What is good medical care?

Is good medical care appropriate, evidence-based care or is it what makes the patient happy? Ideally you would have both, but patients understandably prefer the latter. A quote from the New York Times' health blog (in response to "Six Rules Doctors Need to Know,," by Dr. Rob):

I can report I had my first positive medical experience in 12 years–at Urgent Care. It was last weekend. I did not call my primary doctor of record because he leaves the machine on during business hours, does not have same day appts, of course does not have Sat appts, and would not intermediate when I could not get information from two specialists during a serious episode. Anyway–at Urgent Care, the physicians asst listened to me for 10 whole minutes, smiled at my jokes, asked about my ruined eye (the serious episode mentioned before), and then even asked what antibiotic I wanted. I left with a sheet containing my test results and the line: I hope you feel
better soon. No doctor has EVER said that to me. The clinic even called two days later to see if I did feel better (the vets here do that, not the doctors). Anyway–repeat after me: Urgent Care!

So the poster has some legitimate gripes: Her doctor's office is not open off-hours and hasn't responded well to some of her needs. So she goes to her friendly neighborhood PA, who is such a great health care provider that he smiles at her jokes and gives her paperwork stating he hopes she feels better soon. All of this is great.

But what sticks out to me is that he asked her what antibiotic she wanted. Unless she's a physician herself, how could she know what antibiotic was appropriate to her condition? Isn't selecting the most appropriate treatment for a medical condition the job of the medical provider?

I read a similar post on the New York Times blog a few weeks ago. It was a patient complaining that her regular doctor didn't prescribe her antibiotics for her sinusitis, so she went to a retail clinic and in ten minutes was out the door with her prescription for, you guessed it, antibiotics! Even though the new recommendations for sinusitis state that antibiotics should only be used for severe cases, the NP at the retail clinic was all too happy to pull out her prescription pad and make some money for the pharmacy she works for by prescribing, in all likelihood, one of the more expensive brand names.

We definitely need to spend more time educating our patients about why we choose the treatments we do, and teach them that sometimes antibiotics do more harm than good. And maybe we should smile more at their jokes and have more access for off-hours. But when a patient's perception of good care is equivalent to offering them a choice of antibiotics, something is terribly wrong.