Patient Empowerment and Shared Decision Making Bad For Patients?

I read with interest a study that was recently reported at the May 2012 annual meeting of the Society of Hospital Medicine.   With patient empowerment and shared decision making leading the charge in the patient advocate movement, I was intrigued to learn of yet another study showing potential patient harm  being perpetrated in the interest of patient  satisfaction.     Patient satisfaction scores have been linked to higher mortality.

The patient centered, patient empowered shared decision making platform just keeps getting worse with every passing month.  I suppose we should expect what we pay for.  We don't expect a pilot to fly a plane based on the opinions of 300 lay people enjoying their $2 peanuts and $5 headphones.  Why should we expect a doctor to practice medicine based on the lay opinions of his or her patients?  While patients may feel they have a right to share in the decisions being applied to their body, most are not sophisticated enough to know when their opinion is not the right opinion.  

Perhaps we have all been hoodwinked into believing the patient customer is always right.  The logic here is simple.  Hospitals get paid for good patient satisfaction scores.  Because, patients are happiest when they feel they are in control (empowered), doctors give up their medical decision making in favor of making patients happy by giving patients what they want, not what they need.  Hospitals get paid.  Doctors get congratulated.  

While we win the patient satisfaction game, we lose the battle for quality medicine.  If we define quality as happy, then we should just give our patients free coupons to all-you-can-eat buffets and bonus buy-one-get-one-free coupons for Camel Crush cigarettes.   We'll have lots of happy patient customers and our quality numbers will be pristine.   

But that's not quality.  That's chiro-puncture (or acu-practic) care.   Can you imagine if 300 angry passengers demanding their pilot take off in a hurricane just to make them happy? If the world wants us doctors  to be more like pilots,  why shouldn't we expect patients to behave more like passengers and stop demanding access to the cockpit.

Hyo Jung Tak, Ph.D. enlightened the SHM crowd by presenting data suggesting that shared decisions in the patient empowerment movement resulted in patients being hospitalized  1/3 of a day longer at a cost of $970 more.  This was based on data of 20,213 patients at the University of Chicago Medical Center from 2003-2011.  

Go read the study.  It is empowering to say the least.   At some point the medical community has to decide whether we want to do the right thing for our patients or decide if we are just there to make patients  happy. As more and more physician practices get purchased by large hospital systems, patients will find themselves more likely subjected to the influences of hospital economics that may sacrifice  quality for satisfaction.    

I know from ten years of hospitalist experience that happy patients do not equal good care any more than unhappy patients equals bad medical care.   Heck, some patients are happiest if they have a good looking doctor or nurse.  I'm not kidding. I've heard it said before.

It is important for hospitals to understand this type of data when it comes to valuing their hospitalist advantage.  Are hospitalists who improve patient satisfaction scores worth their hospitalist support and subsidy payments that have contributed to the rapid growth in hospitalist salary if length of stay and resource utilization increases?  The conflicting consequences of the ever growing number of government mandates  are grossly under estimated.  At what point does none of this make sense?  

Now, please enjoy these original Happy Hospitalist ecards, part of an extensive collection on Pinterest.

"It is my medical opinion that you have too many opinions."

It is my medical opinion that you have too many opinions ecard humor photo.

"It is my medical opinion that you should keep your opinions to yourself."

It is my medical opinion that you should keep your opinions to yourself ecard humor photo.

Some of this post contains humor that may only be understood by those in some healthcare professions. Read at your own risk.

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