Satisfied with higher cost, mortality?

Everyone who questioned the endless emphasis on patient satisfaction surveys in modern healthcare might be vindicated by a new study.  The Cost of Satisfaction: A National Study of Patient Satisfaction, Health Care Utilization, Expenditures, and Mortality concluded,

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.

The results may be skewed by a phenomenon noted in the article: among seniors, there is no correlation at all between satisfaction and the “technical quality of care.”

I also question research that indicates that less and/or cheaper care is better, or that doctors over-treat their patients. I sometimes suspect the motive is to advocate for knee-jerk protocols and eventual rationing along with the removal of individual physician judgement in the treatment of individual patients.   (Dont’ think “death panels.” Okay, go ahead.)

However, this particular research looks at whether doctors order tests and treatments their patients ask for, whether or not the evidence supports that route. The researchers correlated these “discretionary” treatments and tests with satisfaction and with mortality, and came up with a 25% higher risk of mortality or death with in the time studied. (In the world of medical statistics, this is not a very high risk, but it is significant to those who die, right?)

The caveat is to watch and wait as the medical community evaluates the study and how the data was “cooked” by the statisticians. One area where the conclusion may be weak is that the health status of the patient was self reported (although mortality was not). I’d like to see correlation with lab values such as measurements of kidney function.

One of my fears has always been that I might become like some of the older docs I saw when I was training:  a very nice doctor who is well-liked but incompetent because I’ve failed to keep up my skills and knowledge. I should have worried about being the doctor who goes along to get along – or to make more money because my pay is directly related to how happy – not how healthy – I keep my patients.