• A pediatric back surgeon told us today that he has a harder time convincing parents that their children with lower back pain shouldn’t have surgery than he does convincing them to undergo surgery. (This is back surgery, notoriously full of complications and risks, as you’re potentially messing with the spine and spinal cord.) He says he believes in educating parents about surgery and the chronic nature of back pain–even in kids. But, he adds, sometimes it’s much easier to give the parents a referral for physical therapy (which he doesn’t support for kids).
• A pediatrician told me she finds that parents are much more reassured and comfortable taking care of their children with fever when she actually writes out a prescription for Tylenol (an over-the-counter medication anyone can buy) than when she just tells them to go buy it.

What is with this? Why do we want some sort of tangible intervention when we leave the doctor’s office? Why is education and discussion not enough, and how can we do a better job of both increasing patient satisfaction while decreasing unnecessary medications and other treatments? I’d be especially interested to learn if this is an American or Western concept, or whether this sort of expectation exists throughout the world–or even if this has only come to exist recently?

I wouldn’t be surprised if there’s a monetary “value for your money” component to it; either you pay a co-pay or a ridiculous amount for your health insurance, so you carry over the expectation of money exchanged for goods (arguably you don’t get “service,” as your doctor may be running late).

I think there’s also a degree of discomfort with “just watching” someone’s condition–either from an impatience standpoint or a worry factor. Or maybe the feeling of the physician abandoning the sick patient, or not showing the patient some sympathy or empathy. “You want me to what? Go home, rest, and drink some liquids? I’ve felt awful for 3 days already, and you’re not going to give me anything for it?” (I’m definitely guilty on this count.)

It looks like physicians as a whole are pretty clueless about patient expectations ; perhaps figuring out what a patient wants to get out of the visit will help to head off some patient disappointment at the end of the visit. I also like the concept of not downplaying a person’s illness; I’m guilty of telling patients “it’s just a virus” many, many times.

A cursory Pubmed search didn’t turn up much, but I wouldn’t be surprised if patient satisfaction increased if all patients were just given a little one-page handout on their condition. It would satisfy the tangible need, reassure them that they have information–including when to expect to feel better, or medication side effects, or when to return for a follow-up appointment–and wouldn’t lead to excess antibiotic usage. It’d be simple to customize the handout with the patient’s name and some other personal info to make it feel even more individualized; anyone know if this has been studied?

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