Net promoter scoring needs to be tweaked for medicine

Net promoter scoring (NPS) measures customer experience and predicts business growth. Recently it is becoming more common for health networks to adopt NPS. The word “customer” should be a red flag. In medicine, we do not have customers; we have patients.

It is common practice for a patient to receive a text message after they leave an office asking them to rate their experience. It generally looks something like this, “How likely is it that you would recommend our company/product/service to a friend or colleague?” Through an open-ended follow-up question, the patient is asked to elaborate on their rating.

This tool has proven to promote the company through word of mouth. For a business with customers, it appears to be a great idea. However, our patients are not customers.

I often say, “I’m not in the ‘make people happy’ business, I’m in the ‘make people healthy’ business.” I care with great empathy for my patients, and I would like to think that it shows. If however, a patient does not agree with my treatment plan but walks out of my office with sound medical care, then why should I receive negative feedback? Even if you can brush off the bad review, you will still have to explain yourself to an administrator.

I do not doubt that we all have strong principals as doctors. But how long until those principles start to crack? When will we subconsciously decide to make a patient happy instead of healthy? I firmly believe that medicine is a science based on peer-reviewed findings. Practicing medicine any other was is no better than a Wild West medicine show. A good health care network will support you no matter the review. I fear that NPS is shifting physicians to practice medicine based on emotions, not science.

I want health care companies to make money. I want them to prosper, and I want to thrive with them, but not at the cost of unsound practices. If scoring tools are proven to be successful, why not create a new one for medicine? Start by viewing our customers as patients.

A new proposal may ask a patient 2 to 5 days later, “How would you rate your care based on your current health?” This subtly reminds the patient that we care foremost about your health while still establishing loyalty. Open-ended follow-up questions would be the same. Next, the review should never get back to the provider. If there are issues with certain doctors within a practice, it is usually an accumulation of many complaints, at which point he/she should be spoken to. Single isolated reviews, good or bad, should not get back to the provider.

In the days of Yelp and Google reviews, ratings are unavoidable. We should all have great bedside manner and treat patients with dignity and respect. We should also try to make them happy, but not at the cost of their health. Health care is not the same as the automobile or food industry. As providers, we have to stay steadfast to our principals and remember why we practice medicine.

Philip DeGaetano is a family physician who blogs at FastPass Medicine and can be reached on Twitter @FastPassMedici1.

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