Through three years of medical school, I’ve seen disgruntled physicians repeatedly slam the recent movement toward patient satisfaction. In our family medicine clinic, a copy of Dr. William Sonnenberg’s essay “Patient Satisfaction is Overrated” hangs on the door to remind attendings, residents, and students of the unfair pressure to keep patients happy despite their demand for antibiotics, imaging studies, or narcotics.

The only way to keep the patients satisfied, the argument goes, is to give in to unreasonable requests. “The mandate is simple,” the author suggests: “Never deny a request for an antibiotic, an opioid pain medication, a scan, or an admission.

But the options are not simply give in to pressure or say “no” and lose patient trust. There is another path that is harder, takes more time, and is particularly challenging for young medical students and doctors: to improve communication.

“Patients aren’t the best judge of what is best for them,” Dr. Sonnenberg writes. This is true, but a physician’s calling includes not only judging what is best for patients, but also helping patients seek out accurate information, educating them, and developing the relationships and trust that ensures they understand the reasons for and against any treatment.

The author concludes with, “We should try to be kind to our patients and take time to understand them, but we must resist these misguided pressures and do the right thing. Sometimes patients have to be told ‘no,’ and the leadership in health care must understand this.”

This takes too narrow a view. Physicians must understand there is more than one way to say no. And going against patient wishes does not always lead to poor satisfaction.

A physician’s job requires — and patient satisfaction flows from — education, empowerment, and encouragement for patient decision-making within the health care delivery system. It’s explaining why his symptoms appear viral and explaining why antibiotics simply won’t help. It’s explaining that narcotics addiction is an illness in its own way, and there are other ways (e.g. rehab programs, exercise, counseling, withdrawal prophylaxis) to address the problem.

Continue reading...