Are You A Slave To Patient Satisfaction Scores?
I am very blessed. The hospital where I practice, while concerned with patient satisfaction, does not worship at its altar. That is, so far our administrators seem to understand that people will occasionally be angry or unsatisfied, and that such dissatisfaction is within the realm of real life. We still have people storm out of the emergency department, prattling on about lawyers and lawsuits, promising to go to another hospital in the future (which we heartily encourage). On the whole, we do a bang-up job of keeping the right people happy, and an adequate job of making the right people unhappy.
But it saddens me to hear about so many physicians, all across the country, who are slaves to Press-Ganey scores and other patient satisfaction tools. These poor, beset practitioners 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. In my life as a columnist for Emergency Medicine News, I’ve received many communications from individuals frustrated by patient satisfaction scores. And worse, physicians who say ‘I’d love to complain about it, but I’ll lose my job.’ They are compelled to apologize to narcotic abusing patients, to give movie tickets to non-paying patients who abuse their care and to bend over backwards to give credence to every dysfunctional individual who demands their services.
Why do hospitals do this? Is it because, as corporate entities they’re desperately concerned with human happiness? Or is it, rather, because they are concerned with the bottom line, with finances, with cold, hard cash? I suspect the answer is cash. Hospitals want happy patients who will come back and spend more money. So, they’re willing to do the wrong thing, willing to give what the patient ‘wants,’ in order to keep paying patients coming back. (Never mind that many of the ones complaining are non-paying…the twisted business philosophy of modern medicine still equates the angry, demanding non-paying patient with a ‘customer.’)
Given this reality of customer service, I find it ironic that physicians are forbidden to accept gifts from pharmaceutical representatives. Why is it that we are told we cannot have their gifts? Their meals? Because we might make decisions based on those gifts. That is, we might ignore sketchy science in exchange for meals, trips, even note-pads or pens ( simpletons that we obviously are). In other words, our prescribing might be adversely affected by our desire for gain.
Hmmm. That sounds remarkably like the practice of using patient satisfaction scores to decide which doctors are doing the right thing! I mean, it’s the same idea, right? If the patient is satisfied, even if it’s for the wrong reason, even if it involves the pillory for a poor, well-meaning physician, then the patient’s dollars may come back.
Help me out here. What’s the difference? Patient satisfaction scores, while sometimes useful…if done properly…should not be used to squash good medicine and good doctors in the interest of some vague hope of financial gain.
Sure, we ought to please our patients when it’s the right thing to do! I’m not saying we should ignore the idea of making our ‘customers’ happy. But let’s be realistic. Some people shouldn’t be made happy; especially because the act of doing it puts the system at risk financially, the patients at risk medically and the physicians at risk ethically.
Customer satisfaction surveys should not be twisted for financial gain. Unless of course, we get our lunches, pens, notepads and occasional trips. What’s good for the CEO, after all, is good for the guy in the trenches. Goose, gander, pot, kettle. Fair is fair. And bad science is bad science, no matter who allows it!
*This blog post was originally published at edwinleap.com*
It is annoying to be held accountable, particularly when the culture within medicine for years has been such that we rarely received negative feedback from patients, at least anyone who we did not view as some sort of crackpot.
One thing I have come to appreciate is that robust and self correcting systems thrive and adapt on feedback. I agree that Press Ganey surveys are crude tools but they were not designed by practicing clinicians. Why? Because we never exhibited particular interest in finding out how well we were fulfilling the needs of our patients. Nature abhors a vacuum and the survey industry was all too happy to step in and deploy a product which measures service measures which are hard to argue with.
We need actual measures which can sort through the good doctor/bad doctor problem and physicians need to take the lead. All physicians need to receive ongoing feedback, including appropriate negative feedback in order to maintain practice excellence.
I find this interesting that I wrote a comment earlier stating that physicians are not used to getting negative feedback, an aspect that our culture that is probably not particularly healthy. Much to my chagrin, the comment appears to have been deleted. There is a certain irony that a comment identifying a perhaps pathological aversion to criticism generates such a response and serves to validate the very hypothesis I put forth.