How the Healthcare Industry Fails Patients and Pins the Blame on Physicians: Patient Satisfaction Surveys
This is the final piece of a three-part series detailing the ways in which patients are harmed by the Healthcare Industry and how I was complicit as an employed physician. I was threatened with a lawsuit due to a patient who suffered medical and financial harm from the Health Insurance System. A Medical Board complaint was made against me due to corporate policies designed to increase profitability. Finally, I was the victim of both libel and verbal assault with the threat of bodily harm by the family member of a patient who was struggling with prescription drug dependency and addiction perpetuated by the Healthcare Industry and its campaign of “Pain as the Fifth Vital Sign”. This series also illustrates the moral injuries perpetuated by corporate healthcare upon physicians.
During my first year as a Direct Primary Care physician, I supported my family by moonlighting in an urgent care clinic while growing my DPC practice. One day, an elderly woman presented with severe rib pain after a fall. She had rib fractures on x-ray, and my intention was to treat her pain with Percocet, an opioid pain medication. Part of safely prescribing controlled substances involves checking a patient’s PMP (prescription monitoring program) to make sure that the patient will not be at risk of accidental overdose by combining multiple sedative medications. This patient was already taking two chronic sedative medications, including Xanax, a benzodiazepine, and Tramadol, an opioid pain medication. I discussed my concerns with the patient, and she was very pleasant and reassured me that although her doctor prescribed a large amount of Xanax on a monthly basis, she took it very rarely. She had paper prescriptions for both Xanax and Tramadol in her pocket and had not filled them yet that month. She offered to give me both prescriptions, so that she could take Percocet for pain without any risk of drug interactions. I thought this was a suitable plan, so I shredded her prescriptions and gave her a new prescription for Percocet and recommended that she follow-up with her primary care physician. She left happily.
While I was seeing the next patient, I heard a commotion in the hall. The elderly woman’s daughter was threatening to fight the nurse who had roomed her mother. When I came out of the room, she threatened me as well for “stealing” her mother’s prescriptions. Her behavior escalated, and we were forced to call the police since she continued to threaten us both with physical violence. One of the other nurses pulled the PMP for the younger woman who was a patient of one of the physicians on the primary care side of the building, and she was filling large doses of multiple controlled substances as well. Based on the evidence at hand, we suspected that she was selling all or some of the prescription medications under her name and her mother’s name in order to support her own addiction. We also suspected that she had been the one to fracture her mother’s ribs, and we shared this information with the police when they arrived.
The following day, the patient’s daughter posed as a patient online, posting multiple inaccurate one star reviews about me. I had just started my Direct Primary Care practice, so these reviews were potentially harmful to my new business as well as being hurtful. I hold no ill will towards this individual, who was clearly struggling with her addiction and likely suffering from physical pain, mental anguish, or both. I do hold the Healthcare Industry responsible for the many harms against both physicians and patients, including the creation of a prescription opioid epidemic in a marketing campaign funded by pharmaceutical companies and supported by government legislation to force physicians to prescribe increasingly higher doses of opioid pain medications for chronic pain or risk harm caused by low patient satisfaction scores. The Healthcare Industry continues to utilize patient satisfaction surveys like Press Ganey, even though higher patient satisfaction scores are associated with an increased mortality risk, and physician reimbursement is often dependent upon these scores. Corporate healthcare administrators intentionally create contentious relationships between physicians and patients because it allows them to maintain control and eventually replace physicians with lesser trained “providers” who are both more profitable and more easily manipulated as their training diminishes.
In Direct Primary Care, patients and physicians are on the same team. They want all the same things: mutual respect, open lines of communication, plenty of appointment availability, optimal health for patients, and career fulfillment for physicians without burnout or moral injury. The majority of Direct Primary Care patients are very pleased with the extra time and attention they receive and with their partnership with a caring physician.
