Had a recent patient encounter that just underscored the importance of Dr. Edwin Leap’s recent article on patient satisfaction.
A demented patient was brought by ambulance from the nursing home. He was allegedly short of breath, but, when asked, stated that nothing was wrong. He was clinically stable, we diagnosed him with pneumonia, and I told the patient’s family that I planned to admit him.
Even though his primary care physician was on staff, the family wanted him transferred to the university hospital because in the past when the patient was hospitalized for pneumonia, he got worse and had to be put on a ventilator.
I told the family that the patient was stable and that we had the capabilities to manage his pneumonia, so a transfer at this point probably would not be considered medically necessary. I told them that I would be happy to transfer him, but they would have to sign a federal ABN form stating that if Medicare did not pay for the transfer, the family would be responsible for paying out of their own pockets whatever Medicare did not pay.
The family didn’t want to accept the possibility of paying for the transfer, so they agreed to have him admitted to our hospital.
I got a nice little note from the attending that a few hours after the patient’s admit, his respiratory status worsened. Eventually he needed to be put on a ventilator. Even though we have an ICU and intensivists, the family demanded transfer to the university hospital. The attending transferred him to avoid further complaints. And the family made sure to get the proper spelling of that emergency doctor’s name so that they could write a letter of complaint.
When hospitals overemphasize the results of patient satisfaction surveys, it may come back to bite them.
Rather than deal with the hassles and potential complaints involved with doing the right thing, some docs take the path of least resistance and do things solely to please the patients. Then Medicare refuses to pay for tests/procedures/transfers that aren’t medically appropriate and the hospital eats the cost of the care. Guess who those costs get passed on to?
And sometimes the patients still aren’t happy.
just curious… do you know why his pneumonia worsened both times requiring a ventilator? and also why didn’t the family direct him to be taken to the university hospital in the first place?
F-E-S-T-E-R M-C-D-R-E-A-M-Y, MD
Well that’s frustrating.
You do your best ..it’s the right thing.
Shows why such “popularity” scores are meaningless. They could even rip you months down the line when they come back for a cold or flu just because of something nowhere near your control happened in the past.
WhiteCoat, you’re on target as always. At the two hospitals I work, there seems to be a movement toward pleasing the patient, even when it is medically and ethically unreasonable. I think hospitals want physicians to take the risk of displeasing the patient, so the hospital doesn’t have to.