Patient satisfaction surveys are good in principle, bad for practices

I once asked a physician, “How do you know that a patient is truly happy with their visit?”

His reply: “They tell me.  And trust me, when they aren’t happy, they really tell me.”

What used to be a frank discussion with a care provider or a staff member to improve practice operations is now another piece of data used to judge a physician’s effectiveness via spreadsheets and quality metrics. Patient satisfaction surveys have replaced the “voice” of the patient. The surveys inform payers, employers and anyone else with access to the results how patients really feel.

And like most data, it can be manipulated in ways that undermine the purpose of its collection in the first place.

Case in point: unnecessary medical tests. If the difference between a happy patient and one who might give a bad score is an additional test that causes no additional physical harm, why not cover all bases and get a good review? Medically necessary? Nope.  Costly? Yep.

Now I’m not going so far as to say that physicians will cater to every single whim of their patients and compromise on what’s right for what’s popular, but patient satisfaction surveys are an imperfect science. And it’s probably not beyond belief that some hospitals and health systems purposefully “teach to the test,” focusing their attention on the key items in these surveys to ensure a good patient experience and hence a good score.

Smaller medical practices don’t have the need or energy to play those same games, but often find themselves in the same dilemmas. Sure, patients can rave about their visit and how great everyone is at the practice, but until they go online and answer a payer survey or mail in their assessment, it doesn’t “count.” And physicians find themselves sheepishly asking patients to give them a good score as it could affect their payment or even their future employment.

A doctor recently explained it like this: “I feel dirty asking for a good review.  I’m a physician providing medical care, not a grocery store looking for additional customers.”

I’m all for improving the quality of healthcare in this country and ensuring that patients are truly satisfied with the care they receive.  But let’s not overlook the importance of one-on-one relationships between physicians and patients. Let’s not rely on artificial surveys to bring in a third party to gauge a doctor’s effectiveness, adding to the “if the box isn’t checked, it doesn’t count” mentality healthcare appears to be adopting.   

Patient satisfaction surveys are here to stay and, used correctly, can perhaps add value. But with all the information available today to patients, they will simply “rate” you with their feet, leaving for another provider if truly dissatisfied-no survey necessary, saving everyone a lot of time and energy.  

Keith L. Martin is the editorial director of Medical Economics. Do you think patient satisfaction surveys have value? Tell us at medec@ubm.com.