Primum Non Nocere and Patient Satisfaction Surveys

No doctor that I know likes to be graded via “physician satisfaction surveys”.   The reason is that it magnifies the differences between doctors and administrators.  Administrators think we should be run like a fast food restaurant or American Eagle store.  Doctors understand that saying “no” to demands of antibiotics, narcotics, and expensive procedure requests may be the right answer even though it doesn’t make the patient happy.    This argument seems to be never-ending without a good  way to solve it…..until now.

A new study from a team of UC Davis researchers found that people who are the most satisfied with their doctors are more likely to be hospitalized, accumulate more health-care and drug expenditures, and have higher death rates than patients who are less satisfied with their care.

Maybe we should rethink the value of these physician satisfaction surveys which remain not only a nuisance and statistically insignificant , but now may also be problematic?    If worrying about patient satisfaction surveys has these effects then maybe the axiom of “first, do no harm” should take precedence?

Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  8 comments for “Primum Non Nocere and Patient Satisfaction Surveys

  1. John Kelly, MD
    February 26, 2012 at 9:24 pm

    Don’t you just love Angie’s List, and all the copies of doctor rating sites online? I had a patient say once, “I don’t want to take up your time. I’m just here to get antibiotics for Tommy’s cold.” When I did a strep test to show her that it wasn’t a bacterial infection and told her the >2/3 odds it was a virus and that antibiotics would not help, she went online to every doctor rating site she could find, said I was appallingly unprofessional and my clinic was “filthy.” I’ve read other evaluations saying that you “have to be before he’ll give you antibiotics.” Of course, then they don’t come in until they’ve asked to be treated over the phone, saying “I know what I’ve got, and I need antibiotics!” Usually it’s a weekend. That’s what I like…, convenient and free! I try to practice medicine, and I get zinged for it, lose business. The local E.R. ALWAYS give antibiotics, so they often leave my clinic and go there, angry at the expense. The E.R. knows how to do business. Give ’em what they want and push them out the door. NEXT! None of this “educate the patient” crap. Here you go! If you are sick enough to call it something, why, let’s put you in the hospital and warm up one of those empty beds! We can sell it to your doctor, even before the labs are back. It’s a circus. So, yes. I have a good relationship with many, and a crap relationship with a few. You seldom get praise in print, and anger fuels complaints, plus it sells online copy. How must I work for free over the phone? People expect it. I want to know what I treat. That really pisses a lot of folk off, in this economy.

    • John Kelly, MD
      February 26, 2012 at 9:28 pm

      The missing word is “dying.” You “have to be dying before he’ll give you antibiotics.”

      Wish I could edit that!

  2. mamadoc
    February 26, 2012 at 5:02 pm

    AND the highly verbal articulate (wealthier) individuals are also more likley to rant about their physician who DOESN’T do what they request, don’t forget that..

  3. Frank J. Rubino MD
    February 22, 2012 at 7:25 pm

    Highly verbal articulate (wealthier) individuals are more likely to rave about their physician who do what they request than are less educated, less verbal (non english speaking) patients . The good people that are less fortunate are more likely express their deep appreciation to the physician personally but that won’t show up on the hospital or clinic web site. Only a certain segment of the population knows how to read and fill out a satisfaction survey.

  4. Ray Wechman
    February 22, 2012 at 11:05 am

    law XIII from the “House of God”: “the delivery of medical care is to do as much nothing as possible”- a cogent re-interpretation of Primum Non nocere

  5. George Voigtlander
    February 22, 2012 at 10:43 am

    A respected endocrinologist in Omaha once told his medical students that “Medicine is a matter of respectability, not popularity”.
    As true now as when he said it over 40 years ago.
    The study shows that Dr Stone was well ahead of his time.

  6. Ken
    February 19, 2012 at 1:07 pm

    I love this study. It has confirmed what all physicians really know, that giving patients everything they want is detrimental to their health. Our group’s policy of surveys has led to jokes of a future policy being: “No patient leaves without an orgasm.” I’m sure administration will ignore this study, just as sure as I am sure they would have embraced it whole-heartedly if it had concluded the opposite.

  7. THEODORE BACHARACH
    February 18, 2012 at 2:58 pm

    Physicians are in the bad position of having to give the patient appropriate, accurate and often less than optimal news. Patient satisfaction probably does little to determine the quality of the care delivered. As pointed out, patient satisfaction bears little relationship to the quality of care the patient receives.

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