Most people would answer that question with a strong affirmative “of course”. So you can imagine my reaction when I opened my weekly Orthopedic Journal’s online publication to read the feature article: “Patient Satisfaction Not Proxy For Quality”. The article basically says that patients can’t tell the difference in the quality of their care and base their satisfaction on the personality or bedside manner of the physician. Further, the author is seeking a “scientific” method to determine the quality of care which includes safety, efficiency and effectiveness of care. The suggestion is that “you can be a doctor with a lot of patient complications and patients who are rarely made better by your care, but if you have a great relationship with your patients they will report being “very satisfied” with their clinical visit or surgical care. Are they kidding???
Sure, patient/physician relationship is very important to the patient’s feeling of receiving good care, but the effectiveness of the treatment is a far larger determinate of patient satisfaction. You see, the problem is that the outcome measurement surveys are not really reflective of the true magic that surgeons perform. This story reminds me of the TV show “Kitchen Nightmares”, where Chef Ramsey intervenes in a failing restaurant and when he discusses the poor quality of the food or service, the owner stubbornly denies that is the problem. He usually blames the cook or other staff, but never the product that he has been serving or himself.
I have a lot of respect for orthopedic surgeons. The many years of vigorous training, internship, residency and fellowship programs that surgeons must undergo is laudable. The issue here is that most surgeons are not really aware of their patient outcomes over time, because once the patient has had the surgery and one or two follow up visits, they go back to their traditional medical providers. The surgeon is only aware of a problem if there are complications, such as infection or nerve/organ damage, stroke, coma or death. In the absence of those complications, the surgeon considers the surgery a success.
The problem is, when patients are asked to complete a questionnaire about their experience, the results are not so good. I don’t blame the surgeons as much as our system, where patients are sent off to specialists for diagnostic testing and specialized treatments (surgery or pain management) and so much of their care falls between the cracks. If a patient has a lot of pain and difficulty after their surgery, they are sent to physical therapy or pain management to deal with the issue, leaving the surgeon out of the loop unless the patient requires revision surgery.
We see many patients, who after their first surgery to correct a problem would rather see hell freeze over before undergoing another one. Yesterday, I met a patient who came in for a knee consultation named Bruno. He is a delightful man of 74 who played and worked hard all his life and had already had hip and knee replacement surgeries. He visited our office after poor results from his first knee surgery and wants to avoid going under the knife for his other knee. When I asked if his surgeon knew that his results had not met his expectations, he said he had no idea and that the surgon or his office had not contacted him since his last visit, which was 3 weeks after his surgery. He still suffers from continous pain of his hip and knee and was very hopeful that he was a candidate for stem cell transplant in his other knee.
My opinion is that the poor outcomes are based on patient expectations. And if surgeons truly understood the real results from their surgeries, they would likely do a better job of explaining the risks and probable outcomes of the operation. So many of our patients have told me that their surgeon confidently assured them that their surgery will fix their problem, which led them to undergo the procedure expecting just that.
My point here is that there is no panacea out there. If you are considering surgery, please research the procedure carefully, then get a second or even a third opinion (perhaps from another type of physician, who is not solely focused on surgical solutions). Consider the alternatives to surgery, because once you undergo the scalpel you may never be the same.
Dr. Norman Deitch