Weekly Article - Patient satisfaction and patient centered care

Posted by Jim Chamberlain, MD

Patient satisfaction and patient centered care - JAMA article

The authors discuss the important differences between patient-centered care (one of the IOM domains of quality) and patient satisfaction (measured by customer surveys).

Patient-centered care means providing medical care that respects the values of the patient/family. It also means structuring the healthcare system and processes around the needs of the patient rather than the needs of physicians and nurses. Patient-centered care is only one of six domains, the others being safety, timeliness, effectiveness, efficiency, and equitability.

Patient satisfaction is a tool used by industry to measure how well we meet customers’ expectations.

Sometimes, the two can be in conflict. For example, many parents come to the ED wanting “tests” to be performed. From a quality standpoint, it is our job (and it is ultimately patient-centered) to provide evidence-based care. In many cases, we will convince the parents NOT to order tests (such as a head CT for blunt head injury). This may result in lower customer service scores in some cases.

One section particularly resonated with me:

“At times, the medical evidence does not support the demands of the patient, and it is the professional duty of the physician to deny these requests even though patient satisfaction may decline. Although patient education may mitigate some of the dissatisfaction, there will always be unsatisfied patients.”

Jim’s opinion here: [The key is in how we do it I think. I will always support quality of medical care over parental desire, but we can usually have it both ways (certainly not with all parents). Most parents can be convinced of the “right” thing to do for their child, but we do face some challenges specific to our patient population].

The article concludes with the scientifically valid proposition that we need to study patient satisfaction as a quality metric and determine how well is correlates with other measures of quality.