Op-ed: Patient satisfaction doesn’t mean the best medical care

A version of this op-ed was published on March 15th, 2010 in the USA Today.

If you recently saw a doctor, you might subsequently receive a survey in the mail asking whether your physician was friendly, spent enough time with you, or showed the appropriate level of concern for your medical issues.

Patient satisfaction surveys are being increasingly used in hospitals nationwide. Press Ganey, a leading organization measuring patient satisfaction, counts more than 10,000 medical institutions in the U.S., and over 40% of hospitals, among its clients.

Happy patients are obviously important, but doctors often have little idea of how patients perceive them. Gauging patient sentiment with satisfaction scores is a useful way to point out deficiencies and improve the patient experience.

In fact, doctors who consciously try to improve their patient interactions are sued less often. According to a study funded by Press Ganey, and published in the public health journal Medical Care, physicians with low patient satisfaction scores were more likely to be involved in malpractice lawsuits.

Patient satisfaction also translates into higher hospital revenue, so it’s no surprise that administrators pay close attention to these numbers, with high scores often finding their way into marketing campaigns.

But can focusing too much on patient satisfaction actually be detrimental?

No correlation to care
Studies from both the Annals of Internal Medicine and the British Medical Journal did not find a strong correlation between patient satisfaction and the quality of care. In other words, just because you’re satisfied with your doctor doesn’t necessarily mean he’s a competent physician.

More worrisome is that hospitals and health plans are increasingly using satisfaction scores in part to determine physician compensation.

The Center for Studying Health System Change estimates that patient satisfaction scores factored into how nearly a quarter of physicians are paid. But paying doctors to keep patients happy gives them a reason to acquiesce to patient demands.

If a medically unnecessary test or drug is requested, for instance, an added financial incentive encourages physicians to comply, rather than risk angering the patient.

Impacts decisions
Already, more than 80% of doctors, according to a survey from HealthLeaders Media earlier this year, said patient pressure influenced their medical decisions. And in primary care, linking bonus pay to patient satisfaction could cause physicians to be more selective in who they see, subtly keeping patients who they know will score them well, and referring disagreeable ones to other providers.

Quality 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.

But Edwin Leap, a nationally recognized physician columnist at Emergency Medicine News, notes that doctors “are constantly under the microscope to give patients what they want, since ‘giving people what they want,’ has been tragically, and falsely, equated with good medicine.”

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 totally happy patient isn’t necessarily one who has received the best medical care.