If you had to deal with a “spousal satisfaction score” on a monthly basis, would this improve your interactions with your spouse? How about a “colleague satisfaction score”? Would you find it helpful to your psyche or would you resent your colleagues monthly critique? Increasingly this is how I feel about patient satisfaction surveys and physician rating sites. How much value are those instruments? Interesting a study from UC-Davis demonstrated an inverse relationship between patient satisfaction and good care. It makes sense, especially in an ER setting with hurried, relatively impersonal care, patients whose expectations are not fulfilled will be unhappy. The classic example in my world is the patient who comes in with a viral upper respiratory infection insisting on a “Z-pack” antibiotic. Seriously, it still happens. Will they leave and go to Angie’s List and give me a bad grade? Did I do the right thing by refusing the antibiotic AND discussing why? Did I try at great length to help them understand the danger? Despite my explanation, were they still upset they didn’t get the med they wanted? Fortunately I am not yet discussing Press Ganey scores in the hospital lounge with my colleagues but we do offer a Target gift card to random patients who take a survey from my office.
Partnering with patients does not imply that we are always satisfied with each other, just as I am not always satisfied with my spouse’s behavior. We work together to improve healthy behaviors, we trust each other to find the best path and we compromise expectations by taking into account factors that impact health. If I am worried about satisfaction, it is easier to hand out that antibiotic script than spend time explaining why a viral illness doesn’t require one. Or give the patient that antidepressant she expects because the TV says she’ll feel better, instead of understanding the reasons behind unhappiness that doesn’t require medication.
In spending enough time with patients to hear their stories, see their body language and listen to the undercurrents in their lives–this might improve my satisfaction scores and ratings, but not necessarily. It will enable me to give the best care regardless of my score. This is my goal. Hopefully, no one will push me toward another.
1. The cost of satisfaction: a national study of patient satisfaction, health care utilization, expenditures, and mortality. Fenton JJ; Jerant AF; Bertakis KD; Franks P. Arch Intern Med. 2012; 172(5):405-11 (ISSN: 1538-3679) http://www.medscape.com/medline/abstract/22331982