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People don't know when they're getting good health care

By dmunger on September 7, 2006.

The Wall Street Journal has an article discussing the accuracy of patient survey results in determining the effectiveness of HMOs. I'm not sure if it's behind a paywall, so I'm going to quote liberally from the article:

Researchers from the Rand Corp. think tank, the University of California at Los Angeles and the federal Department of Veterans Affairs asked 236 elderly patients at two big managed-care plans, one in the Southwest and the other in the Northeast, to rate the medical care they were getting. The average score was high -- about 8.9 on a scale from zero to 10.

Asked questions such as "How often did doctors and other health-care providers listen carefully to you? Did they explain things in a way you could understand?" patients rated their caregivers' communications skills even higher -- at an average of 9.2 on a 10-point scale.

So far, so good, right? Our health care system is coming out all right. Not so fast.

In the second part of their study, the medical researchers systematically examined 13 months of medical records to gauge the quality of care the same elderly patients had received, using a comprehensive measure of quality developed by Rand's Assessing Care of Vulnerable Elders program. (An example: "If a vulnerable elder has an acute myocardial infarction or unstable angina, then he or she should be given aspirin therapy within one hour...")

The average score wasn't as impressive as those in the patient-satisfaction surveys: 5.5 on a 10-point scale. But here's the interesting part: Those patients who graded the quality of their care as 10 weren't any more likely to be getting high-quality care than those who gave it a grade of 5. The most-satisfied patients didn't get better medical care than the least-satisfied.

So patients appear to be a poor metric of how the health care system is doing. This isn't to say that patient-satisfaction surveys are useless, just that they shouldn't be the only way of figuring that out. Regular CogDaily readers won't be too surprised by this result. After all, many patients don't even have a basic understanding of probability.

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Sounds like to me, the ratings the patients were giving mostly had to do with how well they felt connected *emotionally* to their healthcare provider. Logically it'd be hard for a person to know what their healthcare is like in the first place -- for all they know, doctors are using magic to heal them. Their ignorance of their own bodies is the reason they are AT a doctor. To learn about the healthcare solutions available. (How would they know that they were supposed to be given the aspirin? Isn't the doctor supposed to know that, as far as they're concerned?)