The Importance of Patient Satisfaction: A Blessing, a Curse, or Simply Irrelevant?

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We read with great interest the article by Cohen et al. published in Plastic and Reconstructive Surgery entitled “The Importance of Patient Satisfaction: A Blessing, a Curse, or Simply Irrelevant?”1 We agree with the authors that the introduction of patient-reported quality measures has become a mainstay of the health care system and an essential part of physician rankings and reimbursement.
As the implementation of evidence-based medicine grows in everyday practice, there is increasing pressure to adopt validated survey instruments to demonstrate patient-reported outcomes.2 In plastic surgery, measuring the patient’s perspective is highly relevant, as many key outcomes, such as appearance and facial function, are best evaluated through self-report.3 Using qualitative methods to elicit patient stories and using these stories to develop patient-reported outcomes instruments represent a best practice approach to ensure content validity. Although a patient-reported outcomes instrument may be shown to have excellent psychometric properties, if it fails to measure the issues that matter the most to patients, it will not be useful in clinical practice, research, or quality improvement initiatives. Patient-reported outcomes in clinical trials, effectiveness studies, and public health research have been defined as “any report coming directly from subjects without interpretation of the physician or others about how they function overall or feel in relation to a condition and its therapy.”4
A well-developed and validated tool would allow the comparison of techniques, the quantification of positive effects, and the identification of patients most likely to benefit from the procedure, and could also provide a follow-up standard and a benchmark for clinical studies, regulatory studies, and efficacy studies. For all these reasons, it surely could be of fundamental help for every plastic surgeon in daily clinical practice.
Using the latest psychometric methods, the patient’s self-assessment can provide information in time on satisfaction, and can help patients themselves in the search for relevant data to help them better understand the expected results. As Pusic et al. affirmed, comprehensive measurement of surgical outcomes requires the combination of both objective and subjective measures, and to appropriately measure the effect of surgically relevant outcomes, well-developed and validated patient questionnaires are needed. Patient questionnaires that are not formally developed or tested (ad hoc questionnaires) may pose reasonable questions, but unless they are psychometrically tested, we cannot be confident about their reliability or validity.
The use of reliable, valid, and responsive patient questionnaires is essential to provide information about the impact and effectiveness of plastic surgery. Ad hoc outcome tools may be inadequate, as they lack proven reliability and validity. Generic measures may be insufficient because they may not be responsive to surgical change.5
Thus, we must use only specific surgical measures in our clinical practice, which are specific, valid, and sensible. In the literature, some recent systematic, meaningful, and validated instruments exist that we use currently in our clinical practice.
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