Do you like your doctor? It could be the death of you
Satisfaction with NHS is high but it may be bad news
Jeremy Laurance is a writer on health issues. He is former health editor of The Independent and the i and has covered the specialism for more than 20 years. He thinks the harm medicine does is under-appreciated, the harm it prevents over-rated, and that cycling works better than most drugs. He was named Specialist Journalist of the Year in the 2011 British Press Awards.
Wednesday 15 February 2012
Satisfaction with the NHS has been rising steadily for the past decade and is at an all-time high – but that could spell bad news for patients.
The more satisfied patients are with their medical care, the more likely they are to die, US researchers have found.
More care is not always better care and sometimes doctors have to tell patients things they would rather not hear.
The findings run counter to a key aspect of Health Secretary Andrew Lansley's NHS reforms, whose thrust is to increase satisfaction by boosting patient involvement in care – no decision "about me without me".
Findings from the 2011 NHS outpatient survey, published yesterday, show 84 per cent rated their experience as being excellent or very good, the highest level since the survey started in 2002.
Patients said they were better involved in decisions about their care, were treated with respect and dignity and had confidence and trust in staff.
A spokesman for the Care Quality Commission – which carried out the poll of 72,000 people attending outpatient departments in April and May 2011 – said it showed that when key aspects of care were measured, performance improved.
Ann Milton, Public Health minister, said the results were "great news" but said there was "more to do" to improve patients' experience of the NHS.
"We want people to feel involved at every step of the care they get in hospital." she said.
The Department of Health cited independent research by Imperial College London that showed hospitals with better patient ratings tended to have lower death and readmission rates. However, a US study that examined the patients rather than the hospitals found that those who were most satisfied were prescribed more drugs, had more hospital admissions and a 26 per cent higher death rate.
Satisfaction is regarded as "good" in health because satisfied patients are more likely to do what their doctors tell them and take drugs they prescribe.
However, many patients ask for treatments they do not need and may end up being overtreated or labelled as ill in ways that cause harm. They might be better off with a doctor prepared to risk their dissatisfaction by resisting their demands.
The US authors, from the University of California, whose study, The Cost of Satisfaction, is published in the medical journal, Archives of Internal Medicine, warned: "An overemphasis on patient satisfaction could have unintended adverse effects."
In a commentary on the findings, Brenda Sirovich, from the Department of Veterans Affairs Medical Centre in Vermont, said overcoming the "more is always better" fallacy of healthcare remained an enormous challenge.
In a recent survey, almost half of US primary care physicians believed their patients were receiving too much medical care.
Dr Sirovich wrote: "While most Americans may accurately assess how well their washing machines, their hairdressers or even their airlines are performing, their evaluations of physicians and health care interventions may have limited validity."
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