Patient satisfaction, as well as good doctor-patient relationships, have long been indicators of quality health care. Doctors place emphasis on this relationship with the belief that, if a patient likes and trusts their doctor, they are more inclined to follow orders and thus get better. But a team of UC Davis researchers found this might not always be true.
In a study published in the Archives of Internal Medicine on Feb. 13 of this year, researchers found that the patients who are most satisfied with their doctors are the ones more likely to have increased prescription drug expenditures and increased mortality.
Joshua Fenton, assistant professor in the UC Davis Department of Family and Community Medicine and lead author of the study said that the results do not surprise him.
“We conducted this study because prior research had shown that in certain groups, health care intensity varies widely, despite correcting for illness burden,” Fenton said.
Fenton explained that patient satisfaction is currently a widely used indicator of quality health care. But the results of the study question whether this indicator is appropriate. He explained many of the reasons for these tests are often not to rule out diseases, but rather to reassure patients.
“Doctors may order tests or certain procedures because they think it will satisfy and reassure their patients, rather than because they believe the test is necessary,” Fenton said.
Fenton noted that this research is important as unnecessary and inappropriate use of health care has been a well-known fact in the United States for a long time but no research has been done about it.
“Ideally, patients should be satisfied with their doctors but that is because they are providing them with the most appropriate care,” Fenton said.
The study was conducted by evaluating data collected from a national survey of the U.S. that looked at the use and costs of medical services from 2000 to 2007. The survey asked patients about their health status as well as their personal experiences with health care. This survey was then compared alongside the national death certificate registry.
The study indicated that most satisfied patients had about 9 percent higher total health care costs and 9 percent higher prescription drug expenditures. Most surprising to the researchers was the difference in death rates. The most satisfied patients had a 26 percent greater mortality risk than the least satisfied patients.
Fenton explained that the other implication of the study is to find ways to maintain patient satisfaction without risking patient health and well-being.
“We are trying to do research on how to build doctor’s skills in counseling patients. We believe that there are some relatively straightforward communication skills to reassure patients and maintain satisfaction and avoid possibly hazardous tests,” Fenton said.
The study also found that the most satisfied patients are often hospitalized for elective reasons. Fenton said in the future, he and his colleagues hope to analyze what these reasons were in in order to shed light on the current situation.
“We want to evaluate exactly what those hospitalizations are for and what the costs and benefits are to each of those patients,” Fenton said.
Fenton noted that an observational study such as this one only suggest correlation and cannot prove causation. However, he feels this study will shed light on how the patient-doctor relationship can affect health care.
“We hope these studies will improve patient satisfaction and ultimately patient care,” Fenton said.
CLAIRE MALDARELLI can be reached at science@theaggie.org.
