Patient satisfaction scores don’t introduce a new problem, they just exacerbate an existing problem.

In capitated care, the incentive is to withhold care. In FFS care, it is to churn care. In traditional salaried systems, it is to be unavailable and do as little for your wage as possible. Patient satisfaction components is an attempt to counter this, which in turn creates it’s own perverse incentives.

It is the physician’s responsibility to keep the patient first regardless of the system, and if a system creates so much pressure to distort his behavior that he is unable to do so, to refuse to participate and provide his services though some other.

I have worked solo FFS, group FFS, capitated, salaried, and hourly wage, with and without patient satifaction bonuses–in the end the basic need for a commitment to professionalism over personal financial gail is the same. And I have watched a community of physicians move about through these same system–they ones who work put their patients behind their wallet do so consistently, easily shifting their care to match the dollar. The real doctors are consistent and do not change their professional behavior in response to changing compensation systems.

The administrators hate them. If you don’t worship Mammon, they have no hold on you.

The problem with your argument is that you assume the interests of the system and the interests of the patients are mutually exclusive. This is not the case. What is in the interest of the system is often congruent with the interests of the individual. For example, the widespread use of antibiotics for viral illness was a response to patient demand for such treatment and doctors’ desire to satisfy the wants (not needs) of their patients. This has led to the epidemic of multidrug-resistant bacteria which has, in turn, seriously affected countless individual patients everywhere. The decision to offer a patient antibiotics when they truly do not need them, when magnified over the course of hundreds of thousands of patients over several years, can have profound repercussions on public health (the health system) which in turn affects us all. While it may be of no consequence for a single clinician to order a single chest xray unnecessarily, there are widespread consequences when this happens hundreds of times a day. If you don’t think you pay every time a physician acts to merely satisfy the capricious demands of his patients, you’re sadly mistaken.

But that begs the question of whether the physician is correctly determining need for tests, pain relief, or even medication.

Physicians who don’t listen, (perhaps because they’ve”heard it all before”, or have anchored onto a general truth that doesn’t apply in an individual case – can do harm and should have a competing pressure to make the right choice.

You know full well some doctors have sticky ideas or conflicted interests with regard to treatment of a herd vs an individual, cost containment. They may be hassled and overworked, or simply lazy….taking the path of least resistance, avoiding paperwork or pain-in the-neck scrutiny of insurers, bosses, agencies, etc (and who may harbor unrealistic or baseless fears about scrutiny, to boot).

Unless the interest and satisfaction of the patient counts for something, it’s the patient who will end up getting the shaft. ( Or the catheterization instead of the preauth required stress test).

And though physicians sometimes forget, doctoring is about what is best for that one person. Not what is best for the “system”. Patients need to have a way to have their personal experiences factor into that increasingly overarching beast of a “systems” needs.