USA Today op-ed: How patient satisfaction influences medical decisions

My latest USA Today op-ed was published this morning: Patient satisfaction surveys have drawbacks.

I discuss how patient satisfaction scores affect physician salaries, which may, in turn, influence medical decision making.  Of course, patient satisfaction is important and should be measured — but it’s a mistake to use them in part to determine physician compensation. Here’s an excerpt:

USA Today op ed: How patient satisfaction influences medical decisionsQuality health care sometimes means saying “no” to patients; denying them habit-forming pain medications that can feed an underlying, destructive drug addiction, or refusing to order unneeded CT scans that can facilitate harmful radiation exposure.

Satisfaction scores give patients a needed voice to express their concerns, which can help medical professionals improve their patient relations. But it’s a mistake to use patient satisfaction as a doctor’s financial carrot.

After all, a completely happy patient isn’t necessarily one who has received the best medical care.

Enjoy the piece.

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  • Zackary Sholem Berger

    Hi Kevin,

    The Annals paper is tricky. Here’s the measure of patient satisfaction they use:

    “We want to know your rating of all your health care in the last 12 months from all doctors and other health providers. Use any number from 0 to 10 where 0 is the worst health care possible and 10 is the best health care possible. How would you rate all your health care?””

    So we’re talking about a global satisfaction which might have little to do with the individual provider.

    Second, the quality score, as well, is global – that is, whether certain indicated processes were done *at all*, *by anybody*, and recorded in the chart.

    What I think you’d be more interested in is whether satisfaction with an individual provider is connected to either process or outcome measures associated with that provider. I don’t think the Annals paper shows that.


  • csmith

    I’ve had this same thought recently. My practice was bought by a relatively benign local hospital system that’s trying to vertically integrate. They’ve been very helpful, but have tied a percentage of our income to patient satisfaction surveys. I find the feedback helpful, but i do feel more pressure to order tests as my employer profits handsomely from ancillary revenue and patients feel more satisfied if you “leave no stone unturned” as they feel a sense of entitlement due to high insurance premiums. This misalignment in incentives ( or disincentive to provide efficient, cost-effective care) is at the heart of our current predicament.

  • Steve Wilkins

    To quote from Avedis Donabedian, an old professor of mine, :

    “Often patients are, in fact, overly patient; they put up with unnecessary discomforts and grant their doctors the benefit of every doubt, until deficiencies in care are too manifest to be overlooked.

    Generally speaking, one can assume that the quality of care is, actually, worse than surveys of patient satisfaction would seem to show.”

  • H

    It’s nice to know that I prehaps that medical test being recommended is being done for brownie points. Am I supposed to trust a doctor’s recommendation?

    • mm

      caveat emptor

  • buckeye surgeon

    These Press Ganey evals are absurd. I’ve been ranked anywhere from 99th percentile to the 20th from one quarter of the year to the next. There’s no consistency or predictability about them. But it’s a lovely tool for hospital administrators to ogle at their three hour noon conferences.

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