For most patients, a bad hospital experience results from poor communication and the lack of compassion. Patients attribute their unpleasant hospital experiences and negative impression of healthcare services to the deficit in bedside manners as well as to shortages in staffing that lead to long waits and hustled, non-empathic conversations.

While patients feel that the inadequacies of a comprehensive healthcare system influence their experiences in hospitals, does patient satisfaction truly correlate with better quality of healthcare?

When patients’ expectations are unmet

A poor patient experience is an incontinent patient who is left wet due to a shortage of staff, where overworked nurses are withheld from readily tending to all patients. It is when a patient’s son has left before the doctor could speak to him. It is the long wait in the crowded clinic. It is when a patient wants a painkiller for pain, but the clinician decides that it may not be necessary.

Patient experience surveys are the latest trend in healthcare, introduced with the aim to address what makes patients unhappy in hospitals. The perception is such that good patient experience links to good medicine, and the survey responses point the finger to clinicians’ approach to patient care when patients are dissatisfied.

Though the feedbacks are based on small cohorts, they still pressure and affect how healthcare providers deliver their care. Take for example, a physician who opts for conservative treatment for pain such as with ibuprofen or physical therapy. A patient unhappy with the treatment plan will note down his experience in the survey.

Over 12% and 32% of visits to primary care and emergency department respectively involve consultations for pain resulting in such prescriptions of uploads or benzodiazepines and these rates are steadily on the rise.

“The mandate is simple: Never deny a request for an antibiotic, an opioid medication, a scan, or an admission,” said family physician Dr William Sonnenberg, who added that such questionnaire scorings have “become a bigger threat to the practice of good medicine than trial lawyers.”

Bad medicine: giving patients what they want

However, “giving patients exactly what they want, versus what the doctor thinks is right, can be very bad medicine,” wrote Kai Falkenberg from in a Forbes article addressing why rating a doctor is bad for patient health.

A diabetic patient who was not given jam on his toast may complain of his hospital experience, but better a grumpy patient than one comatose from poorly managed glucose levels.

More often than not, patients do not realise that certain regulations and guidelines are reinforced not for bureaucracies but as part of recommended clinical practice. Looking back at the example for pain management, should a physician prescribe controlled drugs and powerful pain medications too readily, he or she may come under fire for irresponsible medical practices.

The truth, however, is that most patients actually understand that their experiences are not related to the necessities in healthcare.

The patients who are most in need tend to complain the least, maybe because their chronic illness has taught them patience and empathy, or maybe because they understand the necessity of having to be stuck waiting on a trolley bed while awaiting chemotherapy.

No doubt, it is essential to address the need to improve healthcare delivery. However, with patient experiences surveys, physicians are often caught in the middle between patient satisfaction, their responsibilities, and hospital regulations.

Fact remains that practising professionalism is not always what meets the eye, and the best approach to strike a balance in patient experience, satisfaction and outcomes is to implement “shared decision-making” with patients. MIMS

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