Is patient satisfaction fueling "integrative medicine?"

Is patient satisfaction fueling "integrative medicine?"

A thoughtful article recently appeared in The Atlantic titled "The Problem with Satisfied Patients," by Alexandra Robbins.  As she explains, the Department of Health and Human Services, probably with the best of intentions, decided that Medicare reimbursement would be based, in part, on patient satisfaction survey scores. Medicare now withholds a percentage of reimbursement and hospitals "earn" it back by getting high scores.

Low satisfaction scores can hurt the bottom line. Naturally, hospitals began to implement measures to up their scores, from scripting nurses' interactions with patients to advertising for nurses with "good customer-service skills."  Some have added valet parking, live music, custom-order meals and VIP lounges for patients in their "loyalty programs."

Thanks, but no thanks, on that last one, considering the qualifications. Better to accumulate frequent flyer miles than frequent hospital patient points. 

But as one clinical instructor interviewed by Robbins noted:

Patients can be very satisfied and be dead an hour later.

 I'll take a cranky, off-message nurse any day if that's the alternative.

Robbins catalogs some of the ridiculous results of this over-emphasis on patient satisfaction -- a burden, she notes, often carried on the shoulders of nurses, whether the particular satisfaction metric is part of nursing care or not.  Take a look at these patient comments from the mandated 32-question satisfaction survey criticizing a hospital's nursing care :

My roommate was dying all night and his breathing was very noisy. 

And this:

The hospital doesn't have Splenda.

As one critical care nurse said, 

many patients have unrealistic expectations for their care and outcomes.

No kidding! She had to argue with a quadruple-bypass surgery patient who thought he was being mistreated because he didn't get enough pastrami on his sandwich. 

But does patient satisfaction mean better care? Not necessarily. Robbins examined Medicare provider data and found that an "alarming number" of providers offer poor care while still getting high satisfaction scores. 

There are hospitals . . .  where a higher number of patients than average will die, be unexpectedly readmitted, or suffer serious complications. And yet two-thirds of those poorly performing hospitals scored higher than the national average on the key [survey] question; their patients reported that "YES, [they] would definitely recommend the hospital. 

Which brings me to "integrative medicine." It's awfully cheap to bring in a reiki practitioner and have her wave her hands over patients. Yet I imagine patients love this sort of thing. Along with homeopathy, acupuncture, herbs and other placebo-inducing rituals that make patients feel they are being "healed" even if they are still as sick as they ever were.  And why not add a "specialist" in "natural medicine" like a "naturopathic physician" to the mix? 

Medicare's emphasis on patient satisfaction didn't create integrative medicine. But it's certainly not discouraging it. 

Like patient satisfaction, there is no evidence that integrative medicine (even after the 20 or so years it's been around) has done one thing to actually improve patient outcomes.  Robbins reaches this conclusion about the misguided emphasis on patient satisfaction:

Many hospitals seem to be highly focused on pixie-dusted sleight of hand because they believe they can trick patients into thinking they got better care. The emphasis on these trappings can ultimately cost hospitals money and patients their health, because smoke and mirrors serve to distract from the real problem . . . : Patient surveys won't drastically and directly improve healthcare.

Pixie dust. Sleight of hand. Trick. Trappings. Smoke and mirrors. All perfect descriptors of integrative care. 

 

Points of Interest 04/28/2015
Points of Interest 04/24/2015