Hold off on patient satisfaction scores until they are done right

We’re living in a world or ratings. Books get rated on Amazon, dry cleaners get rated on Yelp. Doctors are getting rated, too — not only on web sites, but also in ways that end up dictating how much money we can make, or whether we can keep our ability to work in a hospital. Is this a good way to improve medical care or medical outcomes? Is it even fair?

We already know that ratings don’t reflect good medical care. In fact, patients who rate their doctors the best have shorter lifespans. They get more tests, more scans, more antibiotics — which may make them happier, but also makes them sicker.

You do not want a doctor who does what he thinks is going to make you post a positive review. You want a doctor who listens carefully and helps you make the best medical decision. Even if that means you don’t get an antibiotic.

But there may be an even worse, more odious problem being caused by the reliance on ratings to determine income. As Daniela Drake has written, quite bluntly, in he Daily Beast, minority doctors are likely to suffer the most under Affordable Care Act provisions that tie payments to patient satisfaction scores. The bottom line: Patients are far more likely to rate a doctor positively if they are of the same race. Black doctors, if you look at the statistics quoted in that essay, are going to get royally screwed. They may be doing great medicine and helping their patients, but if they don’t get the ratings, their income will drop. Not only that — but it becomes less likely that they’ll be hired by hospitals, because they need to get those high satisfaction scores too.

Paying doctors more for doing good medicine makes sense, but only if you’ve got a good way to measure doctor performance. Measurements ought to reflect whether good medical decisions are being made, and whether docs are helping their patients by following good medical practice. Some elements of being a good doctor are going to be hard to measure, like listening skills and empathy and caring. But it’s clear that patient satisfaction, as it’s measured now, isn’t measuring good doctoring. Let’s abandon patient satisfaction scores, at least until we figure out a way to do it right.

Roy Benaroch is a pediatrician who blogs at The Pediatric Insider. He is also the author of Solving Health and Behavioral Problems from Birth through Preschool: A Parent’s Guide and A Guide to Getting the Best Health Care for Your Child.

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