Psychological Distress Lowers Patient Satisfaction Scores

The main goal of orthopaedic surgeons is to help patients feel and function as well as possible. In that context, the notion of “patient satisfaction” is as old as Hippocrates himself. But in an era when patient satisfaction is eagerly measured and used to evaluate physician performance and determine compensation, the phrase takes on broader significance.

The May 20, 2015 JBJS features a retrospective study by Abtahi et al. that determined that psychologically distressed patients give significantly lower satisfaction scores following spine surgery than patients categorized as “normal.” These findings bolster an increasing body of evidence suggesting that patient-specific characteristics have a greater bearing on patient satisfaction measures than the actual quality of care delivered.

The study looked at 103 patients at a single academic spine surgery center who completed both a patient satisfaction survey (Press Ganey Medical Practice Survey, scored from 0 to 100) and a Distress and Risk Assessment Method (DRAM) questionnaire for the same clinical encounter. Using the DRAM data, researchers classified the patients into four groups: normal, at-risk, distressed-depressive, and distressed-somatic.

The mean overall patient satisfaction scores were as follows:

  • 90.2 in the normal group
  • 94.7 in the at-risk group
  • 87.5 in the distressed-depressive group
  • 75.7 in the distressed-somatic group

Mean scores for patient satisfaction with the provider, in the same group order as above, were 94.2, 94.2, 90.6, and 74.9, respectively.

The authors offer two possible explanations for the findings: “Patients with greater levels of distress and less effective coping strategies may be more likely to  perceive their entire medical care experience in a more negative light, or…psychological distress negatively impacts provider empathy and the communication quality between doctor and patient.”

In a commentary on the study (free content), Robert Barth, PhD observes that implementing scientifically credible health care guidelines often conflicts with patient expectations and decreases patient satisfaction. He argues that “monitoring the scientific credibility of health care is a much more direct and valid approach than judging the quality of health care on the basis of patient satisfaction.” At the same time, Barth cites prior research connecting psychological distress to poorer surgical outcomes and says the findings from Abtahi et al. “emphasize the need for clinicians to thoroughly consider the psychological makeup of the patient when providing surgical and other general medical services.”

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