family medicine

Keeping patients happy may be unhealthy

UC DAVIS (US) — People who are the most satisfied with their doctor are more likely to be hospitalized, accumulate high health-care and drug costs, and have higher death rates than less satisfied patients.

The findings are based on a recent study that is one of the first to suggest that an overemphasis on patient satisfaction could have unanticipated adverse effects.

“Patient satisfaction is a widely emphasized indicator of health-care quality, but our study calls into question whether increased patient satisfaction, as currently measured and used, is a wise goal in and of itself,” says Joshua Fenton, assistant professor of family and community medicine at the University of California, Davis.


Prior studies have shown that patient satisfaction strongly correlates with the extent to which physicians fulfill patient expectations.

“Doctors may order requested tests or treatments to satisfy patients rather than out of medical necessity, which may expose patients to risks without benefits,” Fenton says. “A better approach is to explain carefully why a test or treatment isn’t needed, but that takes time, which is in short supply during primary-care visits.”

Patient-satisfaction surveys are commonly conducted by health systems to evaluate patients’ perceptions of their encounters with physicians. The results can be used to establish quality-improvement measures with the hope of strengthening patient loyalty.

Because many physicians receive incentive compensation based on patient satisfaction, they may be reluctant to bring up the downsides of requested tests or treatments, Fenton says. Providers who are too concerned with patient satisfaction may also be unwilling to bring up uncomfortable issues such as smoking, substance abuse, or mental health, which may then go unaddressed.

For the study, published n the Archives of Internal Medicine, Fenton and colleagues evaluated data from more than 50,000 adult respondents of the Medical Expenditure Panel Survey, a nationally representative survey of the US population that assesses the use and costs of medical services.

Respondents completed questionnaires about their health status and experiences with health care, including how often their health-care providers listened carefully, were respectful, and spent enough time with them. Participants also were asked to rate their health care on a scale of 0 to 10. The data were linked to the national death certificate registry.

The study found that patients who were most satisfied had greater chances of being admitted to the hospital and had about 9 percent higher total health-care costs and 9 percent higher prescription drug expenditures. Most strikingly, death rates also were higher: For every 100 people who died over an average period of nearly four years in the least satisfied group, about 126 people died in the most satisfied group.

More satisfied patients had better average physical and mental health status at baseline than less satisfied patients. The association between high patient satisfaction and an increased risk of dying was also stronger among healthier patients.

“We therefore think it’s unlikely that more satisfied patients are somehow more sick and, in turn, more likely to die,” says Fenton, who notes a definitive cause-and-effect relationship could not be inferred from the study.

The researchers will next determine why more satisfied patients tend to be hospitalized more frequently by evaluating the clinical situations that lead to hospitalization for the least and most satisfied patients. They also intend to study why prescription costs are higher in the most satisfied group.

“Patients should be satisfied with their physicians, but ideally it’s because their physicians guide them toward the best care,” Fenton says. “Not merely because their physicians provide tests or treatments that may do more harm than good.”

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