John Hopkins researchers interviewed 177 hospitalized patients on their day of discharge and found that while most described themselves as “very satisfied” with their care, the degree to which they shared understanding with their clinicians of their diagnoses, medication indications and tests/procedures was fairly low.

Intuitively, it makes sense that even thought patients overwhelmingly reported being listened to carefully and spoken to in a “courteous” manner, these indicators did not necessarily equate to a good understanding of their medical condition, the care they had received and their post-discharge care going forward. It also raises questions about patient satisfaction being an important quality measure for value-based reimbursement systems because if patients do not understand their care, their satisfaction rating means little for a value-based payment system whose ultimate goal is to hold down costs.

“The higher the patients’ perception of good understanding the higher their level of satisfaction,” noted Sosena Kebede, M.D., M.P.H., the lead researcher on the study in an interview with MedicalResearch.com. “This suggests that whatever drives the perception of good shared understanding can drive better satisfaction. Knowing what patients expectations and even values are for their care would be important if we want to find out what makes them satisfied with the care we provide. We used measured shared understanding as a surrogate marker for effective communication. Despite some difficulty in objectifying the degree of shared understanding between patients and their physicians the overwhelming majority of patients’ high level of satisfaction that tracks their perceived understanding rather than their measured understanding raises doubt if quality of care correlates with satisfaction at all. It is possible that our patients tend to be satisfied in spite of our suboptimal quality of care delivery — in this case they seem to be satisfied despite suboptimal  effective communication as evidenced by their suboptimal shared understanding.”

Dr. Kebede’s study included internal medicine patients who had two or more medical conditions, two or more medical procedures, and two or more days of hospitalization between June 2012 and February 2013. Nearly half (45 percent) of the patients had an education level that was “college and above.” The mean age was 56.4 years and the mean length of stay was 7.7 days. On the day of discharge, they were asked to rate their satisfaction, identify their medical diagnoses, identify their medication instructions and correctly select the tests and procedures they had undergone from a list. These results were then compared to the patients’ clinical documentation to see how well the patient’s understanding matched what was in the clinical record.

According to Kebede, evidence of “suboptimal communication” also raises questions about the degree to which hospital patients are able to participate in informed consent.

Other studies have also questioned the use of patient satisfaction scores as an indicator of quality care. Last year, a study of more than 7,000 British outpatient practices by the Cambridge Centre for Health Services found that correlation between clinical quality and patient satisfaction was “weak” and “the quality of clinical care and the quality of interpersonal care should be considered separately to give an overall assessment of medical care.”