患者滿意度的提高＝死亡率升高2倍＋發病率增高1.5倍＋抗生素增加8倍

美國一項嚴格的前瞻性多中心對照研究進行了10年,因其對患者危害巨大而提前終止。這項將患者隨機分為兩組：一組採用常規醫護；另一組進行患者滿意度調查,結果作為醫生收入和獎懲依據。結果顯示:提高患者滿意度使死亡率升高238%,發病率增高146%,抗菌素應用增加858%。結論：讓醫學知識缺乏的患者滿意會讓生命付出代價！

原文如下：

Patient Satisfaction Survey Study Halted, Mortality Increased 238% with Patient Satisfaction.

By Doktor Schnabel - August 2, 2014

LOS ANGELES, CA– 「We have to halt this study immediately!」 was a warning issued by lead researcher, Dr. Hans Willford from UCLA. 「Long term mortality rates are sky rocketing over our placebo groups.」

patient satisfaction surveyIn an effort to decrease medical costs and to improve patient care, a multicenter randomized study was launched nine years ago to determine if satisfied patients led to an actual improved quality of care, healthcare cost savings, and increased life expectancy. Contrary to popular beliefs from administrators and politicians, the results were disastrous.

「This is not what we expected at all,」 said Patrick Rhinno, CEO of Prezz Ganey, a healthcare consulting firm. 「I mean, we were expecting this study to help launch our patient satisfaction computer programs into every single hospital and medical clinic in America. I』m sure the study is flawed.」

The PISS study, short for Patient Improvement Satisfaction Study, took patients and divided them into two groups. The placebo group would receive routine medical care while the second group implemented patient satisfaction surveys and linked scores to monetary reimbursement. Physicians were told before treating patients which group the patient belonged to. Physician and hospital reimbursement remained normal in the placebo group, but in the survey group, physician salary and hospital reimbursement were tied directly to patient satisfaction scores from surveys.

Patients in the survey group demonstrateda 238% increase in mortality and a 146% increase in morbidity with chronic medical conditions over the 10 year period.

「Patient satisfaction appears to be directly related to increased mortality and morbidity,」 said FDA spokesman Dr. Rachel Barthow. 「Counterintuitive to many other aspects in life, satisfaction in medical care does not always equate to improved care. As a matter of fact, it may be detrimental to one』s health.」

Gomerblog』s medical correspondent, Dr. Bryan Thompson, gave Gomerblog this analysis:

「The problem with linking reimbursement to patient satisfaction is completely flawed from the start. Here』s an example. A patient that weighs 340 pounds comes into your clinic. We all know the healthiest intervention for this patient is weight loss. However, if a doctor mentions weight loss to the patient and they get upset, guess what? Negative patient satisfaction survey, which could mean decreased reimbursement. A doctor looking for increased reimbursement will possibly tell the patient that everything looks great and just keep doing what you are doing in eating those cheeseburgers. Guess what, excellent patient satisfaction survey.」

The study also showed an 858% increase in antibiotic prescriptions to patients with viral like symptoms in the survey group. Those patients developed more antibiotic resistant infections and C. diff than over the placebo group. ER physician, Dr. Rachel Kenners said, 「If we don』t give antibiotics to patients who come to the ER for their runny nose and cough, than we are almost guaranteed a negative survey. To get paid and to keep our jobs, we have to prescribe antibiotics even though they aren』t warranted.」

Cherry picking healthy patients and avoiding sicker patients was clearly evident in the study. 「One physician told a dialysis patient that it was OK to skip a week of dialysis so that the patient could head down to Disneyland,」 said an undercover internal medicine physician.

He had the patient fill out a glowing survey before leaving the clinic. A week later when the patient returned with chest pain and peaked T waves, the physician forced his junior partner to see the patient, so that he could see teenager sports physicals. For the physicals he just signed on the bottom line and had all patients in and out in 5 minutes. He received glowing satisfaction surveys from parents due to the quickness of his exams, without ever laying a stethoscope on them.

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Dr. Goop continued: 「And, as one can see another way to improve patient satisfaction is to decrease patient wait times. Ok, so a doctor who spends less time with patients and less time thinking about their medical problems will lead to decreased wait times. Boom, excellent patient satisfaction scores!」

A medical ward nurse was recently written up for bringing a diabetic patient an ADA approved food tray, instead of the ham sandwich that the patient wanted. 「The patient』s blood sugar was in the 300s. I refused to bring him a ham sandwich with chips and I got slapped with a horrible survey!」

Anti-vaxxers pose a unique challenge during satisfaction surveys. Essentially primary care providers have to tell them that vaccines do cause Autism and they should not get vacccines to even think of getting reimbursed fully.

Some hospitals have even resorted to a 「Ask for Dilaudid, Get Dilaudid」 policy just to ensure possibly breaking even in managing and treating drug seekers. Cost analysis demonstrates that passing out Dilaudid to everyone who asks for it brings in more money in the long run even when you account for patients who die of respiratory depression or other opioid induced complications.

A family physician, wishing to remain anonymous had this to say: 「Doctors and nurses aren』t paid to be your friend or to sugarcoat things. We are here to give sound medical advice and to treat medical problems. It』s what we were taught to do. Yes, we want to be your friend,we want to treat you if respect as long as you treat us with respect, but we have to do the right thing for you and sometimes that means telling you things that you may not want to hear or do.」

「Thinking that doctors and nurses will only do the right thing in medicine by dangling dollar bills in front of us is actually a complete insult, and the companies and governments imposing these stipulations upon us need to redirect their actions towards their own flaws and greed.」

原文地址：http://gomerblog.com/2014/08/patient-satisfaction-2/

來源：中國醫學博士聯絡站

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