I don’t mean to pick on McDonald’s. Insert any other large retail business where customer satisfaction massively trumps every other consideration of the relationship between employee and customer.
Telemedicine companies have exploded the past few years. I suspect a lot of my readers have already seen this, but just in case not, a recent study in JAMA Internal Medicine measured the correlation between customers with a cold who called one of the telemedicine companies and received antibiotics with the doctors’ patient satisfaction scores. 66% of the time an antibiotic was prescribed, which if we’re practicing using best evidence should almost never happen. You know where this is going. The doctors who wrote the highest percentage of antibiotics got the highest patient satisfaction scores.
In fact, the Discussion section included this: For individual physicians, frequent prescription of antibiotics was associated with better satisfaction ratings. Few physicians achieved even the 50th percentile of satisfaction while maintaining low rates of antibiotic prescribing. To reach the top quartile, a physician had to prescribe antibiotics at least half the time; almost all physicians above the 90th percentile had a rate of antibiotic prescribing greater than 75%.
What should the doctors do? We are trapped in the middle between the American corporate mindset that demand high patient satisfaction scores vs. our duty to protect society from the next superbugs, resistant to all but the newest and most expensive antibiotics. This is not just in telemedicine companies. It’s everywhere in large healthcare systems where the doctors have been widgetized. If anyone out there wonders why physician morale is low, this is one large brick in a much larger wall. We want to do the right thing, but monied forces push back hard. We’re only human. We can’t do the right thing unless we have support, which we have precious little of at the moment.
Yep this is so true. I try really hard not to prescribe and antibiotic for colds and URIs but my patients goes to any fast track ER or even the ones associated with a hospital and they all get antibiotics and usually a steroid shot. How can I compete with that?
Yep, it’s hard. We all feel your pain and stay chronically mad at the healthcare systems that don’t support us doing the right thing.
“stay chronically mad at the healthcare systems that don’t support us doing the right thing”
AND the medical societies such as the AAFP that don’t support us. They’re big fans of linking patient satisfaction to pay.
The patient should get what he or she wants, after discussion, no matter what the doctor thinks. Medicine is the only industry in which you do not get what you pay for. I strongly believe the patient makes the final decision in all matters. It is the patient’s risk and if the wrong decision is made, the doctor still gets paid and goes home at night. Why shouldn’t patients – the customers – get the satisfaction they came for. As to antibiotics, I was prescribed these for the last three viral infections. Two were based on unique circumstances and uncertainty, thus given under a cautious approach. The other I initially declined the offer, but took them when prescribed a couple days later. We can debate whether harm was done by this last one, but again isn’t it the patient’s decision?
Bob,
If the patient lived in a vacuum, completely without interaction with anything else, I’d agree with you. There are 2 problems with your argument that have to do with the balance of the needs of the individual vs. society. First, if any insurance money is used to pay for the antibiotic, then the individual is asking the others in the insurance pool to pay for a useless intervention (not a large cost, for sure). Second, it increases the general pressure on antibiotic resistant bacteria in the community.
The patient should NOT get what he or she wants, they should get what they need. Most patients are poorly informed about medical treatments and why certain prescriptions and treatments are given. They just want to feel better. In addition to the pressure on promoting resistance, there are other risks that come with taking unnecessary antibiotics in particular but any medication in general. Some of these include superinfection with a more resistant organism, diarrhea, liver failure, hypo or hypertension, etc. The first line of the Hippocratic oath has the line, “Primum non nocere” (first do no harm). By prescribing unnecessary antibiotics and making the patient happy in the short run, we are potentially causing harm and much distress down the road