I Can’t Get No (Satisfaction Scores)


So they passed the SGR (Doc Fix) bill, huh.  And now quality indicators are going to eventually count for 50% of physician pay?  Nice. Even sweeter is that a major part of these indicators will be patient satisfaction scores.  All of this unproven.  All of this easily manipulated.  All of this destroys the medical profession.  Soon, doctors will be doing what is needed to make their scores better instead of trying to get their patients better.  Think I am wrong?  Well, I have been saying this for a decade on this website.  Here is the Johnny-come-lalety The Atlantic saying the same thing:

  • Patients have complained on the survey, which in previous incarnations included comments sections, about everything from “My roommate was dying all night and his breathing was very noisy” to “The hospital doesn’t have Splenda.” A nurse at the New Jersey hospital lacking Splenda said, “This somehow became the fault of the nurse and ended up being placed in her personnel file.”
  • An Oregon critical-care nurse had to argue with a patient who believed he was being mistreated because he didn’t get enough pastrami on his sandwich (he had recently had quadruple-bypass surgery).
  • In fact, a national study revealed that patients who reported being most satisfied with their doctors actually had higher healthcare and prescription costs and were more likely to be hospitalized than patients who were not as satisfied.

I will leave the rest of the article for you to read.  There is a place for satisfaction scores and satisfying patients.  They are still customers.  The problems comes when you care NOTHING about these scores because you are an arrogant prick or you care TOO MUCH about these scores because you know how this is how you get paid.  The answer lies somewhere in the middle but, most importantly, it needs to be handled by the physician himself without the input of administrators, insurers or the government.

When a local hospital administrator asked me what my metrics were I told her that when patients feel I am not doing a good job, they leave.  She was pissed.

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. Steve O' says:

    Hospital prostitutes. That’s what we should do – legalize hospital prostitution. It could bring down one’s reputation to associate with sleazy people – we’ll keep them away from UR and administration so they aren’t morally corrupted.
    For the bluenoses among us, I give it five years, and Press Gainey and HEDIS scores, applied to hospital-based prostitution, it will drive them out of business.
    Then, they could always go to law school – but there’s some things a prostitute simply won’t do.
    [PS-it’s no surprise that Abraham Flexner, who wrote the Flexner Report that brought us to this point after 100 years, spent six years researching his next topic – the nature of Prostitution In Europe. The report’s so dry and boring, I gave up after five pages.]

  2. Perry says:

    It’s perfect. You can either cater to the patient and order what they want, tests, antibiotics, narcotics, whatever, or you can cater to the ACO which wants austerity measures. Either way, you lose.

  3. Pat says:

    Love your answer to the hospital administrator.

  4. drhockey says:

    See the below 2 articles. They support your thoughts regarding patient satisfaction scores with more specific data and examples.

    Why Rating Your Doctor Is Bad For Your Health:

    The cost of satisfaction: a national study of patient satisfaction, health care utilization, expenditures, and mortality.
    Arch Intern Med. 2012 Mar 12;172(5):405-11. doi: 10.1001/archinternmed.2011.1662. Epub 2012 Feb 13.

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