower mortality rates.

Thanks, but those studies are making a different point entirely.

The study I posted looked at outpatients screened prospectively over several years, recording their satisfaction scores over time, relative to healthcare utilization and mortality.

The heart study looked at patients hospitalized for acute heat attacks, and correlated inpatient satisfaction to survival. The second study is similar, looking at patients hospitalized for surgery. Among other outcomes, the most satisfied patients died less.

So, being satisfied with the care you receive for an acute, serious illness is good, as is being pleased after surgery. But liking the relationship with your outpatient doctors may not be.

This begs chicken-or-the-egg questions, as well as suggesting pleasing patients, as customers, may not always be right. And we may be providing healthcare of dubious benefit.

Fair point about outpatient versus hospitalization but at the end of the day all three studies focus on patient satisfaction. To me it seems like you’re choosing to highlight one narrow, selective study because it backs up your narrative from the other thread.

No, I think the difference is critically important. Details and study design matter, which underscores the need to scrutinize research data carefully.

In this instance, I'll argue my study is far more generalizable, with better design to investigate the relationship between patient satisfaction and future outcomes.

Study design matters but it still feels like you’re using one narrow example to push a broader point.

 

[Terminalxylem]

Here's a study that says patient satisfaction is associated with lower mortality rates in heart patients.

Another that says hospitals with higher patient satisfaction had significantly lower mortality rates.

Thanks, but those studies are making a different point entirely.

The study I posted looked at outpatients screened prospectively over several years, recording their satisfaction scores over time, relative to healthcare utilization and mortality.

The heart study looked at patients hospitalized for acute heat attacks, and correlated inpatient satisfaction to survival. The second study is similar, looking at patients hospitalized for surgery. Among other outcomes, the most satisfied patients died less.

So, being satisfied with the care you receive for an acute, serious illness is good, as is being pleased after surgery. But liking the relationship with your outpatient doctors may not be.

This begs chicken-or-the-egg questions, as well as suggesting pleasing patients, as customers, may not always be right. And we may be providing healthcare of dubious benefit.

Fair point about outpatient versus hospitalization but at the end of the day all three studies focus on patient satisfaction. To me it seems like you’re choosing to highlight one narrow, selective study because it backs up your narrative from the other thread.

Abandoned thread when it doesn't go your way, then try again.

I'm not sure why you've adopted this hostility, but I'd appreciate it if you'd stay on topic.

I left the other thread because I thought my commentary was distracting productive discussion.

 

[Peggy]

Here's a study that says patient satisfaction is associated with lower mortality rates in heart patients.

Another that says hospitals with higher patient satisfaction had significantly lower mortality rates.

Thanks, but those studies are making a different point entirely.

The study I posted looked at outpatients screened prospectively over several years, recording their satisfaction scores over time, relative to healthcare utilization and mortality.

The heart study looked at patients hospitalized for acute heat attacks, and correlated inpatient satisfaction to survival. The second study is similar, looking at patients hospitalized for surgery. Among other outcomes, the most satisfied patients died less.

So, being satisfied with the care you receive for an acute, serious illness is good, as is being pleased after surgery. But liking the relationship with your outpatient doctors may not be.

This begs chicken-or-the-egg questions, as well as suggesting pleasing patients, as customers, may not always be right. And we may be providing healthcare of dubious benefit.

Fair point about outpatient versus hospitalization but at the end of the day all three studies focus on patient satisfaction. To me it seems like you’re choosing to highlight one narrow, selective study because it backs up your narrative from the other thread.

Abandoned thread when it doesn't go your way, then try again.

I'm not sure why you've adopted this hostility, but I'd appreciate it if you'd stay on topic.

I left the other thread because I thought my commentary was distracting productive discussion.

Doubling down probably not the right choice here. Just IMHO

 

[Terminalxylem]

Here's a study that says patient satisfaction is associated with lower mortality rates in heart patients.

Another that says hospitals with higher patient satisfaction had significantly lower mortality rates.

Thanks, but those studies are making a different point entirely.

The study I posted looked at outpatients screened prospectively over several years, recording their satisfaction scores over time, relative to healthcare utilization and mortality.

The heart study looked at patients hospitalized for acute heat attacks, and correlated inpatient satisfaction to survival. The second study is similar, looking at patients hospitalized for surgery. Among other outcomes, the most satisfied patients died less.

So, being satisfied with the care you receive for an acute, serious illness is good, as is being pleased after surgery. But liking the relationship with your outpatient doctors may not be.

This begs chicken-or-the-egg questions, as well as suggesting pleasing patients, as customers, may not always be right. And we may be providing healthcare of dubious benefit.

Fair point about outpatient versus hospitalization but at the end of the day all three studies focus on patient satisfaction. To me it seems like you’re choosing to highlight one narrow, selective study because it backs up your narrative from the other thread.

No, I think the difference is critically important. Details and study design matter, which underscores the need to scrutinize research data carefully.

In this instance, I'll argue my study is far more generalizable, with better design to investigate the relationship between patient satisfaction and future outcomes.

Study design matters but it still feels like you’re using one narrow example to push a broader point.

Words like "narrative" and "push" imply I'm not posting in good faith.

I'm open to discussing your concerns with the study designs, or other, supporting literature, but I'm curious how you think my study is narrow? What makes those you linked more generalizable?

Prior to the other thread, I've been consistent in my stance on unnecessary testing, including things like routine physicals, yearly bloodwork, MRIs for low back pain, etc. This study builds upon those concerns, which all impact patient satisfaction.

 

[Terminalxylem]

Here's a study that says patient satisfaction is associated with lower mortality rates in heart patients.

Another that says hospitals with higher patient satisfaction had significantly lower mortality rates.

Thanks, but those studies are making a different point entirely.

The study I posted looked at outpatients screened prospectively over several years, recording their satisfaction scores over time, relative to healthcare utilization and mortality.

The heart study looked at patients hospitalized for acute heat attacks, and correlated inpatient satisfaction to survival. The second study is similar, looking at patients hospitalized for surgery. Among other outcomes, the most satisfied patients died less.

So, being satisfied with the care you receive for an acute, serious illness is good, as is being pleased after surgery. But liking the relationship with your outpatient doctors may not be.

This begs chicken-or-the-egg questions, as well as suggesting pleasing patients, as customers, may not always be right. And we may be providing healthcare of dubious benefit.

Fair point about outpatient versus hospitalization but at the end of the day all three studies focus on patient satisfaction. To me it seems like you’re choosing to highlight one narrow, selective study because it backs up your narrative from the other thread.

Abandoned thread when it doesn't go your way, then try again.

I'm not sure why you've adopted this hostility, but I'd appreciate it if you'd stay on topic.

I left the other thread because I thought my commentary was distracting productive discussion.

Doubling down probably not the right choice here. Just IMHO

I think this is the part where I suggest you have a nice season?

 

[Peggy]

Here's a study that says patient satisfaction is associated with lower mortality rates in heart patients.

Another that says hospitals with higher patient satisfaction had significantly lower mortality rates.

Thanks, but those studies are making a different point entirely.

The study I posted looked at outpatients screened prospectively over several years, recording their satisfaction scores over time, relative to healthcare utilization and mortality.

The heart study looked at patients hospitalized for acute heat attacks, and correlated inpatient satisfaction to survival. The second study is similar, looking at patients hospitalized for surgery. Among other outcomes, the most satisfied patients died less.

So, being satisfied with the care you receive for an acute, serious illness is good, as is being pleased after surgery. But liking the relationship with your outpatient doctors may not be.

This begs chicken-or-the-egg questions, as well as suggesting pleasing patients, as customers, may not always be right. And we may be providing healthcare of dubious benefit.

Fair point about outpatient versus hospitalization but at the end of the day all three studies focus on patient satisfaction. To me it seems like you’re choosing to highlight one narrow, selective study because it backs up your narrative from the other thread.

Abandoned thread when it doesn't go your way, then try again.

I'm not sure why you've adopted this hostility, but I'd appreciate it if you'd stay on topic.

I left the other thread because I thought my commentary was distracting productive discussion.

Doubling down probably not the right choice here. Just IMHO

I think this is the part where I suggest you have a nice season?

There were a number of things you could have clarified or responded to in the other thread but chose not to. Now you're taking a different angle. Seems like pounding a square peg trough a round hole to me is all.

 

[Nipsey]

Here's a study that says patient satisfaction is associated with lower mortality rates in heart patients.

Another that says hospitals with higher patient satisfaction had significantly lower mortality rates.

Thanks, but those studies are making a different point entirely.

The study I posted looked at outpatients screened prospectively over several years, recording their satisfaction scores over time, relative to healthcare utilization and mortality.

The heart study looked at patients hospitalized for acute heat attacks, and correlated inpatient satisfaction to survival. The second study is similar, looking at patients hospitalized for surgery. Among other outcomes, the most satisfied patients died less.

So, being satisfied with the care you receive for an acute, serious illness is good, as is being pleased after surgery. But liking the relationship with your outpatient doctors may not be.

This begs chicken-or-the-egg questions, as well as suggesting pleasing patients, as customers, may not always be right. And we may be providing healthcare of dubious benefit.

Fair point about outpatient versus hospitalization but at the end of the day all three studies focus on patient satisfaction. To me it seems like you’re choosing to highlight one narrow, selective study because it backs up your narrative from the other thread.

No, I think the difference is critically important. Details and study design matter, which underscores the need to scrutinize research data carefully.

In this instance, I'll argue my study is far more generalizable, with better design to investigate the relationship between patient satisfaction and future outcomes.

Study design matters but it still feels like you’re using one narrow example to push a broader point.

Words like "narrative" and "push" imply I'm not posting in good faith.

I'm open to discussing your concerns with the study designs, or other, supporting literature, but I'm curious how you think my study is narrow? What makes those you linked more generalizable?

Prior to the other thread, I've been consistent in my stance on unnecessary testing, including things like routine physicals, yearly bloodwork, MRIs for low back pain, etc. This study builds upon those concerns, which all impact patient satisfaction.

You say you're posting in good faith but when you post a single, selective study that fits neatly with your stance from the other thread, it’s hard not to see it as reinforcing a narrative.

 

[Terminalxylem]

Here's a study that says patient satisfaction is associated with lower mortality rates in heart patients.

Another that says hospitals with higher patient satisfaction had significantly lower mortality rates.

Thanks, but those studies are making a different point entirely.

The study I posted looked at outpatients screened prospectively over several years, recording their satisfaction scores over time, relative to healthcare utilization and mortality.

The heart study looked at patients hospitalized for acute heat attacks, and correlated inpatient satisfaction to survival. The second study is similar, looking at patients hospitalized for surgery. Among other outcomes, the most satisfied patients died less.

So, being satisfied with the care you receive for an acute, serious illness is good, as is being pleased after surgery. But liking the relationship with your outpatient doctors may not be.

This begs chicken-or-the-egg questions, as well as suggesting pleasing patients, as customers, may not always be right. And we may be providing healthcare of dubious benefit.

Fair point about outpatient versus hospitalization but at the end of the day all three studies focus on patient satisfaction. To me it seems like you’re choosing to highlight one narrow, selective study because it backs up your narrative from the other thread.

No, I think the difference is critically important. Details and study design matter, which underscores the need to scrutinize research data carefully.

In this instance, I'll argue my study is far more generalizable, with better design to investigate the relationship between patient satisfaction and future outcomes.

Study design matters but it still feels like you’re using one narrow example to push a broader point.

Words like "narrative" and "push" imply I'm not posting in good faith.

I'm open to discussing your concerns with the study designs, or other, supporting literature, but I'm curious how you think my study is narrow? What makes those you linked more generalizable?

Prior to the other thread, I've been consistent in my stance on unnecessary testing, including things like routine physicals, yearly bloodwork, MRIs for low back pain, etc. This study builds upon those concerns, which all impact patient satisfaction.

You say you're posting in good faith but when you post a single, selective study that fits neatly with your stance from the other thread, it’s hard not to see it as reinforcing a narrative.

As I said, I've been consistent in my stance, even prior to that thread. Why? Because there are multiple studies on the subject.

I've shared my critique of the two links you posted, and can certainly offer other supporting literature, if you think that would be productive. But first, it would be helpful to understand your concerns with the study in the OP - care to elaborate?

Alternatively, when you find studies with seemingly opposite conclusions, how do you decide which is accurate/applicable to your understanding, and how does that influence behavior?

 

[Terminalxylem]

Here's a study that says patient satisfaction is associated with lower mortality rates in heart patients.

Another that says hospitals with higher patient satisfaction had significantly lower mortality rates.

Thanks, but those studies are making a different point entirely.

The study I posted looked at outpatients screened prospectively over several years, recording their satisfaction scores over time, relative to healthcare utilization and mortality.

The heart study looked at patients hospitalized for acute heat attacks, and correlated inpatient satisfaction to survival. The second study is similar, looking at patients hospitalized for surgery. Among other outcomes, the most satisfied patients died less.

So, being satisfied with the care you receive for an acute, serious illness is good, as is being pleased after surgery. But liking the relationship with your outpatient doctors may not be.

This begs chicken-or-the-egg questions, as well as suggesting pleasing patients, as customers, may not always be right. And we may be providing healthcare of dubious benefit.

Fair point about outpatient versus hospitalization but at the end of the day all three studies focus on patient satisfaction. To me it seems like you’re choosing to highlight one narrow, selective study because it backs up your narrative from the other thread.

Abandoned thread when it doesn't go your way, then try again.

I'm not sure why you've adopted this hostility, but I'd appreciate it if you'd stay on topic.

I left the other thread because I thought my commentary was distracting productive discussion.

Doubling down probably not the right choice here. Just IMHO

**** post.

This place is usually good for civil disagreement, and I’ve not recognized that poster as a “troll” before. Didn’t expect such heated responses.

 

[Peggy]

Here's a study that says patient satisfaction is associated with lower mortality rates in heart patients.

Another that says hospitals with higher patient satisfaction had significantly lower mortality rates.

Thanks, but those studies are making a different point entirely.

The study I posted looked at outpatients screened prospectively over several years, recording their satisfaction scores over time, relative to healthcare utilization and mortality.

The heart study looked at patients hospitalized for acute heat attacks, and correlated inpatient satisfaction to survival. The second study is similar, looking at patients hospitalized for surgery. Among other outcomes, the most satisfied patients died less.

So, being satisfied with the care you receive for an acute, serious illness is good, as is being pleased after surgery. But liking the relationship with your outpatient doctors may not be.

This begs chicken-or-the-egg questions, as well as suggesting pleasing patients, as customers, may not always be right. And we may be providing healthcare of dubious benefit.

Fair point about outpatient versus hospitalization but at the end of the day all three studies focus on patient satisfaction. To me it seems like you’re choosing to highlight one narrow, selective study because it backs up your narrative from the other thread.

Abandoned thread when it doesn't go your way, then try again.

I'm not sure why you've adopted this hostility, but I'd appreciate it if you'd stay on topic.

I left the other thread because I thought my commentary was distracting productive discussion.

Doubling down probably not the right choice here. Just IMHO

**** post.

This place is usually good for civil disagreement, and I’ve not recognized that poster as a “troll” before. Didn’t expect such heated responses.

There were a number of things you could have clarified or responded to in the other thread but chose not to. Now you're taking a different angle. Seems like pounding a square peg trough a round hole to me is all.

 

[Ilov80s]

My dad worked his entire career in the hosptial system, eventually as a Food and Beverage director for several years at a very large city hospital. They did a lot of surveys/studies at the hospital. One thing that he said came up over and over was the patients most satisfied with their stay and least likely to seek litigation, complain, etc. were the ones who felt satisfied with their relationships/interactions with staff. From the doctor down to the food runner who brough their lunch, if they felt welcomed, heard and treated warmly than they were very likely to have a positive view of the experience even if their health wasn't improved during the stay. The biggest factor in wanting to sue, complain, etc. wasn't ineffective care but actually feeling like they were treated poorly, weren't listened to.

Yes, litigation risk is one reason (among several) hospitals have pushed patient satisfaction as a quality metric. It's catering to patients as "customers". And of course patient satisfaction is important, but unclear if it drives better outcomes in all settings, and increases healthcare utilization.

It is a lesson that stuck with me for my teaching career. All of public K-12 ed has learned this lesson as well although I promise it doesn't lead to better educational outcomes, it does lead to happier parents.

 

[Tecumseh]

In addition, patients often request discretionary services that are of little or no medical benefit, and physicians frequently accede to these requests, which is associated with higher patient satisfaction. Physicians whose compensation is more strongly linked with patient satisfaction are more likely to deliver discretionary services, such as advanced imaging for acute low back pain.

Although benefits of discretionary care are by definition limited or absent, discretionary services may lead to iatrogenic harm via overtreatment, labeling, or other causal pathways.

Yes, it is counterintuitive. The bolded may suggest part of the mechanism, per the study investigators. I’m sure there’s a lot more to it, but this is one (of many) problems associated with treating medicine like other businesses, imo.

I’ve mentioned this phenomenon repeatedly, in threads where people talk about frustrations not getting the tests/treatment they want, or conversely, satisfaction with “VIP care.”

In my experience, this is the equivalent of our patients giving our docs negative scores because they won’t prescribe Fen/Ben and ivermectin for cancer. It happens a lot.

 

[Alex P Keaton]

To build upon the "Doing your own research" thread, I'll introduce a related topic: patient satisfaction.

Intuitively, it's important to advocate and be involved in shared decision making with one's healthcare provider. Presumably, this leads to an optimal patient:clinician relationship. As others have stated, doctors work for patients, not the other way around.

But how does patient satisfaction impact care? What makes patients satisfied?

An interesting study on this topic.

While most health care quality metrics assess care processes and health outcomes, patient experience or satisfaction is considered a complementary measure of health care quality. Patient satisfaction data may empower consumers to compare health plans and physicians, and both the Centers for Medicare & Medicaid Services and the National Committee on Quality Assurance require participating health plans to publicly report patient satisfaction data. Health plans use patient satisfaction surveys to evaluate physicians and to determine incentive compensation, and consumer-oriented Web sites often report patient satisfaction ratings as the sole physician comparator.

Satisfied patients are more adherent to physician recommendations and more loyal to physicians, but research suggests a tenuous link between patient satisfaction and health care quality and outcomes. Among a vulnerable older population, patient satisfaction had no association with the technical quality of geriatric care, and evidence suggests that satisfaction has little or no correlation with Health Plan Employer Data and Information Set quality metrics.

In addition, patients often request discretionary services that are of little or no medical benefit, and physicians frequently accede to these requests, which is associated with higher patient satisfaction. Physicians whose compensation is more strongly linked with patient satisfaction are more likely to deliver discretionary services, such as advanced imaging for acute low back pain.

Although benefits of discretionary care are by definition limited or absent, discretionary services may lead to iatrogenic harm via overtreatment, labeling, or other causal pathways. In a national Medicare sample, health care intensity varied widely among patients across US regions, despite similar illness burdens. Within 3 chronic illness cohorts, greater health care intensity was associated with increased patient satisfaction with some aspects of care but also with higher mortality and without improvement in the quality of care.Discretionary care has been similarly associated with added risks and costs in other studies.

The associations among patient satisfaction, health care intensity, and outcomes have not been studied within a national sample that includes adults of all ages. Therefore, we used Medical Expenditure Panel Survey (MEPS) data to assess the relationship between patient satisfaction and health care utilization, expenditures, and mortality in a nationally representative sample.

Results Adjusting for sociodemographics, insurance status, availability of a usual source of care, chronic disease burden, health status, and year 1 utilization and expenditures, respondents in the highest patient satisfaction quartile (relative to the lowest patient satisfaction quartile) had lower odds of any emergency department visit (adjusted odds ratio [aOR], 0.92; 95% CI, 0.84-1.00), higher odds of any inpatient admission (aOR, 1.12; 95% CI, 1.02-1.23), 8.8% (95% CI, 1.6%-16.6%) greater total expenditures, 9.1% (95% CI, 2.3%-16.4%) greater prescription drug expenditures, and higher mortality (adjusted hazard ratio, 1.26; 95% CI, 1.05-1.53).

Conclusion In a nationally representative sample, higher patient satisfaction was associated with less emergency department use but with greater inpatient use, higher overall health care and prescription drug expenditures, and increased mortality.

tl;dr In ~52K outpatients followed over a 4 year period, those with the highest healthcare satisfaction had greater total expenditures, were hospitalized more, and 26% more likely to die, in comparison to the least satisfied.

As an aside, the number of deaths in this study was relatively low, but the mortality difference was statistically significant, and aligns with other, related research findings.

Thoughts?

I’m visiting my aging parents this weekend, and my father was telling a story that reminded me of this topic.

About 15-16 years ago my dad quit smoking at the direction of his physician. My dad tried quitting many times before but couldn’t. His doc was kind of aggressive about telling him to quit — in an appropriate way. Pops grudgingly quit but was really annoyed with his doctor.

Fast forward, 12 years ago my dad had a mild heart attack. He survived the heart attack and had very few consequences from it. When he met with his doctor a few weeks later he said “doc, you told me to quit smoking and I did, but I still had a heart attack anyway! Why did I listen to you?” And his doctor (who is very “Wisconsin”) said to him “yeah, you had a heart attack. But you didn’t die did you? So what’s your problem? Shut up and be happy you’re alive.”

If the doc had focused purely on his patient’s satisfaction, his patient probably would be dead. I’m glad the doc did the right thing, and I send him a thank you card every year on my dad’s birthday.

 

[jm192]

I try not to put a lot of worry into this. You can't "win." Content people don't fill out surveys. Angry people bury you on them. Extremely happy people build you back up on them. If 90+% of my patients are content: they're not the ones filling out surveys.

In general, I try to be polite and professional. I sit down with people and try to repeat things back so they know I'm listening/hearing them. I try to do what people want within reason. I try to explain why I think it's not always the right move if I disagree with it. But I'll still do it if it's not just egregious.

Most of my negative surveys are for not meeting some ridiculous ask.

I had a guy drive from an hour away to get Pain killers. He had been fired from 4 or 5 other clinics for abusing pain killers. He was verbally abusive to those clinics when they cut him off. So he drove an hour and proceeded to tell me off because I also wouldn't do what he wanted/felt like he needed.

I had a 25 year old that was sick with covid-19. She had several vague "I just don't feel good symptoms." Her biggest hang up was her blood pressure of 125/68. To be honest, if you're sick--I wouldn't really stress about your blood pressure being a little on the high side. But to so...normal...It didn't even register to me. She told me that her normal was 95-100 on the top number, and that I needed to do something or she would have a cardiac event. I calmly and politely explained that's not how it works. She told me I didn't know her body like she did. She demanded an answer to why her blood pressure was running higher and "You're sick" wasn't cutting it. I spent 25 or 30 minutes talking to this girl about her covid-19 symptoms and her normal blood pressure.

Terrible review. I'm just a mean heartless doctor. I completely dismissed her. 0/10 would not recommend to anyone. She later came back and saw my physician partner. Blood pressure back down, no cardiac events. Everything I told her was correct, she just...didn't want that answer.

 

[Terminalxylem]

What’s most interesting to me is the contrast between what patients want/think is good for their health, versus what the data actually shows.

I can understand distrust, and even a little contempt for authority, along with suspicion for secondary gain. These feelings are compounded by the trope of egomaniacal, dismissive doctors with god-complexes, churning patients to ensure early tee times. And alt medicine capitalizes on it.

But even if you have the critical thinking skills and scientific background, it’s reaalllly hard to know what you don’t know. And it’s not just because the information is complex; it’s evolving.

Doctors are humans, so of course they’re fallible, and there are bad apples. Still, training and experience have to count for something.

Lastly, I’ll mention how important delivery is to optimize the message. I was shocked how quickly the other thread went off the rails, largely due to my word choice. No amount of reason or evidence can overcome an unreceptive listener.

 

[Peggy]

What’s most interesting to me is the contrast between what patients want/think is good for their health, versus what the data actually shows.

I can understand distrust, and even a little contempt for authority, along with suspicion for secondary gain. These feelings are compounded by the trope of egomaniacal, dismissive doctors with god-complexes, churning patients to ensure early tee times. And alt medicine capitalizes on it.

But even if you have the critical thinking skills and scientific background, it’s reaalllly hard to know what you don’t know. And it’s not just because the information is complex; it’s evolving.

Doctors are humans, so of course they’re fallible, and there are bad apples. Still, training and experience have to count for something.

Lastly, I’ll mention how important delivery is to optimize the message. I was shocked how quickly the other thread went off the rails, largely due to my word choice. No amount of reason or evidence can overcome an unreceptive listener.

First sentence: Yeah we know.

Last sentence: This is a pattern with you, you start to take some responsibility (poor word choice) but before you can finish your thought it's someone else's problem (unreceptive listeners).

 

[Sparky Polastri]

What’s most interesting to me is the contrast between what patients want/think is good for their health, versus what the data actually shows.

I can understand distrust, and even a little contempt for authority, along with suspicion for secondary gain. These feelings are compounded by the trope of egomaniacal, dismissive doctors with god-complexes, churning patients to ensure early tee times. And alt medicine capitalizes on it.

But even if you have the critical thinking skills and scientific background, it’s reaalllly hard to know what you don’t know. And it’s not just because the information is complex; it’s evolving.

Doctors are humans, so of course they’re fallible, and there are bad apples. Still, training and experience have to count for something.

Lastly, I’ll mention how important delivery is to optimize the message. I was shocked how quickly the other thread went off the rails, largely due to my word choice. No amount of reason or evidence can overcome an unreceptive listener.

Not sure why you're surprised GB. Mis/disinformation is more readily available than anything. It travels fast. Throw on top of that, the research and data is collected and reported with other scientists in mind. The target audience isn't your average Joe Schmoo. Most don't have the capacity to process things in that form IF they even know where to go to find the studies and research.

BTW, your word choice isnt the problem in that other thread.

 

[rockaction]

Not sure whether to talk about Guns N’ Roses or the Stones here.

 

[Terminalxylem]

What’s most interesting to me is the contrast between what patients want/think is good for their health, versus what the data actually shows.

I can understand distrust, and even a little contempt for authority, along with suspicion for secondary gain. These feelings are compounded by the trope of egomaniacal, dismissive doctors with god-complexes, churning patients to ensure early tee times. And alt medicine capitalizes on it.

But even if you have the critical thinking skills and scientific background, it’s reaalllly hard to know what you don’t know. And it’s not just because the information is complex; it’s evolving.

Doctors are humans, so of course they’re fallible, and there are bad apples. Still, training and experience have to count for something.

Lastly, I’ll mention how important delivery is to optimize the message. I was shocked how quickly the other thread went off the rails, largely due to my word choice. No amount of reason or evidence can overcome an unreceptive listener.

Not sure why you're surprised GB. Mis/disinformation is more readily available than anything. It travels fast. Throw on top of that, the research and data is collected and reported with other scientists in mind. The target audience isn't your average Joe Schmoo. Most don't have the capacity to process things in that form IF they even know where to go to find the studies and research.

BTW, your word choice isnt the problem in that other thread.

Yeah, covid taught me it’s impossible to reason your way through a never ending deluge of BS. Easier just to avoid some topics altogether. But that’s not a recipe for effective healthcare.

And even if I know what I meant (why would I lie?) and tried to clarify intent, unsuccessfully, the delivery poisoned the well. Of course there are some who would object regardless, but a good communicator should judge his audience better. Lesson learned.

 

[Terminalxylem]

Not sure whether to talk about Guns N’ Roses or the Stones here.

Welcome to the jungle, you’ll get no satisfaction here. Even the most patient patients.

 

[Terminalxylem]

What’s most interesting to me is the contrast between what patients want/think is good for their health, versus what the data actually shows.

I can understand distrust, and even a little contempt for authority, along with suspicion for secondary gain. These feelings are compounded by the trope of egomaniacal, dismissive doctors with god-complexes, churning patients to ensure early tee times. And alt medicine capitalizes on it.

But even if you have the critical thinking skills and scientific background, it’s reaalllly hard to know what you don’t know. And it’s not just because the information is complex; it’s evolving.

Doctors are humans, so of course they’re fallible, and there are bad apples. Still, training and experience have to count for something.

Lastly, I’ll mention how important delivery is to optimize the message. I was shocked how quickly the other thread went off the rails, largely due to my word choice. No amount of reason or evidence can overcome an unreceptive listener.

Not sure why you're surprised GB. Mis/disinformation is more readily available than anything. It travels fast. Throw on top of that, the research and data is collected and reported with other scientists in mind. The target audience isn't your average Joe Schmoo. Most don't have the capacity to process things in that form IF they even know where to go to find the studies and research.

BTW, your word choice isnt the problem in that other thread.

Thinking about it, a lot of mis/disinformation IS packaged for Joe Schmo, using logical fallacies like the appeal to nature, and advertising psychology to harness emotion versus the "scientific industrial complex". Sure, they may cite some quasi-legitimate study, knowing most people won't/can't scrutinize the methodology, or ascertain the weight of evidence.

Even in this thread, several responses reflect our tendency to skip to the tl;dr summaries. I mean, who has the time to read a screenful of text? Easier to trust the short form AI summary, especially if it feeds confirmation bias.

Upon reflection, I shouldn't be surprised at all.

 

[Sparky Polastri]

What’s most interesting to me is the contrast between what patients want/think is good for their health, versus what the data actually shows.

I can understand distrust, and even a little contempt for authority, along with suspicion for secondary gain. These feelings are compounded by the trope of egomaniacal, dismissive doctors with god-complexes, churning patients to ensure early tee times. And alt medicine capitalizes on it.

But even if you have the critical thinking skills and scientific background, it’s reaalllly hard to know what you don’t know. And it’s not just because the information is complex; it’s evolving.

Doctors are humans, so of course they’re fallible, and there are bad apples. Still, training and experience have to count for something.

Lastly, I’ll mention how important delivery is to optimize the message. I was shocked how quickly the other thread went off the rails, largely due to my word choice. No amount of reason or evidence can overcome an unreceptive listener.

Not sure why you're surprised GB. Mis/disinformation is more readily available than anything. It travels fast. Throw on top of that, the research and data is collected and reported with other scientists in mind. The target audience isn't your average Joe Schmoo. Most don't have the capacity to process things in that form IF they even know where to go to find the studies and research.

BTW, your word choice isnt the problem in that other thread.

Thinking about it, a lot of mis/disinformation IS packaged for Joe Schmo, using logical fallacies like the appeal to nature, and advertising psychology to harness emotion versus the "scientific industrial complex". Sure, they may cite some quasi-legitimate study, knowing most people won't/can't scrutinize the methodology, or ascertain the weight of evidence.

Even in this thread, several responses reflect our tendency to skip to the tl;dr summaries. I mean, who has the time to read a screenful of text? Easier to trust the short form AI summary, especially if it feeds confirmation bias.

Upon reflection, I shouldn't be surprised at all.

Bingo.

 

[Drunken Cowboy]

To build upon the "Doing your own research" thread, I'll introduce a related topic: patient satisfaction.

Intuitively, it's important to advocate and be involved in shared decision making with one's healthcare provider. Presumably, this leads to an optimal patient:clinician relationship. As others have stated, doctors work for patients, not the other way around.

But how does patient satisfaction impact care? What makes patients satisfied?

An interesting study on this topic.

While most health care quality metrics assess care processes and health outcomes, patient experience or satisfaction is considered a complementary measure of health care quality. Patient satisfaction data may empower consumers to compare health plans and physicians, and both the Centers for Medicare & Medicaid Services and the National Committee on Quality Assurance require participating health plans to publicly report patient satisfaction data. Health plans use patient satisfaction surveys to evaluate physicians and to determine incentive compensation, and consumer-oriented Web sites often report patient satisfaction ratings as the sole physician comparator.

Satisfied patients are more adherent to physician recommendations and more loyal to physicians, but research suggests a tenuous link between patient satisfaction and health care quality and outcomes. Among a vulnerable older population, patient satisfaction had no association with the technical quality of geriatric care, and evidence suggests that satisfaction has little or no correlation with Health Plan Employer Data and Information Set quality metrics.

In addition, patients often request discretionary services that are of little or no medical benefit, and physicians frequently accede to these requests, which is associated with higher patient satisfaction. Physicians whose compensation is more strongly linked with patient satisfaction are more likely to deliver discretionary services, such as advanced imaging for acute low back pain.

Although benefits of discretionary care are by definition limited or absent, discretionary services may lead to iatrogenic harm via overtreatment, labeling, or other causal pathways. In a national Medicare sample, health care intensity varied widely among patients across US regions, despite similar illness burdens. Within 3 chronic illness cohorts, greater health care intensity was associated with increased patient satisfaction with some aspects of care but also with higher mortality and without improvement in the quality of care.Discretionary care has been similarly associated with added risks and costs in other studies.

The associations among patient satisfaction, health care intensity, and outcomes have not been studied within a national sample that includes adults of all ages. Therefore, we used Medical Expenditure Panel Survey (MEPS) data to assess the relationship between patient satisfaction and health care utilization, expenditures, and mortality in a nationally representative sample.

Results Adjusting for sociodemographics, insurance status, availability of a usual source of care, chronic disease burden, health status, and year 1 utilization and expenditures, respondents in the highest patient satisfaction quartile (relative to the lowest patient satisfaction quartile) had lower odds of any emergency department visit (adjusted odds ratio [aOR], 0.92; 95% CI, 0.84-1.00), higher odds of any inpatient admission (aOR, 1.12; 95% CI, 1.02-1.23), 8.8% (95% CI, 1.6%-16.6%) greater total expenditures, 9.1% (95% CI, 2.3%-16.4%) greater prescription drug expenditures, and higher mortality (adjusted hazard ratio, 1.26; 95% CI, 1.05-1.53).

Conclusion In a nationally representative sample, higher patient satisfaction was associated with less emergency department use but with greater inpatient use, higher overall health care and prescription drug expenditures, and increased mortality.

tl;dr In ~52K outpatients followed over a 4 year period, those with the highest healthcare satisfaction had greater total expenditures, were hospitalized more, and 26% more likely to die, in comparison to the least satisfied.

As an aside, the number of deaths in this study was relatively low, but the mortality difference was statistically significant, and aligns with other, related research findings.

Thoughts?

Most people have no idea what makes a doctor good. Patient satisfaction is often judging things like waiting time and personality that have little to nothing to do with their care.

 

[Joe Bryant]

What’s most interesting to me is the contrast between what patients want/think is good for their health, versus what the data actually shows.

I can understand distrust, and even a little contempt for authority, along with suspicion for secondary gain. These feelings are compounded by the trope of egomaniacal, dismissive doctors with god-complexes, churning patients to ensure early tee times. And alt medicine capitalizes on it.

But even if you have the critical thinking skills and scientific background, it’s reaalllly hard to know what you don’t know. And it’s not just because the information is complex; it’s evolving.

Doctors are humans, so of course they’re fallible, and there are bad apples. Still, training and experience have to count for something.

Lastly, I’ll mention how important delivery is to optimize the message. I was shocked how quickly the other thread went off the rails, largely due to my word choice. No amount of reason or evidence can overcome an unreceptive listener.

Not sure why you're surprised GB. Mis/disinformation is more readily available than anything. It travels fast. Throw on top of that, the research and data is collected and reported with other scientists in mind. The target audience isn't your average Joe Schmoo. Most don't have the capacity to process things in that form IF they even know where to go to find the studies and research.

BTW, your word choice isnt the problem in that other thread.

Thinking about it, a lot of mis/disinformation IS packaged for Joe Schmo, using logical fallacies like the appeal to nature, and advertising psychology to harness emotion versus the "scientific industrial complex". Sure, they may cite some quasi-legitimate study, knowing most people won't/can't scrutinize the methodology, or ascertain the weight of evidence.

Even in this thread, several responses reflect our tendency to skip to the tl;dr summaries. I mean, who has the time to read a screenful of text? Easier to trust the short form AI summary, especially if it feeds confirmation bias.

Upon reflection, I shouldn't be surprised at all.

It's not only mis/disinformation.

Absolutely, advertising psychology is used to shape public opinion for profit.

Pharmaceutical companies are literally running expensive, highly produced and targeted advertisments seemingly non stop. Crafted by experts in advertising and persuasion psychology. Something fairly unique to the US.

As said above, I can see how that creates challenges for others downstream from the Pharmaceutical companies.

And absolutley, confirmation bias and looking to believe what one wants to believe is a huge factor in all this.

 

[dgreen]

What’s most interesting to me is the contrast between what patients want/think is good for their health, versus what the data actually shows.

I think this is true across many disciplines. An econ professor of mine wrote a book about how voters consistently favor economic policies that aren’t supported by most economists. I’m learning more and more about how big the gap is between what’s widely accepted in Biblcial scholarship and what the average pew-sitter thinks is accurate.

 

[Sparky Polastri]

What’s most interesting to me is the contrast between what patients want/think is good for their health, versus what the data actually shows.

I think this is true across many disciplines. An econ professor of mine wrote a book about how voters consistently favor economic policies that aren’t supported by most economists. I’m learning more and more about how big the gap is between what’s widely accepted in Biblcial scholarship and what the average pew-sitter thinks is accurate.

The feels over facts phenomena. It's not unique to any particular industry. People make that choice often. It's biological. Same thing with the need to be part of the pack.

 

[Joe Bryant]

What’s most interesting to me is the contrast between what patients want/think is good for their health, versus what the data actually shows.

I think that's a valid point. I think there also can be some distrust among people of the data. Specifically how it's created and if there are billion dollar incentives behind it.

Obviously, Pardue Pharma debacle is the one everyone knows.

The Promotion and Marketing of OxyContin: Commercial Triumph, Public Health Tragedy​

The Promotion and Marketing of OxyContin: Commercial Triumph, Public Health Tragedy - PMC

I focus on issues surrounding the promotion and marketing of controlled drugs and their regulatory oversight. Compared with noncontrolled drugs, controlled drugs, with their potential for abuse and diversion, pose different public health risks when ...

pmc.ncbi.nlm.nih.gov

That one was obviously scandalous.

But others are less bold but extremely effective. From the past:

Sugar lobby paid scientists to blur sugar's role in heart disease – report​

New report highlights battle by the industry to counter sugar’s negative health effects, and the cushy relationship between food companies and researchers

Sugar lobby paid scientists to blur sugar's role in heart disease – report

New report highlights battle by the industry to counter sugar’s negative health effects, and the cushy relationship between food companies and researchers

www.theguardian.com

Sugar industry secretly paid for favorable Harvard research

Sugar industry secretly paid for favorable Harvard research

A sugar industry trade group secretly paid for two Harvard studies in the 1960s that downplayed the role of sugar in coronary heart disease.

www.statnews.com

And to be clear, nobody is saying all research and data is flawed or can't be trusted. I may not like that research may be influenced by corporations and profit, but I certainly understand it. If you have a billion-dollar business, you want to stay in business. If that means spending some money in the right places, I understand why they do it.

I'll also say, maybe there's no way to discuss this without it turning political. I don't think for-profit corporations exerting influence on research is political, but I know some do.

This to me though is a reason why I think some people (reasonably I think) question some things. It's not saying you can't trust for profit corporations. As I said on that earlier, navigating life will be pretty tough if you can't interact with any company making a profit. What I am saying is I think it's reasonable to research and ask questions and consider the incentives.

 

[Joe Bryant]

Also - apologies as my post above is really more for the research thread. Didn't realize what thread I was in.

 

[Joe Bryant]

And again, the influence of corporations may not be something we should talk about here.

 

[Tau837]

 

[Ilov80s]

What’s most interesting to me is the contrast between what patients want/think is good for their health, versus what the data actually shows.

I think this is true across many disciplines. An econ professor of mine wrote a book about how voters consistently favor economic policies that aren’t supported by most economists. I’m learning more and more about how big the gap is between what’s widely accepted in Biblcial scholarship and what the average pew-sitter thinks is accurate.

The feels over facts phenomena. It's not unique to any particular industry. People make that choice often. It's biological. Same thing with the need to be part of the pack.

I think that is a huge part of it. We are social creatures constantly looking to find groups and identity. Whether it's favorite sports team, political party, online community, social label, hobbies,etc. And with those certain groups there are often other values or interests that are more tolerated and so I really do believe people just assimilate in and instead of making millions of little decisions about how they think about everything, they just adopt wholesale values of the group they are in or trying to be in. This includes medical/health opinions. Crossfit community probably has different expected beliefs than the nature hikers, power lifters vs long distance runners, conservative vs liberal, Laborer vs Artisan, gamer vs reader, etc.

 

[Terminalxylem]

What’s most interesting to me is the contrast between what patients want/think is good for their health, versus what the data actually shows.

I think this is true across many disciplines. An econ professor of mine wrote a book about how voters consistently favor economic policies that aren’t supported by most economists. I’m learning more and more about how big the gap is between what’s widely accepted in Biblcial scholarship and what the average pew-sitter thinks is accurate.

The feels over facts phenomena. It's not unique to any particular industry. People make that choice often. It's biological. Same thing with the need to be part of the pack.

I think that is a huge part of it. We are social creatures constantly looking to find groups and identity. Whether it's favorite sports team, political party, online community, social label, hobbies,etc. And with those certain groups there are often other values or interests that are more tolerated and so I really do believe people just assimilate in and instead of making millions of little decisions about how they think about everything, they just adopt wholesale values of the group they are in or trying to be in. This includes medical/health opinions. Crossfit community probably has different expected beliefs than the nature hikers, power lifters vs long distance runners, conservative vs liberal, Laborer vs Artisan, gamer vs reader, etc.

You’re absolutely right.

The problem is, healthcare is kinda important, and involves some of the most complex decisions we make. It would serve everyone to be well informed, and objective as possible.

 

[Ramblin Wreck]

And again, the influence of corporations may not be something we should talk about here.

Yep. You either go down a political route or you people accusing you of "feels over facts". Not even worth engaging that mess and trying to keep it non-political.