Are patients more satisfied with hospitalists or are they more satisfied with the care of their primary care physician? That is a question that was asked and reported in the February 2012 Journal of Hospital Medicine (volume 7, number 2) in research titled Patient Satisfaction With Hospital Care Provided by Hospitalists and Primary Care Physicians.
I read the full text article. Continuity of care has been said to increase patient satisfaction scores in the outpatient setting by creating a bond of trust. To the casual observer, it would make sense that patients would be more satisfied with doctors for whom they trust in their in their long term relationship. I have always doubted this reasoning. We don't care about trust. Patients will be much more satisfied with their doctors if they are treated like royalty. Would you be more happy with a doctor you trust or one that waves your $50 copay. Be honest with yourself. I know you'll take the money. Satisfaction is not about trusting your physician. It's about amenities. It's about FREE=MORE. It's about getting something for nothing. Provide iPads and laptops to waiting patients and you'll see your satisfaction scores sky rocket overnight. I don't need an overpaid consultant to tell me that.
The theory of this research says that primary care doctors should have better patient satisfaction scores than hospitalists because of their greater continuity and trust in their long term longitudinal relationship. The interesting thing, though is that this hypothesis has very little research to support this conclusion. Until now. What did this important research tell us? Patients cared for by hospitalists do not have a statistically significant difference in patient satisfaction, defined as physician care quality, behavior, communication or pain control.
What this tells me is that continuity of care is not all that it's cracked up to be. It's what I have said all along. In fact, the article's discussion touches on this point. There are many factors that go into how patients perceive how satisfied they are with their care. Using the AIDET method is one way to improve satisfaction scores. My ideas are different and more clinically relevant. If you want to know what makes patients happy, I've compiled my list of required actions hospitals must take to reach 100% on their patient satisfaction scores and get paid for the work provided.
Study specifics: 8295 patients (3597 cared for by 59 hospitalists and 4,698 cared for by 288 primary care physicians) interviewed between 2003 and 2009 at three Massachusetts hospitals affiliated with Baystate health (75% from a large tertiary referral center and 25% from two smaller community hospitals). Patient characteristics were quite similar between hospitalists and primary care physicians. Interestingly, both primary care physicians and hospitalists achieved nearly 80% for the highest satisfaction category and 5% for the lowest satisfaction category.One other thing. Many of our patients bounce back so often that they see the hospitalist more than they see their primary care physician. Who says hospitalists don't provide continuity of care. It's what we do for a living.