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Wednesday, November 11, 2015

High-spending doctors less likely to be sued

Distressing correlation. I go to work everyday to be a good medical fiduciary for my patients. I try to give medical advise which I believe is in my patients best interest. It is up to my patients to accept or reject that advise. Admittedly, I feel the pressure to deviate from best medical advise at times. The greatest source of pressure are not financial, insurance or cost of care but, rather, patient preference and satisfaction. Don't get me wrong, two-way communication absolutely is essential for best patient care. I absolutely appreciate and desire communication from my patients. I formulate my recommendation with such communication which takes into account not just medical facts but my patients' preferences. However, doctors are not immune to the influence of expectations. "So, you're not going to do anything for me?" "I heard you were the best doctor and I know you wouldn't let me leave your office without relief." "I've already tried everything! You've got to help me." "How do you expect me to go to work/live like this?" "If you can only do something to get me through the week, I would appreciate it." "What do you mean you don't know?" "I took my afternoon off work for this? You haven't told me anything new." "All of my past doctors over the past 20 years have given me antibiotics for this. Why won't you order it for me?" "What do you mean I have to return for another appointment/more tests? I thought I would get an answer today." Now that doctors are graded on patient satisfaction, amongst other variables, the pressure is greater to keep our customers (patients) satisfied. Satisfaction from service provided is an excellent goal, but what if best satisfaction correlates with poor quality of care? What doctors know and some may not realize is that a satisfied patient may receive poor clinical care. And, a patient who received best quality care with sound judgement may be entirely dissatisfied. Consider, a financial adviser who advises her client not to go to Vegas every month and hit the casinos but rather to limit such activities and invest the residual into an IRA. The financial adviser has done their fiduciary obligation to provide advise believed to be in the best financial interest of the client, but she may have a dissatisfied client. Would one sue their financial adviser for such advise which causes dissatisfaction? At the core of the issue is perception. The perception that satisfaction equates to quality care and dissatisfaction equates to poor quality care. Such correlations are short cuts of the brain akin to the perception that a pricier merchandise in a store must be of better quality than a more cheaply priced merchandise. In healthcare sometimes such associations are true, but when they are not it leads to anxiety, frustration, distrust and 'defensive medicine'. How is this dissonance to be remedied?
from Rajesh Harrykissoon, MD