Viewpoint

‘(I Can’t Get No) Satisfaction’

FROM THE CHIEF MEDICAL EDITOR

Larry E. Patterson, MD

There is a new problem in medicine. It hasn’t really hit us yet, but it has been hitting hospital and ER docs. What is this new obstacle to patient care foisted upon us again by — say it with me — the government? Patient satisfaction surveys. Yes, all around the country doctors are getting reimbursed based on patient responses to external surveying agencies.

What are the effects of such surveys? In brief, there are many reports of patients being prescribed antibiotics for viral infections, narcotics for minor pain and hospital admissions because patients are demanding these things. If the doctor practices good medicine and refuses these improper requests, he gets penalized in subsequent patient satisfaction surveys, and his income suffers.

Some argue that a little known company, Press Ganey, may be a bigger threat to us practicing good medicine than trial lawyers. As Dr. William Sonnenberg, president of the Pennsylvania Academy of Family Physicians, recently noted in his own editorial: “For the past decade, the government and health-care administrators have embraced the ‘patient is always right’ model and will punish providers that fail to rate well in these surveys.”¹

Forbes magazine quoted Press Ganey’s CEO, Patrick Ryan, saying, “Nobody wants to be evaluated; it’s a tough thing to see a bad score, but when I meet with physician groups I tell them the train has left the station. Measurement is going to occur.”²

As I wrote recently, measurement of health-care outcomes can be a great tool, especially with a mechanism like the AAO’s IRIS registry. But there’s no evidence whatsoever that patient satisfaction is in any way linked to quality care. Instead what’s happening is doctors are overprescribing and over-testing to make sure patients, who are in a poor position to judge quality, are “happy”. In the past, many overprescribed and over-tested to avoid malpractice. Now these practices are occurring to protect our endangered income.

How will (not could) this eventually affect us? Imagine suddenly having to prescribe antibiotic drops to every conjunctivitis patient we see, even though the majority are viral and the rest are mostly mild and self-limiting. Or the child who refracts +0.50 D and you tell the mother why she doesn’t need glasses, but the office down the road happily takes her insurance money and prescribes a lovely pair. Or the patient with dry eye who still can’t understand your repeated and patient explanation as to why her eyes water if they are dry.

And what about smoking and obesity? I don’t make my AMD patients “happy” when I talk about the critical need for smoking cessation. My overweight diabetic with his third vitreous hemorrhage is not “satisfied” with my discussion about diet. We tell patients what they need to hear — not what they want to hear.

If only the Rolling Stones were in charge of health care. OM

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