On the other hand, there are multiple articles in the literature that come to far different conclusions. In a review published in 2009, it was found that physician communication correlates strongly with patient adherence rates to treatment recommendations in acute and chronic disease.³ The authors noted that there were, at that time, more than 100 observational and 20-plus experimental studies published demonstrating the correlation of communication (patient satisfaction) with compliance. Compliance with treatment regimens has significant influence on quality measures in chronic disease and outcomes.3 In a review of the medical literature published in the British Medical Journal in 2013, patient experience was positively associated with clinical effectiveness and patient safety in 77.8 percent of studies, no association was found in 22 percent of studies, and a negative association was found in only one study (0.2 percent).⁴ Academic Medicine published a study titled “Physicians’ Empathy and Clinical Outcomes for Diabetic Patients,” which was based on the experience in the Department of Family & Community Medicine at Thomas Jefferson University. It found that, after removing all confounders, patients who rated their doctor’s empathy high had better clinical outcome markers, lower HgbA1C and LDL levels, than those who rated their physician’s empathy lower. The authors concluded, “Empathic engagement in patient care can contribute to patient satisfaction, trust, and compliance, which lead to more desirable clinical outcomes.”⁵ In another paper titled “Communication and Medication Refill Adherence,” published in Archives of Internal Medicine in 2012, after adjusting for potential confounders, the prevalence of poor refill adherence increased by 0.9 percent (95 percent CI, 0.2–1.7 percent, P=.01) for each 10-point decrease in CAHPS (patient satisfaction) scores.⁶

All of these studies support what, to me, is common sense: If physicians practice evidence-based medicine and communicate better with patients, and consequently patients have more trust in their physicians and better understand what they should do, patients will follow those evidence-based recommendations more often and will have better clinical outcomes. There are unfortunately no specific studies in this area in emergency medicine, and studying clinical outcomes in and of itself in emergency medicine is fraught with difficulty.

In a review of the medical literature…patient experience was positively associated with clinical effectiveness and patient safety in 77.8 percent of studies, no association was found in 22 percent of studies, and a negative association was found in only one study.

The entire issue of how the patient satisfaction surveys are then used is an entirely different matter. We do need to understand that our hospital administrators, the Centers for Medicare & Medicaid Services, and private insurers will continue to use the patient experience as a metric to measure quality, and they will then tie that value to payment, rewarding physicians and hospitals that do well and penalizing those that do not.