4 ms·

> How doctors of all professions lost their professional agency to do-nothing administrators within a generation is quite puzzling and a bit terrifying to me.

> How doctors of all professions lost their professional agency to do-nothing administrators within a generation is quite puzzling and a bit terrifying to me. I have a lot of friends at various levels of healthcare, from nursing up through low and mid-level administrative positions. The one thing they all seem to agree on is that patient satisfaction surveys have been terrible for healthcare. Once the emphasis shifted to patient satisfaction, everything became more of a game of catering to what the patient thinks they want. With the spread of rampant medical misinformation on the internet and the rise of alternative-medicine podcasts/blogs/influencers masquerading as informed medical professionals they have a constant influx of patients who show up believing they have a certain condition or need a certain medication. If you disagree too much or refuse to give them the medication they want, you risk a negative review. Too many negative reviews could negatively impact your compensation or even cost you your job. Even at offices that don't perform patient satisfaction surveys, providers are at the mercy of negative online reviews. Again, if you don't do exactly what the patient thinks they want, you risk scathing online reviews. This is terrifyingly problematic given the trend of people to self-diagnose with anxiety or infections who show up demanding Xanax or antibiotics. Puts doctors in a situation where they don't really think prescribing those medications is a good idea, but they also feel like they can't deny too many patients or they risk their reputation/bonus/reviews. It's also a huge problem with conditions like obesity or alcoholism or smoking, where the doctors can see obvious patient-induced health issues but the patient really doesn't want to hear the truth from their doctor.

hedora 5y ago
That reminds me. I have one laying around to fill out. 10/10 plan to get sick again.
CityOfThrowaway 5y ago
Patient satisfaction surveys are the legible feedback mechanism showing that something is deeply broken, but not the source of the problem itself. It's clear from your comment that the source of the problem is the increasingly sharp divide between what the credentialed medical professionals believe and what lay people believe. The satisfaction survey is simply uncovering that fact. It would be vastly worse if patients were being treated and had no recourse when they felt their health was mismanaged. It may well be the case that the patients are wrong, but it is extremely dystopian to imagine a world where individuals are not empowered to make decisions about their own bodies.
- PragmaticPulp 5y ago
  That's the theory - That patient satisfaction surveys will uncover the bad providers. But in the real world, if someone is receiving bad care they don't continue making followup appointments with that doctor. Nobody continues going back to the same bad doctor over and over again and writing negative reviews. It's really easy to calculate churn rate for individual providers. The hot topic now is tracking outcomes: The idea is that with enough data collection and crunching, we can eventually start tracking which providers have better outcomes among their patients. This is one of those things that sounds great on paper but has a lot of challenges in the real world. It's also prone to gaming, as we've seen from surgeons who have learned to avoid difficult cases so they can avoid the risk of another patient death statistic.
  - bumby 5y ago
    This is spot on. It's not the metric itself which is the problem, but how the metric is interpreted and formed into action. We can all understand the ramifications if we rated parents on "child satisfaction". Lots of kids would be having candy for dinner. The real metric we probably want is improved patient outcome, which may not be synonymous with patient satisfaction. I don't think that's necessarily incongruent with the OPs point. If the metrics are being gamed or the metrics are being used to inaccurately gauge provider care, those are systemic issues. Or it could be the case of well-intentioned, but poorly chosen metrics.
- pc86 5y ago
  Patients have always been entitled to make decisions about their bodies. You can decline procedures, and treatment, and you can get second, third, fourth, fifth opinions. Satisfaction surveys do nothing to increase that autonomy. The dystopian world you speak of is a straw man. The problems stems from people believing they are consumers of healthcare, on equal footing with the practitioner they are seeing. They're not, objectively. A 45 minute Google search doesn't equal 4 years of college (usually in something like biochem but not always), 4 years of medical school, 3-7 years of residency training and potentially another 1-4 years of fellowship training. If you're seeing anyone above a family doctor/PCP, they 100% know more about your condition than you do, whether you've been living with it for a decade or not. That doesn't mean you don't have autonomy, or that you shouldn't question your doctor's decisions and ask for explanations, but it does mean you should err on the side of thinking the person whose spent at least a decade, but probably closer to two, educating themselves to get where they are probably knows what they're talking about.
deleted 5y ago
[deleted]
bitsnbytes 5y ago
"The one thing they all seem to agree on is that patient satisfaction surveys have been terrible for healthcare." My Wife is an ER nurse manager and while you have many self entitled idiotic patients that think they are staying in a resort versus visiting an ER, the patient satisfaction surveys is not very high in regards to the issue and why nurses are leaving. My wife actually had a person complain that the ER did not have cow bells to call for a nurse (She claimed to be a retired nurse and they always had that for back up, lol) and they constantly complain how come they came in first for a stubbed toe, but another patient with a gunshot wound or heart attack is being seen first. The bigger issue as why nurses are leaving the field from what she has seen and experienced is: 1. wages: The wages are beyond inadequate in certain nursing specialties and many have left to become traveling nurses or contracted nurses that get paid double the standard nurse pay. 2. Burn out: Besides covid, Hospitals Patient to nurse ratio is often exceeded and no accountability for the hospital to break those ratios. Nor any consideration for a high demand patient versus a low demand patient. Then when something goes wrong the hospital looks to pin it on the nurses. This was an issue before covid . but covid just added fuel to the fire. 3. BS. nurses get bs from ALL sides. They get bs from the patients and even more bs from upper management who set unrealistic process in place that is more concerned by hiding accountability and making things look good on paper than actual patient care. Then you had that whole BS covid movement crap calling nurses hero but besides lip service they did absolutely nothing for them. In fact they did the opposite. I know my wife had to fight the executives because they wanted to make nurses use their vacation time for sick time if they got covid. Their explanation for this that if the nurses got covid it was not likely from the hospital as the hospital takes extreme precautions to prevent it. The funny thing was that the same hospital spewing that BS also wanted nurses to not wear mask due to possible shortages at the beginning of covid. Insert the BS is to DAMN High meme here. 4. RaDonda Vaught's conviction. This is certainly not helping the case to get more nurses.
- PragmaticPulp 5y ago
  > My Wife is an ER nurse manager and while you have many self entitled idiotic patients that think they are staying in a resort versus visiting an ER, the patient satisfaction surveys is not very high in regards to the issue and why nurses are leaving. ER is definitely a different ballgame. Thanks for the additional perspective. The patient satisfaction surveys apply more to domains where repeat visits are the norm: Family doctor, nurse practitioners, and so on. (Ideally, none of us becomes a frequent customer of the ER nurses!)
mikkergp 5y ago
I get what you're saying, but the promise of the medical system and the implementation of the medical system aren't really aligned. Sure 50% of problems are naive patients, but the other 50% are doctors or a system that doesn't know how to talk to you or treat you, or there's just an ocean of uncertainty in how to operate. You show the negative side from the doctor perspective, but on the other hand. Doctor's aren't really trained in 'health' they're trained in pathology. If you're really sick they can provide help, but if you want to optimize or you're kind of sick, or your numbers are borderline. Medicine is just sort of not a hard science, there's way too much uncertainty. You mention people demanding antibiotics, but the doctor's are just as bad -- last time I tried to have a nuanced discussion about it with a practitioner, the answer was a simple "x days is the standard of care". Not to mention that the doctors would have to be up to date on the latest versions of research in a ton of different areas to have some of those answers anyway. I'm not going to leave terrible reviews about it, but I rarely leave a medical office feeling satisfied that there are firm answers on anything.

hedora 5y ago

That reminds me. I have one laying around to fill out. 10/10 plan to get sick again.

CityOfThrowaway 5y ago

Patient satisfaction surveys are the legible feedback mechanism showing that something is deeply broken, but not the source of the problem itself. It's clear from your comment that the source of the problem is the increasingly sharp divide between what the credentialed medical professionals believe and what lay people believe. The satisfaction survey is simply uncovering that fact. It would be vastly worse if patients were being treated and had no recourse when they felt their health was mismanaged. It may well be the case that the patients are wrong, but it is extremely dystopian to imagine a world where individuals are not empowered to make decisions about their own bodies.

PragmaticPulp 5y ago
That's the theory - That patient satisfaction surveys will uncover the bad providers. But in the real world, if someone is receiving bad care they don't continue making followup appointments with that doctor. Nobody continues going back to the same bad doctor over and over again and writing negative reviews. It's really easy to calculate churn rate for individual providers. The hot topic now is tracking outcomes: The idea is that with enough data collection and crunching, we can eventually start tracking which providers have better outcomes among their patients. This is one of those things that sounds great on paper but has a lot of challenges in the real world. It's also prone to gaming, as we've seen from surgeons who have learned to avoid difficult cases so they can avoid the risk of another patient death statistic.
- bumby 5y ago
  This is spot on. It's not the metric itself which is the problem, but how the metric is interpreted and formed into action. We can all understand the ramifications if we rated parents on "child satisfaction". Lots of kids would be having candy for dinner. The real metric we probably want is improved patient outcome, which may not be synonymous with patient satisfaction. I don't think that's necessarily incongruent with the OPs point. If the metrics are being gamed or the metrics are being used to inaccurately gauge provider care, those are systemic issues. Or it could be the case of well-intentioned, but poorly chosen metrics.
pc86 5y ago
Patients have always been entitled to make decisions about their bodies. You can decline procedures, and treatment, and you can get second, third, fourth, fifth opinions. Satisfaction surveys do nothing to increase that autonomy. The dystopian world you speak of is a straw man. The problems stems from people believing they are consumers of healthcare, on equal footing with the practitioner they are seeing. They're not, objectively. A 45 minute Google search doesn't equal 4 years of college (usually in something like biochem but not always), 4 years of medical school, 3-7 years of residency training and potentially another 1-4 years of fellowship training. If you're seeing anyone above a family doctor/PCP, they 100% know more about your condition than you do, whether you've been living with it for a decade or not. That doesn't mean you don't have autonomy, or that you shouldn't question your doctor's decisions and ask for explanations, but it does mean you should err on the side of thinking the person whose spent at least a decade, but probably closer to two, educating themselves to get where they are probably knows what they're talking about.

deleted 5y ago

[deleted]

bitsnbytes 5y ago

"The one thing they all seem to agree on is that patient satisfaction surveys have been terrible for healthcare." My Wife is an ER nurse manager and while you have many self entitled idiotic patients that think they are staying in a resort versus visiting an ER, the patient satisfaction surveys is not very high in regards to the issue and why nurses are leaving. My wife actually had a person complain that the ER did not have cow bells to call for a nurse (She claimed to be a retired nurse and they always had that for back up, lol) and they constantly complain how come they came in first for a stubbed toe, but another patient with a gunshot wound or heart attack is being seen first. The bigger issue as why nurses are leaving the field from what she has seen and experienced is: 1. wages: The wages are beyond inadequate in certain nursing specialties and many have left to become traveling nurses or contracted nurses that get paid double the standard nurse pay. 2. Burn out: Besides covid, Hospitals Patient to nurse ratio is often exceeded and no accountability for the hospital to break those ratios. Nor any consideration for a high demand patient versus a low demand patient. Then when something goes wrong the hospital looks to pin it on the nurses. This was an issue before covid . but covid just added fuel to the fire. 3. BS. nurses get bs from ALL sides. They get bs from the patients and even more bs from upper management who set unrealistic process in place that is more concerned by hiding accountability and making things look good on paper than actual patient care. Then you had that whole BS covid movement crap calling nurses hero but besides lip service they did absolutely nothing for them. In fact they did the opposite. I know my wife had to fight the executives because they wanted to make nurses use their vacation time for sick time if they got covid. Their explanation for this that if the nurses got covid it was not likely from the hospital as the hospital takes extreme precautions to prevent it. The funny thing was that the same hospital spewing that BS also wanted nurses to not wear mask due to possible shortages at the beginning of covid. Insert the BS is to DAMN High meme here. 4. RaDonda Vaught's conviction. This is certainly not helping the case to get more nurses.

PragmaticPulp 5y ago
> My Wife is an ER nurse manager and while you have many self entitled idiotic patients that think they are staying in a resort versus visiting an ER, the patient satisfaction surveys is not very high in regards to the issue and why nurses are leaving. ER is definitely a different ballgame. Thanks for the additional perspective. The patient satisfaction surveys apply more to domains where repeat visits are the norm: Family doctor, nurse practitioners, and so on. (Ideally, none of us becomes a frequent customer of the ER nurses!)

mikkergp 5y ago

I get what you're saying, but the promise of the medical system and the implementation of the medical system aren't really aligned. Sure 50% of problems are naive patients, but the other 50% are doctors or a system that doesn't know how to talk to you or treat you, or there's just an ocean of uncertainty in how to operate. You show the negative side from the doctor perspective, but on the other hand. Doctor's aren't really trained in 'health' they're trained in pathology. If you're really sick they can provide help, but if you want to optimize or you're kind of sick, or your numbers are borderline. Medicine is just sort of not a hard science, there's way too much uncertainty. You mention people demanding antibiotics, but the doctor's are just as bad -- last time I tried to have a nuanced discussion about it with a practitioner, the answer was a simple "x days is the standard of care". Not to mention that the doctors would have to be up to date on the latest versions of research in a ton of different areas to have some of those answers anyway. I'm not going to leave terrible reviews about it, but I rarely leave a medical office feeling satisfied that there are firm answers on anything.