Bioethics Blogs

Patient Satisfaction and the Possibility of Bad Medicine

In the March 18, 2016, AMA Wire Practice Perspective entitled
“When Patient Satisfaction Is Bad Medicine”
Drs. Joan Papp (Case Western Reserve University) and Jason Jerry (Cleveland
Clinic) make the argument that the institutional drive for higher patient
satisfaction scores on Hospital Consumer Assessment of Healthcare Providers and
Systems (HCAHPS) questionnaires may be contributing to the opioid prescription
drug crisis nationwide. They note the results of an Ohio State Medical
Association-Cleveland Clinic Foundation survey 1,100 Ohio physicians:

… 98 percent of the
physicians who participated reported that they felt increased pressure to treat
pain, and 74 percent reported that they felt an increased pressure to prescribe
opioids because of the perverse pain management incentives in the patient
satisfaction surveys.


Additionally, 67 percent of respondents “agreed
that, in general, physicians in the United States over-prescribe controlled
substances to treat pain.”

Papp and Jerry pointed to HCAHPS questions 2 and 3 specifically that may be a

(1) “During this hospital stay, did you need
medicine for pain?” Patients can answer “yes” or “no.” (2) “During this
hospital stay, how often was your pain well controlled?” Patients can answer
“never,” “sometimes,” “usually” or “always.” (3) “During this hospital stay,
how often did hospital staff do everything they could to help you with your
pain?” Patients can answer “never,” “sometimes,” “usually” or “always.”


Unless patients answer “always” to these last two
questions, the hospital is considered an “underperformer” by Centers for
Medicare & Medicaid Services (CMS) and may be financially penalized.

these survey results, one may reasonably wonder if a “cultural paradigm of
overly aggressive pain management … exists and will continue to be a barrier to
efforts to address the opioid epidemic.”

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.