'Patient satisfaction ratings may do more harm than good'

Contrary to the popular perception, subjective patient satisfaction ratings may actually lead to lower-quality care in some situations, according to new research.
"Increasingly used as a measure of physician performance, patient satisfaction data can be flawed and not broadly applicable," said Terence Myckatyn of Washington University School of Medicine in the US.
"While patient satisfaction is important, we think that better rating tools are needed to measure it," said Myckatyn.
Myckatyn and colleagues share some concerns about the trend towards using patient satisfaction ratings as a measure of physician performance.
The focus on patient satisfaction is driven by the fact that the US spends more than any other nation on health-care, but lags behind in outcomes, researchers said.

Patient satisfaction is now among the quality of care indicators used in "pay for performance" programmes tying financial reimbursement under Medicare and the Affordable Care Act.

However, using patient satisfaction ratings in this way is having some unintended consequences, the researchers said.
For example, some hospitals are upgrading their physical facilities and adding luxury amenities, in an attempt to improve patient satisfaction scores.
"One could argue that these costly expenses have more to do with the perception of health-care quality rather than actual outcomes," Myckatyn said.
There are even anecdotal reports of doctors altering their medical judgement to improve patient satisfaction and minimise negative reviews - for example, prescribing antibiotics or strong pain medications to keep patients happy and move them quickly through the system.

"Behaviour motivated by patient satisfaction becomes especially dangerous when ratings are directly tied to compensation," researchers said.
Meanwhile, it is unclear whether satisfaction and other measures of patient experience are correlated with traditional measures of health care safety and quality.
"The truth is that there is little high-level evidence to support that patient satisfaction surveys will provide Americans with improved medical outcomes, but there are plenty of contradictory data," said Myckatyn.
Some studies even suggest that higher-intensity health-care is associated with increased patient satisfaction but also with increased mortality, with no impact on objective quality measures.
While other studies have linked higher satisfaction to better outcomes, interpretation of these studies is limited by the fact that patient satisfaction is "inherently subjective and labile."

Plastic surgery does not have a strong body of research on patient satisfaction and its relationship to outcomes. Yet especially for aesthetic surgery, plastic surgeons have always been attuned to the importance of patient feedback.
The research was published in the journal Plastic and Reconstructive Surgery.