Patient satisfaction surveys and the blame game

The problem is that what matters to patients and doctors does not always align. Someone may push for unnecessary testing because they read it on Google or Dr. Oz recommended it on his show. Someone may push for medications that are not medically indicated, i.e. antibiotics for viral infections. Someone may push for narcotics but refuse other pain control options offered by their providers. People are not always receptive to “no,” and some will threaten doctors with a low score…

I agree with Dr. Lee that patient satisfaction surveys have their place. I agree they can deliver valuable information that can impact positive change. However, as they stand now, they also promote false expectations. They hand the definition of “quality care” to the patients and undervalue the medical judgment of clinicians. There have been negative consequences as a result. To imply that patient satisfaction surveys have not contributed in some way to the opioid epidemic is to shamelessly pass the buck…

No one wants to take responsibility for the opioid crisis. The truth? Multiple factors led to the current state of affairs. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) emphasized pain scales with the implication that patients ought to be pain-free, an unrealistic expectation. Patient satisfaction surveys inadvertently decreased the importance of clinical judgment in the eyes of the public. The federal government also played a part by financially incentivizing hospitals based on patient satisfaction scores. Some doctors began to overprescribe medications due to these external pressures…

I’m a doctor. I have a medical degree. Therefore, I know what’s best. Really? Is that why about 400,000 patients die every year from doctors’ mistakes? Doctors admit they don’t have time to get to know their patients, yet we’re supposed to trust that they know what’s best for us?

Everybody involved in the drug war, including doctors, play their own versions of the blame game for the opioid “epidemic.” Sure, blame pain scales, although I’ve never looked at a pain scale and thought, oh boy, this says I can be pain-free! Doctor, I want to be a zero on the pain scale! Make it happen!

Sure, blame patient satisfaction surveys, although during my 25 years of being treated by the medical industry, I don’t recall filling out too many surveys. The last time I was in the hospital, I vaguely recall a postcard-sized survey, which I filled out to say nice things about one of my nurses. But for all the doctors I’ve seen? No, I don’t recall filling out any patient satisfaction surveys. And I can’t recall Medicare sending me any surveys, either.

Under comments:

Maggie1212 • 5 days ago
Amen. My hospital for about 2 years actually linked our entire bonus to patient satisfaction scores, instead of any measurable factors such as time to cath lab, appropriate ACLS meds given during Code 99s, time to antibiotics for pneumonia, etc which we suggested. During that time we had incredible pressure from hospital administrators to prescribe narcotics. You would get calls, asking, “why didn’t you just give him enough to get him through the weekend?” Absolutely unreal stuff.

DZ-015, M.D. Maggie1212 • 5 days ago
It’s very simple. Once the patient is on benzos or opioids for more than three weeks (with the exception of chronic progressive disease) the patient satisfaction score doesn’t count because their judgment on the issue is now impaired.

What should a bonus be tied to? Because I find it hard to believe that a hospital would base an entire bonus on patient satisfaction scores, instead of including things like how long the employee has worked there. And I also find it hard to believe that hospital administrators pressured employees to prescribe narcotics, although prescribing enough for the weekend doesn’t sound unreasonable. This hospital employee’s attitude pretty much says it all — it’s unreal to be asked to prescribe a couple days worth of painkillers. And low patient satisfaction scores just mean patients didn’t get the drugs they wanted — they have nothing to do with the employee’s performance at all.

Obviously, Medicare is collecting this data, although how many patients are actually participating is questionable. And the information is only on hospitals, not specific doctors.

Patient Experience encompasses 8 important aspects of hospital quality:

Communication with nurses
Communication with doctors
Responsiveness of hospital staff
Pain management
Cleanliness and quietness of hospital environment
Communication about medicines
Discharge information
Overall rating of hospital

Performance period: January 1, 2014 – December 31, 2014

UNM Hospital
Pain management: 0 out of 10
Overall rating: 2 out of 10

Lovelace Medical Center
Pain management: 1 out of 10
Overall rating: 2 out of 10

Lovelace Westside Hospital
Pain management: 4 out of 10
Overall rating: 6 out of 10

UNM Sandoval Regional Medical Center
Rio Rancho
Pain management: 0 out of 10
Overall rating: 4 out of 10

Christus Vincent Regional Medical Center
Santa Fe
Pain management: 3 out of 10
Overall rating: 1 out of 10

The opioid war targets cancer patients

First they came for the drug addicts. Then the pot smokers. Then chronic pain patients. Now they’re after cancer patients. The “experts” are doing everything they can to separate chronic pain from acute pain, because doctors only have to treat acute pain (but not always). And now cancer patients will be seen as potential drug addicts, too.

FRIDAY, July 29, 2016 — More people are surviving cancer, but many are left with persistent pain after treatment. New guidelines from the American Society of Clinical Oncology (ASCO) recommend that doctors routinely screen for such pain.

The guidelines also advise doctors to consider the use of non-traditional treatments for pain. These include hypnosis, meditation and medical marijuana where it’s legal.

ASCO also cautioned doctors to assess patients’ risk for overuse of opioid painkillers…

Advances in cancer diagnosis and treatment have led to a record 14 million cancer survivors in the United States. But, about 40 percent of survivors have persistent pain as a result of treatment, ASCO says…

The guidelines note that there are non-drug treatments for pain. These may include physical rehabilitation, acupuncture, massage, hypnosis and meditation. Also non-opioid painkillers — such as acetaminophen or non-steroidal anti-inflammatory drugs (NSAIDs) like aspirin — can ease pain. Certain types of antidepressants and anticonvulsants may be prescribed to relieve chronic pain and/or improve physical function, ASCO said…

Do you think these medical associations/societies are on the side of patients? No, they exist only to protect doctors. And yet they’re “guidelines” are followed like law, just like the CDC’s rules.

If there were active advocacy groups for patients, they would be reporting that anyone who is diagnosed with cancer should be aware — before treatment — of the possibility of developing a chronic pain condition from the treatment, which your doctor will refuse to treat after a certain period of time. In other words, you will probably survive, but there’s a good chance you will be in pain for the rest of your life. Sound good? Here, sign on the dotted line.

Do you think being a cancer survivor (or being terminal) will automatically grant you access to painkillers? Think again.

If I were a cancer survivor in chronic pain, and my doctor prescribed hypnosis or aspirin to treat my pain, I’d tell him to fuck off. (Doctors suck.)