Patient Satisfaction

In the past decade more emphasis has been placed on personal satisfaction. We can rate and review EVERYTHING. Love the new dentist? Write a Yelp review! Find a hair in your food? Leave a bad review on Google or Yelp. Mad at your NP who wouldn't prescribe a Z-pack? Write her up on HealthGrades. It seems like the Burger King slogan of, 'Have it your way', has infiltrated every industry.

Unfortunately, it occurs in health care. Why unfortunately? Because sometimes the best thing for the patient will not make them happy. Giving a Z-pack to a patient who does not need it can cause more harm than good. In the 80's we were given an antibiotic for everything! Sinus infections got amoxicillin. I know because I took a ton of it growing up. However, we have developed these pesky super bugs. MRSA and VRE are the two most well-known. MRSA is beginning to show resistance to even the most sophisticated antibiotic.

What does this mean? Trouble. It means that when you demand an antibiotic and your PCP caves into your pressure (your satisfaction, remember?), you receive the medication and your body slowly builds up resistance. Those bacteria become a little more tough, a little smarter, a little more resistant. Imagine now 50 years of this cycle. Finally, you have a skin infection that won't respond to Keflex, Doxycycline, or Bactrim. This means you end up in the hospital on IV antibiotics to kill a super bug. And! When you take an antibiotic it not only kills the bad bacteria, it also kills some good bacteria. Yeast infection, ladies? How many times have you taken an antibiotic to treat an ear infection only to develop a yeast infection? Why? Because the antibiotic has killed the good bacteria and the yeast take over.

Let me lay it out for you: Antibiotics kill bacterial infections; not viral. What's a viral infection? The common cold and the flu. If we catch the flu and it tests positively, you may be given an anti-viral to help recover. So what can you do when you get sick? Well, most viruses last 3-5 days. You'll feel terrible; possible fever, cough, aches, runny nose, sore throat. If, after 3-5 days there is no improvement, come on in! We'd love to see you! But, if you're starting to feel better, ride that wave. And remember, the cough is the last to go; as long as the cough is improving every few days, great! Bacterial infections typically do not improve on their own after 3-5 days and you need an antibiotic. Think UTI or Strep throat. So, stay home, rest, wash your hands, take a nap, rest, hot showers, warm salt water gargling, rest, zinc, Emergen-C, Vit C, Airborne, rest.

Back to the topic at hand: patient satisfaction. If the patient has a virus and I do not prescribe an antibiotic they become unhappy. This can cause complaints, bad reviews, decreased reimbursement, loss of jobs, etc. That last one is a tad extreme, but decreased reimbursement is key. Providers, hospitals, and medical groups who receive low patient satisfaction scores may not be payed for all services provided. Just because the patient didn't get the antibiotic. Or their food was cold, or they didn't get the right meal. Do you see where I'm going with this? It becomes a bit absurd to allow patients to completely dictate the culture of care.

How can this be improved? Communication. Education. You're right, 30 years ago we did give antibiotics for everything. Unfortunately, now, we know better. Make sure we communicate clearly to patients about the virus or disease process and things to look for. If it gets worse, doesn't improve, spreads, persists for a month, etc., come back and tell us! Those are the red flags.

A man far more educated than me discussed this on his blog a few years ago and it bears sharing. KevinMD.com is our voice in this new and changing landscape.

When your PCP decides it's best to not give the antibiotic, ask why and trust them.

*The scenarios presented here are not to be taken as medical advice. If you have any medical condition or concern, please see your PCP and seek their advice.