“As the great sage Jagger said, “You can’t always get what you want!”” House.
According to Zack Cooper and Julian Le Grand, writing in support of patient choice and provider competition in the BMA News in May 2009, “the true test of how a health service is performing is whether patients are satisfied with their care”.[1] It seems extraordinary that this should be the ‘true test’ of healthcare rather than for example, improved clinical outcomes, such as better diabetic control or better mobility and pain control after orthopaedic surgery, or a reduction in mortality after angioplasty, but a brief reflection on the parallel system of private healthcare in the UK is explanatory. Historically and presently people have paid to ‘go private’ are in order to have direct access to a consultant specialist, to be seen at a convenient time such as an evening or weekend, to guarantee hospital care in a private room or for other non-clinical hotel comforts such as plush carpets or luxury menus. Unsurprisingly the costs of having a specialist at your beck and call and staying in hotel luxury accommodation after your operation vastly exceeds the costs of equivalent NHS care. Satisfaction rates may be higher, but there’s no evidence for any difference in clinical outcomes. At my surgery in Hackney, East London patients have to fill in ‘satisfaction questionnaires’ every year and the responses are one of our ‘performance indicators’ which determine how much we are paid. Frequently there are complaints about our lack of beverage facilities and the quality of reading material in the waiting area. More seriously, of the 26 key performance indicators for Independent Sector Treatment Centres (ISTCs) only 8 are clinical indicators of any kind and only one can be considered a ‘pure clinical outcome indicator’.[2] Whilst I would never deny that I want my patients to be satisfied, I know that quite frequently what they want (viagra) is not the same as what they need (a test for diabetes)
One hundred years ago Bernard Shaw wrote in the Preface to the Doctor\’s Dilemma, “Please do not class me as one who “doesn’t believe in doctors.” One of our most pressing social needs is a national staff of doctors whom we can believe in, and whose prosperity shall not depend on the nation’s sickness, but its health”
Satisfaction is the ‘true goal’ of private medicine because satisfied consumers keep coming back for more.