The Stepford Doctors

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This article in The Daily Beast was really well done.  It explains the utter uselessness in patient satisfaction surveys.  Here are some highlights:

  • The government has bet big on these surveys, as a recent article in Forbesnotes. Armed with the idea that “patient is always right,” Washington figured that more customer satisfaction data “will improve quality of care and reduce costs.”
  • In fact, the most satisfied patients are 12 percent more likely to be hospitalized and 26 percent more likely to die, according to researchers at UC Davis. 
  • We find ourselves in another kind of world—one turned upside-down—where the most ethical doctors are ousted and the most servile are raised high.
  • “The mandate is simple,” wrote Dr. Sonnenberg. “Never deny a request for an antibiotic, an opioid pain medication, a scan, or an admission.” So instead of better care and cheaper care, satisfaction scoring is making patients sicker and driving up costs. 
  • And many physicians claim that hospital administrators explicitly tell them to do whatever it takes to raise scores even if it means compromising their professional standards.
  • According to Forbe, Press Ganey, the biggest of the survey firms, went from a valuation of $100 million to nearly $700 million in just four years—bringing in over $200 million a year. And with cash comes political influence, so of course the government plays along. Medicare uses the surveys to withhold payment to doctors and hospitals that don’t have high scores.

All this, the article states, makes physicians into Stepford Doctors, “pleasing everyone with your perfect smile and agreeable demeanor, hoping that your patient satisfaction survey will be favorable, no matter the cost.” I couldn’t agree more.

So how do we stop them?  Well, if you are employed by a hospital then you can’t.  The administrators need to make money off you.  They also need a paper trail in case they want to fire you.  Satisfaction surveys work great on both accounts.  If you are independent doctor then you can consider making your patients sign a “gag contract”.  That may seem extreme but may be the only way to stop the rogue patient who wants to hurt you and your career because he didn’t get what he wanted.  More on this for another day.

53520cookie-checkThe Stepford Doctors