I love it when Karen Sibert, of A Penned Point, gets mad. Her words are truth, and I don’t just say that because she’s an anesthesiologist/blogger like me. Yesterday she wrote a post about a recent article in the Wall Street Journal about doctor dissatisfaction (http://apennedpoint.com/his-diagnosis-is-right-but-the-treatment-is-all-wrong/). Read it.
One of the articles Sibert cites has to do with patient satisfaction surveys. This one, in The Atlantic, is by Richard Gunderman and relates to narcotic prescribing. And let me just say that the terms “Patient satisfaction” and “Narcotic prescribing” go together like Obama and Cheney. Here is what Gunderman says: (http://www.theatlantic.com/health/archive/2013/10/when-physicians-careers-suffer-because-they-refuse-to-prescribe-narcotics/280995/)
“Though attending more carefully to patients should strike any physician as a good idea, such perceptions are not always reliable. For one thing, a patient’s assessment of a physician visit or hospitalization can be colored by a variety of factors not under the control of either. For example, a patient frustrated by the difficulty or expense of parking may assign lower scores to every aspect of a hospitalization, including the quality of care provided by the physician. Such patient satisfaction data are playing an increasing role in a number of important healthcare decisions. For one thing, physicians can be hired, fired, promoted, and compensated based in part on their patient satisfaction scores. Increasingly, these scores also determine how hospitals are ranked and paid. The Center of Medicare and Medicaid Services has been publishing this data and has begun distributing funds to hospitals based in part on patient satisfaction.”
Last weekend I went to a wedding. My husband and I stayed at a very nice, modern hotel and as we were exiting the building we were commenting on how great the service had been. Then my husband turned to the valet and asked to have our car brought up at a certain time. The valet said “Just call us when you need it. Here’s the number.” And just like that, our whole experience of the hotel service changed. The valet should have just said “Of course, sir, we’ll take care of it.” It’s not like we were demanding special treatment. That’s the level of service we expected, based on our experience of the rest of the staff. If we had been asked to fill out a satisfaction survey, we would have had the option of degrading our opinion of the hotel based on the response of one individual (we didn’t).
Now, say a patient (i.e, hotel guest) comes to the hospital and everyone is super nice and helpful and the whole experience is great, but as she’s leaving the unit secretary is rude to her, or the guard at the entrance won’t let her husband idle at the curb, or she gets home and can’t find her cell phone charger and the lost-and-found guy is dismissive. In most cases people are able to perceive that the good overall experience overrides the one negative moment, but the negative moment is there. Now say the patient gets a short email from the hospital asking her to rate her experience. She rates a 4 instead of a 5 because of that lingering unpleasantness at the end. A month later her doctor gets a call, saying his satisfaction numbers are down, and he’s getting penalized. This is the problem with patient satisfaction surveys.
Add in now the patient who wants something specific from the system or doctor, something the system or doctor knows she can’t or shouldn’t have, or that the system cannot provide. Narcotics abusers, for instance. Or people looking for antibiotics for a cold. Or people looking for an MRI for their back pain. A doctor who refuses these requests, based on good evidence, fiscal responsibility, and clinical expertise, will have terrible patient satisfaction scores. The customer is not getting what he or she wants. The dissatisfaction of the patient has nothing to do with the level of attentiveness provided by the doctor. This is the problem with patient satisfaction surveys.
In the world of hotels, guest satisfaction surveys make sense because the whole point of the industry is service, especially at luxury hotels. In the world of medicine, the point of the industry is to make people better, keep them well, or help them die well. It is not a service. Patients cannot just demand whatever they want. This is the problem with patient satisfaction surveys.