Patient Satisfaction. What happened to, "First, do no harm?"


Remember this study from 2012?  

The Cost of Satisfaction: A National Study of Patient Satisfaction, Health Care Utilization, Expenditures, and Mortality.


The conclusion:  "In a nationally representative sample, higher patient satisfaction was associated with less emergency department use but with greater inpatient use, higher overall health care and prescription drug expenditures, and increased mortality."

Yet we continue to use patient satisfaction scores.

What happened to, Primum non nocere? First, do no harm. 

During B-school, I learned that what gets measured, gets done.  But what if the thing we are measuring is causing harm to our patients?

I get it though. I love to see happy patients who say, "Thank you!" It makes me feel good about my career. 

But I don't what that measured, especially if it's causing harm! 

If doctors are paid to please patients, how does an MD tell his patient to lose weight, quit smoking, eat right, and that antibiotics are unnecessary for their URI?

The solution is simple. 

D/C patient satisfaction scores. 

Ketamine instead of 5150?

I frequently see patients who are depressed and suicidal. It's tough for our patients and I wonder what can be done for them.

My typical plan of action is to medically screen these patients, including: history, physical exam, labs, urine toxicology screen, and call for a psychiatry consult, if available.

Usually, these patients wait for a long time to be transferred to a psychiatric medical center where they can be evaluated by a psychiatrist.

Now, studies have shown that giving a low-dose ketamine (0.5mg/kg) intravenous push can rapidly alleviate these symptoms. 

http://www.ncbi.nlm.nih.gov/m/pubmed/23982301/

http://mobile.nytimes.com/2014/12/10/business/special-k-a-hallucinogen-raises-hopes-and-concerns-as-a-treatment-for-depression.html?referrer=&_r=0

Would it be more beneficial for some patients to be treated with ketamine in the ED with outpatient psychiatry followup? 

This would enhance medical care in several ways:

1. No waiting in ED for psych bed
2. Rapid alleviation of depression symptoms
3. Return to home sooner for patients

The next step is to do randomized controlled studies in ED patients who present with suicidal ideation and see if they benefit from a dose of ketamine.