At first glance, scoring doctors based on patient satisfaction surveys sounds like a good idea. It's logical to assume that doctors would be more highly motivated to provide the best possible care if they knew they were going to be graded by their patients. Unfortunately, it turns out that patient satisfaction scores may be causing more harm than good.
Anecdotal reports suggest that an increasing number of physicians are reluctant to take on the sickest patients, because they're afraid it will negatively impact their patient satisfaction scores. "I don't think there's a single specialty where you can say risk aversion is absent," says Dr. Keith Naunheim of the Saint Louis University School of Medicine (politico.com).
One recent study shows that more than 75% of physicians feel that patient satisfaction scores have had a negative impact on the quality of patient care. "Regarding treatment, more than 40% of respondents had altered treatment due to the potential for a negative patient satisfaction survey. More than half stated that patient satisfaction scores increased the amount of testing they performed." Eleven percent of the survey physicians described adverse outcomes as a result of unnecessary testing and treatment (epmonthly.com).
Doing what's best for the patient is oftentimes at odds with what the patient wants or expects, especially when satisfying the patient becomes the major objective. Put in this predicament, a doctor is more likely to do what the patient requests rather than take the time to explain why the request is not in the patient's best interest. Besides, doctors claim that patient satisfaction surveys are too subjective--that the surveys are actually a deterrent to the objectivity required in a doctor-patient relationship.
Another study looked at 1300 doctor visits and found that two-thirds of the patients asked the doctor to refer them to a particular specialist, perform specific lab or radiology tests, or prescribe a pain medicine or antibiotic (Reuters). Doctors complied with these requests 85% of the time. "When doctors didn't acquiesce, however, patient satisfaction scores after the visits were dramatically lower than when the requests were fulfilled," said the study's lead author, Dr. Anthony Jerant of the University of California at Davis. "Part of the problem may be how often doctors are saying 'yes' to patient requests."
In an editorial response to these findings, Dr. Joseph Ross of Yale University says that physicians need to ask why patients are making these requests: "Sometimes patients have seen a treatment advertised on television, or heard about it from a friend or family member. Other times, patients aren't happy with their care and think a specialist may be needed." Simply stated, patients often feel cheated if they don't get what they want.
"This entire scoring system has become a game," states emergency medicine physician Ron Elfenbein, M.D. (epmonthly.com). "What does it say about patient [satisfaction] scores that emergency departments hire 'patient sat experts' who teach physicians little tidbits to get their scores up." Dr. Elfenbein is a vocal advocate for the complete elimination of patient satisfaction surveys. Most hospital administrators, however, don't support his recommendation. They argue that "the effect of patient satisfaction scores [make] it significantly less likely that providers [will] render inappropriate medical treatment."