Wednesday, November 28, 2012

Pain and Patient Satisfaction Surveys

Consumerism is all around us, particularly at this time of year.  The last decade has introduced a new level of consumerism in health care in various forms: high deductible plans that encourage choice of lower price providers, public and private agencies publishing hospital safety and efficacy data, and of course, the concept of patient satisfaction and its accompanying surveys, consequences, and controversies. 

I used to be a hospital strategy consultant and I've seen hospital leaders grapple with the concept of patient satisfaction.  On the one hand, there appears to be a correlation between patient satisfaction and overall health outcomes for an institution.  On the other hand, an individual patient's definition of "satisfaction" can be shockingly misaligned with the appropriate care pathway. 

Perhaps no better example of this can be found than in the area of chronic pain treatment.  The patient wants the pain to go away.  The doctor (unfortunately and all too often) wants the patient to go away.  The harsh reality of treating chronic pain: once all the surgeries and procedures have been tried, there isn't much money to be made in maintenance care.  (The exception, of course, is the physician who dispenses drugs from his office, creating one of healthcare's most obvious, most egregious, and most perverse incentives).

The best way to deal with this set of circumstances and keep the patient "satisfied" is to write another set of prescriptions.  Better yet, just call it into the pharmacy and have the patient go pick it up. 

I was encouraged to see Dr. Zachary Meisel and Dr. Jeanmarie Perrone take a stand on this topic in a piece that wrote for Time magazine:

"Medical guidelines already state that doctors shouldn’t be choosing opioids for most patients with chronic pain. But we doctors also need to start scaling back on prescribing opioids for acute pain, since some acute pain turns into chronic pain. Everyone with new pain should be started on a high dose of ibuprofen (like Motrin or Advil) or acetaminophen (like Tylenol). These medications have been proved to work as well as the opioids even for conditions like gall-stone attacks. For some patients, we can add a prescription for a limited number of opioid pills to be filled only if absolutely necessary. With that small prescription should come a big warning. Something like: 'These drugs are highly addictive, even in short-term use. These drugs have been associated with death, even in therapeutic dosing. These drugs, when accidentally ingested by children, are fatal.' As doctors, we must stop fearing patient-satisfaction surveys and talk honestly to our patients about pain. It may take an extra few minutes, but it will save lives."


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