The Stepford Doctors


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.

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]

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5 Responses

  1. Fred LaVenuta MD says:

    I retired twelve years ago as I could see the handwriting on the wall. Docs need to bug out en mass and create an MD shortage to restore the balance between physician availability and oversight – the bureaucrats can’t regulate docs who aren’t there. Retirees may take a lifestyle hit but not as much as you would think.

  2. Pat says:

    More examples of why I continue to say that medicine is a fundamentally dishonest pursuit. Being a modern physician means being someone’s bitch until you can (hopefully) retire.

    …and why (though I don’t partake) I favor medical marijuana use – for all medical personnel, just to help them not care.

    As the Japanese sub commander in the movie “1941” said, while forcing Slim Whitman to drink prune juice in order to recover a swallowed compass: “This has not been honorable.”

  3. Phil Lavine says:

    AMEN! I was recently investigated by my med board as a result of a disgruntled patient’s formal complaint. She only wanted me to prescribe an antidepressant. The fact that I deemed her suicidal and sent her to the hospital really pissed her off. A perfect example. Thankfully I’m in private practice. The med board dropped it in record time, but still, must of cost my malpractice company plenty….

  4. SteveofCaley says:

    I think I get it now. I’m preparing “early retirement” and bugging out to a Government job with great retirement benefits. It only requires a bachelor’s degree – I double-majored, so I can just pick one.
    Since day #1, there have always been pesty patients – that’s part of the game in dealing with humans. But what I’ve seen over twenty years is the loss of ability to discuss medicine with them.
    People now seem to believe that Reality is a choice, and the louder you yell, the more likely you are to get what you want. There is no such thing as diagnosing a “true cause” of an illness, in many people’s minds – it is hotly debated, and you can pick an answer from the Internet. Maybe it’s celiac! Try gluten-free!
    I was reamed out by a family that filed a treatment complaint. Pop came in short of breath, with a cardiac history, atrial fibrillation and mitral valve regurgitation, and was wet. They wanted antibiotics, I gave diuretics, and then the hospital’s QM department came in to investigate their complaint. The hospital determined that there was “not enough evidence to support a finding,” even though the chart documented no fever, low sats, JVD, an X-ray (which I read personally) showing failure but no infiltrate. How dare I pick “my” diagnosis over “their” diagnosis? There was no “the” diagnosis – the hospital would not dare sass the customer.
    I think I’m about to “retire” from this business. Internal Medicine is a fun gig, and I’m good at it – but now that it’s a case of doing the right thing OR keeping your job, I think I’ll go work in an area where substandard mediocrity doesn’t hurt anyone. Ciao.

  5. R Watkins says:

    And yet another crucial issue where our distinguished medical societies are either MIA or actively working against the interests of their physician members.

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