Assessing the influence of healthcare outcomes as compared to provider "patient friendliness" is difficult.

Last month, @cancergeek (AKA JACR associate editor Andy DeLaO) tweeted a presentation slide from a Health:Further conference in Tennessee. (Health:Further is an event for people who believe that together we can make healthcare better.) The slide shows a bar graph with the results of a published patient survey about what patients want in their healthcare.

This led to a tweet by @pjonwhite (AKA Jon White, acting deputy national coordinator for the Office of the National Coordinator for Health Information Technology at the U.S. Department of Health and Human Services) commenting that the results did not include anything about fixing the patient's problem. In other words, the survey results show nothing about how patients value a good healthcare outcome. I hypothesized that maybe patients assume the physician can fix whatever problem they have and only ranked what they wanted from the relationship characteristics of the interaction with the physician. Or it could be that healthcare outcomes are not important for patient satisfaction.

Do patients think about outcomes when they meet with their physicians? Is it different when looking for a new physician as compared to visiting your regular physician for an immediate health issue? Do patients comparison shop on outcomes for new physicians while not holding their regular physician to the same standard because there is already an established relationship?

I reflected on a recent personal experience. I visited my regular primary care doc for lower back pain radiating to my right leg, resulting in a limp. Within 10 minutes, my doc of 15 years commented that my right leg was shorter than my left leg and that my spine was not straight. I got an x-ray. I took home a CD with the images and popped it into my laptop. Even as a lay person, I could see my spine was not straight. I took pictures of the x-ray images on the computer screen and sent them to a good friend who is a thoracic surgeon. His comment was it looked like I had a lot of degenerative disease. A week later, I got the radiologist report. The radiologist confirmed I had spinal scoliosis, degenerative disk disease, advanced arthritis, and a partially slipped disc — a veritable Chinese menu of back issues. (As an aside, I would have loved to talk to the radiologist right at the time of the x-ray instead of having to wait a week while improvising my own diagnosis in the meantime.)

My dad, his brother, and his sister all have spinal scoliosis. Scoliosis can be hereditary and can be caused by one leg being shorter than the other. My primary care doc did not pick up on my scoliosis in my 15 years of annual visits. I have to mention here that I really like my primary care physician and trust his medical knowledge and judgement. I was a little surprised that he did not notice my shorter right leg and my back not being straight for what may have been many years.

I recounted this episode to my stepdaughter. Her first question was: Are you going to find another primary care physician? That thought had never occurred to me. I have a long-term relationship with my doc, I like him, he is very patient friendly, and he seems very competent to me.

Why do I think he is competent? Because he listens to and considers my input, because he admits when he doesn't know something and researches it and gets back to me, because he is open to alternative treatments and approaches that are evidence based, because he spends the amount of time with me that I need even if he has a tight schedule, because he is not afraid to say he made a mistake, and because he respects me. Just because I like him, does this mean I give him the benefit of the doubt for what may seem to be an oversight or mistake? Or is it because, up until now, I haven't had any problems with his care (that I know of)?

Would I consider the same things to be important if I needed surgery? Would I turn down a surgeon with great results if I found her to be unfriendly in our initial discussion? Would I accept a surgeon with mediocre results if I perceived him to be patient friendly? What would I do if a radiologist I never met made a mistake reading an imaging study? Would I ask that my future imaging results be read by a different radiologist?

Do healthcare outcomes matter to patient satisfaction? Does it depend on the length and nature of the relationship? Or maybe the information on healthcare outcomes is not available or is not easy to understand or compare so we use patient friendliness as a surrogate measure to assess competence.

What do you think?

​Additional Resources

Patient Satisfaction: Opportunities for Quality Improvement

How a Culture of "Commitment to Respect" Enhances Quality of Care and Patient Satisfaction

Factors Influencing Patients' Perspectives of Radiology Imaging Centers: Evaluation Using an Online Social Media Ratings Website