Patient satisfaction: A danger to be avoided

By Ben White, MD, for MDLinx
Published October 30, 2019

Key Takeaways

Doctors intuitively know that the Yelpification of medicine is bad. But it’s not just toxic to the physician-patient relationship and bad for burnout, it’s actually dangerous. 

The outsized and misplaced importance of patient satisfaction scores is a perfect embodiment of Goodhart’s law, well-paraphrased as “when a measure becomes a target, it ceases to be a good measure.” 

If you make patient satisfaction scores a critical target—and they are—you will see consequent mismanagement. This is so blatantly apparent when it comes to urgent care and pain management that, if anything, high satisfaction scores are likely a more meaningful signal of poor care.

If a patient comes to an urgent care for a URI and wants antibiotics, they will be most “satisfied” when they receive the prescription they didn’t need. And all that over-treatment is not without risk. 

Even outside of quality metrics, you need patients to make money, and the “customer” is always right.

A study published in JAMA is a great example of the obvious negative externalities of prioritizing patient satisfaction scores. It analyzed a large number of telemedicine visits for URI:

72 percent of patients gave 5-star ratings after visits with no resulting prescriptions, 86 percent gave 5 stars when they got a prescription for something other than an antibiotic, and 90 percent gave 5 stars when they received an antibiotic prescription.

In fact, no other factor was as strongly associated with patient satisfaction as to whether they received a prescription for an antibiotic.

Higher costs and more prescriptions

Another study out of UC Davis analyzed a >50,000 person national Medical Expenditure Panel Survey and found that patients who were most satisfied had greater chances of being admitted to the hospital, had ~9% higher total health-care costs, and 9% higher prescription drug expenditures. Of course, if you’re a for-profit entity (and most “non-profit” hospitals certainly are), higher costs and more prescriptions often just mean more profit. A win-win-win.

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