Patient Satisfaction is Killing Both You and I

PatientSatisfactionSurvey spotlight_140204

I was asked recently to contribute to a popular column on MedpageToday.com called “10 Questions.” One of the questions was:

If you could change or eliminate something about the healthcare system, what would it be?

My response:

The very misguided focus on “patient satisfaction.”  Physicians have been pressured to be medically “PC” by administrators who are, for the most part, non-physicians. The unspoken threat is there that if your group is not performing well in terms of “patient satisfaction,” they can find another group to cover their ED (or, another hospitalist group to staff the hospital.) This is akin to a business corporation indirectly practicing medicine without a license. That is to say the way we diagnose and treat our patients can be subtly influenced by concern over backlash by administration. We need to redirect our focus on the patient’s well-being and not solely on the patient’s emotional satisfaction.

It isn’t clear to me how over the past several years, patient satisfaction had become such a focus for every hospital administration and by the the federal government. But, recently, there has been a surge of posts and articles on social media and online magazines expounding on the evils of patient satisfaction surveys, its negative impact on actual patient well-being and the detrimental effect it has on physician morale.  “Soul-crushing” is the way Dr. Birdstrike put it.  I wholeheartedly agree.

Just a week ago during our monthly ED Committee meeting with administration, we were berated by our hospital CEO for the declining patient satisfaction scores over the past 12 months. While there had been no major changes within the physician group during the year, there were several major administration-lead mandates and changes. But, the fault was placed squarely on the ED group. I felt quite chastised and my head hung just a tad lower the rest of the day.

But, should I have? There is no logical reason to be so dispirited. Yet, I was. In his post, Dr. Birdstrike said,

“You can save a life, walk out of the trauma bay drained but proud, and be pulled aside and told that on last months survey, you didn’t get a patient a coffee “like they do at the car dealership.”

You are told, “Get those scores up.  Administration is watching.”

It translates into, “You suck.”

This is absolutely true. I am sure I am not the only ER doc who feels this way.  Administration is watching. How did it come to this? When did the physician-patient relationship become a car dealer-car buyer one? When did our service to mankind become selling off of our knowledge and expertise? Perhaps Dr.Sonnenberg‘s post gives us a clue:

“I believe that this little-known company, Press-Ganey, from South Bend, Indiana, has become a bigger threat to the practice of good medicine than trial lawyers.”

Who is Press-Ganey? If you work in healthcare, you have heard of them. Press-Ganey is the nation’s leading provider of patient satisfaction surveys. According to Forbes.com,

Press-Ganey was taken private in 2003 by American Securities, a New York private equity firm, for a reported $100 million. Four years later it was flipped to another private equity outfit, Vestar, for a reported $673 million. Since then revenue at Press-Ganey has grown at high single digits; it earned $82 million (Ebitda) on $217 million in sales in 2011.”

Forbes.com is savvy to our plight:

THE MATH IS NOW SIMPLE FOR DOCTORS: More tests and stronger drugs equal more satisfied patients, and more satisfied patients equal more pay. The biggest loser: the patient, who may not receive appropriate care.

In my 22 years of practicing EM, I have seen that whenever a financial incentive is tied into what is an intrinsically noble profession and calling, motivations become suspect and integrity loses its prominence. Linking patient satisfaction to physician pay and hospital reimbursement is simply asking for trouble. It can’t help but increase over-testing and over-treatment with documented detriment to the patient.

Dr. Sonnenberg states:

“Over-treatment is a silent killer. We can over-treat and over-prescribe. The patients will be happy, give us good ratings, yet be worse off.”

Didn’t we, physicians, at one point swear “to do no harm”?

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