What patients want

June 19, 2009

wantDB asked in his blog “When you consider physician quality, what attributes do you consider?” My response was:

  1. Unbiased treatment advice
  2. Physician knows more than I do

An ideal treatment is (at least in concept) effective with minimal side effects – cost is not an issue for insured patients. Yet, some physicians steer patients towards a treatment that may not be ideal for that patient – prostate cancer is one example. This leads to people using the internet and other sources to be their own patient advocate. Whereas it would be silly to think such research makes one competent, it is not good if one gets the feeling the doctor is not as knowledgeable as the patient.

Other responses were similar.

A Kano diagram is useful to frame the issue.



The green line is expected attributes. For example, if someone is going into a hospital for a total left hip replacement and the left hip is replaced (as opposed to the right hip), this is expected! It is not thought of as quality. Hence, there is no satisfaction for fulfilling this goal, only dissatisfaction if it is not fulfilled. This is similar to the airlines. One does not ask to review the maintenance records of a flight one is taking nor review the pilot’s resume. One expects these attributes to be in order.

The red line is also not specified. For example, if someone with a chronic condition was suddenly diagnosed and cured by a new doctor, this would be unexpected although of course there would be great value.

It is the blue line that is specified by patients. Take surgery for example. A famous urologist once said he would love to redo his first 100 prostatectomies. Surgery skill, notwithstanding the difficulty in getting this information is valued by patients. My and the other responses dealt with other attributes valued by patients.

I doubt if anyone would specify outcome measures such as “Percentage of patients who received advice to quit smoking” or any of the other 25 measures.