Most customer service businesses are very concerned about consumer satisfaction, or else the businesses would risk failure. The practice of medicine is no exception to the rule: the customer comes first. Beyond the bottom line, patient satisfaction insures quality healthcare by a primary mechanism called “continuity of care”. If an unsatisfied patient bounces from one doctor to the next, the lack of continuity can increase the risk for a missed diagnosis, decrease the ability for healthcare providers to collaborate, and can create a disjointed pathway towards disaster. If doctors had a cure for everything, then no one would have to worry about fulfilling patient expectations. Unfortunately, medicine rarely offers a cure for anything, especially conditions like chronic pain, diabetes, and cancer. So what other expectations can doctors work towards fulfilling?
When a patient comes to a doctor’s office, he/she usually has a desire for something. Most people expect a doctor to actively address the problem. Most people expect a doctor to offer a specific diagnosis. Most people also expect a detailed, quality explanation of that diagnosis. And finally, especially those with chronic pain, patients expect validation of their suffering. Patients want to be acknowledged and taken seriously. If these desires are not meet, the patient will walk away from the doctor with the sour taste of dissatisfaction. Who is satisfied with their doctor?
A recent study from the University of North Carolina attempted to answer this question by examining the issues of patient satisfaction. In this study of individuals with chronic back pain, 69% of those surveyed were completely satisfied with their doctor. However, that means that one third of those with chronic pain were not satisfied at all. The biggest factor linked to dissatisfaction was the lack of insurance. A lack of insurance creates huge barriers to quality care. Those patients most likely to be satisfied were the ones who were prescribed opioid pain medications. The authors of this study speculated why opioid use was so strongly linked to patient satisfaction. Opioid medications may “act as a means of validating (the symptoms)”. Opioid use may improve “functional status” or the “patient’s sense of well-being”. But one thing the author did not acknowledge was the issue of pure and simple pain relief. Most individuals with chronic pain are very happy if the pain intensity is taken down a few notches, even when being pain-free is not possible. A cure for pain would be nice, but pain management with opioid medications seems to be the next best thing.
Ultimately, patient satisfaction leads to better teamwork. The patient and the doctor can agree upon a treatment plan and work together. A doctor can then orchestrate teamwork amongst other healthcare providers. With this improved continuity of care, quality healthcare can be delivered. However, the “customer comes first” rule has a dark side when it comes to the practice of medicine. Sometimes fulfilling a patient’s every wish and desire can be harmful. For example, excessive use of imaging studies can expose a patient unnecessarily to harmful radiation. So, doctors first must obey the cardinal rule: Do no harm. That rule separates doctors from the rest of the business world. Consumer satisfaction sometimes has to be jeopardized in the effort to do no harm. If the doctor can adequately explain the treatment choices to the patient and the two parties can agree on a treatment decision, then everyone on the healthcare team can be satisfied.