Who is Satisfied?

How are we going to do this?

In other industries customer satisfaction is part of the delivery, but not directly tied to product price. Companies are “paid” by happy customers with more business (referral, word of mouth, etc), or market leverage to increase the cost of service (increased value of product) with customers happy to pay that increase due to increased value, to them.

This works in a market system, where individuals are in charge of their monetary decisions. But that isn’t health care.

In a move towards payment for outcomes, where will customer satisfaction have a role? (we don’t know whether we will be paid better for better outcomes, or paid a set fee for an average expected outcome and it’s up to us to beat that average… who knows)

Is there any talk of adding customer satisfaction directly to payment? Sometimes that’s all we have. No significant change in patient status, but a very satisfied customer with the care, service, advise and input given. Perhaps they leave with an understanding of their condition, ways to manage it and strategies to avoid deleterious effects of their disease/dysfunctional process… but no change in ROM, strength or patient reported outcome measures. Continue reading

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On the subjective nature of pain

Image Credit: "Inverted qualia of colour strawberry" by made by Was a bee. - Original strawberry's image is from Image:Fragaria_Fruit_Close-up.jpg uploaded by User:FoeNyx,and original man's image is from Image:Munemitsu Mutsu 2.jpg uploaded by User:Ueda.H,and I User:Was a bee combined it in one image.. Licensed under CC BY-SA 2.5 via Commons - https://commons.wikimedia.org/wiki/File:Inverted_qualia_of_colour_strawberry.jpg#/media/File:Inverted_qualia_of_colour_strawberry.jpg

Image Credit: “Inverted qualia of colour strawberry” by made by Was a bee. – Original strawberry’s image is from Image:Fragaria_Fruit_Close-up.jpg uploaded by User:FoeNyx,and original man’s image is from Image:Munemitsu Mutsu 2.jpg uploaded by User:Ueda.H,and I User:Was a bee combined it in one image.. Licensed under CC BY-SA 2.5 via Commons – https://commons.wikimedia.org/wiki/File:Inverted_qualia_of_colour_strawberry.jpg#/media/File:Inverted_qualia_of_colour_strawberry.jpg

Some things in life are definite. Some are definitely not. And some are somewhere in between.

Same goes in healthcare and medicine. When you see a hyperactive deep tendon reflex or produce an upper motor neuron sign via Babinski or Hoffmann’s, its pretty obvious. Usually, there isn’t much debate about its existence. There may be some back and forth about the degree to which it exists or to its implications; but, again, most parties will agree “that just happened.”

Same goes for an infected wound. One look, maybe one smell, most people can agree about the degree of bacterial colonization (i.e. infection or no). We can take this further with abnormal heart sounds, clubbing of the digits (indicative of lung/heart disease), or yellowing of the sclera indicating jaundice. The list can go on, but it doesn’t need to. There are a host of objective signs that indicate the presence of disease or pathology. We can even go further with laboratory diagnostics and imaging studies to attempt to confirm or rule out suspicions about the presence of a disease processes.

We have quite a body of information and resources at our disposal when trying to figure out what is wrong with the patient sitting before us. Even more than that, we have gained enough knowledge to decipher and utilize people’s reported symptoms, their subjective report, to aid in this process. As fraught with bias and inaccuracy as an individual’s own perception of their situation could be, we still have found ways to weed through the minutiae and find bits of key detail that aid in the diagnostic process. It could be how long their symptoms have been present, or what activities exacerbate their symptoms. You might ask, “Do you have any popping or clicking? Or feelings of instability?” Or if the patient reports numbness or tingling in a certain area. All of these details paint a little more of the broad picture of the patient’s condition. And one of the most helpful details when painting that picture Continue reading