Is a satisfied patient the goal?

A friend posted this article today, which reminded me of a growing problem in health care–patient satisfaction isn’t correlated with better patient outcomes.

[In fact, the most satisfied patients are 12 percent more likely to be hospitalized and 26 percent more likely to die, according to researchers at UC Davis. “Overtreatment is a silent killer,” wrote Dr. William Sonnenberg in his recent Medscape article, Patient Satisfaction is Overrated. “We can over-treat and over-prescribe. The patients will be happy, give us good ratings, yet be worse off.”]

I personally get stuck in this problem.  The world of pregnancy and birth are a little different from most types of health care, because most of our patients are actually healthy.  And for the most part, most of what our patients want isn’t going to make any big differences in the measured outcomes (i.e. maternal mortality does not increase because women listen to music and walk around during labor).

But the question actually goes deeper. If patient satisfaction is not related to better outcomes in pregnancy and birth, would that mean something is wrong with our concept of autonomy?  I could see this answered both ways, so I would love to know your thoughts on it.

First, I can see that with autonomy comes the right to choose to not have the better outcome. If we truly value patient autonomy it means we must accept this balance as desirable.

But, then I remember when the outcomes become less desirable, it is not the patient who is scrutinized, criticized and denied payment for services rendered due to “poor care”. We measure things like cesarean rate by provider, by hospital and by region. So while the woman may have the right to decide to have an elective cesarean, it is the provider and hospital that get “marked down” for providing her with the care she freely chose.

Yes, real life isn’t quite that black and white. But I do wonder about the problems caused by the disconnect between the care experience and the surveillance data for that event. Administrative records used to track 30 day readmission to hospitals don’t care that the patient decided they didn’t want to make a follow-up appointment, or that they didn’t think  they really needed to take that medication.  Again, the real life situations are much messier than this, but the point is if we are going to accept patient autonomy as a high value in health care then we need to start changing the way we think about our outcomes data.