Should the medical system be concerned with how people feel about their interactions with the medical system? "Patient satisfaction" with medical care has been tracked in recent surveys and studies, often with unanticipated results: for instance, patients with the highest reported satisfaction with medical care are more likely to use more medical care - and more likely to die. Are the feelings of patients something we should care about enough to measure and track? Or are they totally irrelevant?
Oncology nurse Theresa Brown argues in the New York Times that patient satisfaction is irrelevant. Beginning with a description of a horribly painful medical procedure known as pleurodesis, Brown argues that the most effective medicine is often painful.
Brown seems to understand that there is a trade-off between suffering and efficacy. But she does not seem to understand that patients might well wish to trade longer lifespan for less suffering. In fact, that is exactly what doctors facing terminal illness frequently do - avoid the painful, dehumanizing treatments that might possibly buy them more time, in order to enjoy the time they have left (or just to avoid prolonged suffering).
My problem with the medical system is that built into it is a core assumption that longer lifespan is the only concern - that there is such a thing as "health," and all other concerns are properly subjugated to this concern, except - perhaps - in cases of terminal illness. Brown says that "a survey focused on 'satisfaction' elides the true nature of the work that hospitals do. In order to heal, we must first hurt." Some patients may wish to go through painful procedures if it is the only way to prolong life; but this should not be the assumption in every case, and if medical professionals are surprised that people are unsatisfied with torturous-but-life-prolonging medical care, that demonstrates the depth of their bias. One wonders how the average psychiatric patient would rate his or her "satisfaction" with the "care" applied to him or her by force; but non-psychiatric medical care is not another kind of thing, but on a spectrum with psychiatric "care."
Humans have many concerns; one of them is often lifespan, but that is not the sole value that most people care about. I have noticed that many medical professionals are quick to defend awful, dehumanizing procedures on the ground that they save lives - even if the person being "saved" does not want the treatment. I think that measuring "patient satisfaction" is a sideways way of gauging the degree to which painful, degrading medical treatment is truly voluntary.
Our medical systems in the developed world are an arm of government, even where medicine is for-profit and not socialized. Doctors are given a huge amount of police power, such as deciding what treatments or drugs their patients are allowed to access. I suspect that a truly free market in medicine - one in which doctors were advisers only, and not cops - would result in both lower lifespan and greater "patient satisfaction" (happiness). That's only a bad thing if you think lifespan is the only goal, and that everyone should be forced to pursue it.