Reply: The Importance of Patient Satisfaction

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We would like to respond to the letter by Barone et al. on the role of patient-reported outcome measures in plastic surgery. The authors have a clear understanding of the complexity of creating useful, relevant, and validated patient outcome measures. They have expanded on our discussion of the critical components and highlighted that these surveys can be monumental undertakings to create, test, and revise, especially when “one size will not fit all.” The BREAST-Q and FACE-Q remain good examples of the type of instrument that we need, but they have to be expanded to the entire realm of plastic surgery and, indeed, to all clinicians in the United States. In addition, the survey’s focus would need to be retuned to encompass the entirety of a patient’s interaction with the health care system and not just focus on aesthetic or reconstructive outcomes. Once developed, these surveys could serve as an unexpectedly powerful way to compare different surgical and clinical courses. Provided that objective medical metrics are equivalent, these questionnaires could serve as a tool with which to compare patient-focused outcomes of various techniques in any arena, from hand fracture management to rhytidectomy to breast reduction. These implications can also extend beyond surgeons to physical therapists treating back pain or psychiatrists managing depression.
Unfortunately, all physicians are being currently evaluated and compensated based on ad hoc questionnaires. This landscape is unlikely to change even with the current alterations being proposed to the Affordable Care Act. Interesting ethical dilemmas may arise if the conclusions of evidence-based measures run contradictory to improved patient satisfaction. Clinicians will be forced to weigh the effects of improving a patient’s health or improving happiness, and there will rarely be clear answers. This topic is certainly a hot-button issue, which was picked up by Medscape,1 with quite a few passionate and differing opinions being expressed in the comments section. Although there is evidence to suggest better patient satisfaction is correlated within the realm of major operations,2 there are many fields of medicine that have not been thoroughly investigated and some that may have perverse incentives based on anecdotal evidence and a priori assumptions.
We would like to congratulate the early adopters who are trying to implement these surveys into their clinical practice. We look forward to seeing the results so that both patients and plastic surgeons can benefit from their insights.
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