Since patient-centered metrics are likely to remain relevant in the future, and with the unique challenges this can present to practicing gastroenterologists, achieving higher degrees of patient satisfaction remains both aspirational and difficult. We will be asked to reconcile and manage not only clinical conundrums but also seemingly conflicting realities of patient preferences. For example, it has been shown that, among patients with irritable bowel syndrome (IBS), more testing led to higher satisfaction only until that testing was performed within the context of a gastroenterologist’s care.13 In contrast, within the endoscopy setting, a preprocedure diagnosis of IBS did not increase the risk for procedure-related dissatisfaction, provided patients were not prescribed chronic psychotropic medication, nervous prior to the procedure, distressed or in pain during the procedure, or had unmet physical or emotional needs during the procedure.14 Furthermore, there is poor correlation between endoscopic quality measures with strong evidence – such as adenoma detection rate, withdrawal time, and cecal intubation rate – and patient satisfaction.15
So, when considering these conflicting findings and evidence that patients’ global rating of their health care is not reliably associated with the quality of the care they receive,16 should we emphasize experience over outcome? As clinicians practicing in an increasingly transparent and value-based health care environment, we are subject to many priorities contending for our attention. We strive to provide care that is at once patient centric, evidence based, and low cost; however, achieving these goals often requires different strategies. At the end of the day, our primary aim is to provide consistently excellent patient care. We believe that quality and experience are not competing principles. Patient satisfaction is relevant and important, but it should not preclude adherence to our primary responsibility of providing high-quality care.
When trying to make clinical decisions that may compromise one of these goals for another, it can be helpful to recall the “me and my family” rule: What kind of care would I want for myself or my loved ones in this situation?
We thank Dr. Ziad Gellad (Duke University, Durham, N.C.) for his assistance in reviewing and providing feedback on this manuscript.
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Dr. Finn is a gastroenterologist with the Palo Alto Medical Foundation, Mountain View, Calif.; Dr. Leiman is assistant professor of medicine, director of esophageal research and quality in the division of gastroenterology, Duke University, Duke Clinical Research Institute, and chair-elect of the AGA Quality Committee.