Patient Satisfaction: the New Measure of Medicine

It used to be, before people were forced into health insurance networks, that patients would vote with their feet if they weren't satisfied with the medical care they received. Physicians were motivated by the immediate feedback from the front desk when patients brought up the charge slip after being seen. If they didn't like the service or the charge for that service, they would tell the desk and all in the waiting room within earshot. Physicians knew that one negative comment would require 10 positive comments to neutralize and break even. Thus, they were committed

to give the best care and communication to their patients. Physicians got their business by word of mouth from satisfied customers. No satisfaction, no positive word of mouth, no business. Simple, immediate, accurate.

Now we have surveys, seemingly exhaustive lists of questions that administrators can collect and manipulate to see what's going on from a distant office with never any direct observation of those patients and their satisfaction. With the internet physician profiles there's an added element in which disgruntled patients or even non-patients can give their feedback or vent their spleen. By such methods, a physician can be smeared for giving good care, but not what the patient wanted or expected.

In such an environment, especially with the added pressure of computer controlled communication and 15-minute visits, physicians are more likely to give the patients what they want to save time and reduce the dissatisfaction risks. In that scenario, any confrontation of unhealthy lifestyles is inhibitted. Killing the messenger bearing bad news didn't stop with the fall of ancient kingdoms.

The health care industry has distorted the physician-patient relationship. Now strangers care for strangers, neither knowing the other inside the white coat or outside the white sheet. There is little or no social interaction or context. Abuses can happen in that environment. Administrators needed to come up with a system of oversight. The patient satisfaction survey was born.

The old physician-patient relationship with its long-standing, often generational history of care, never required patient satisfaction surveys. In my 2-physician clinic, we had a 90-95% satisfaction rating. Once we joined a large clinic, that satisfaction dropped to about 60% within months. For intimate and personal health care, bigger clinics are not better.

Now there is the push to establish "medical homes"--trying to reinvent the family practice "wheel " that was the victim of an intentional blow-out two decades ago. If those same administrators are in charge of the process you can bet there will be more exhaustive surveys to follow. But not necessarily better care.

Good cost-effective medical care requires the marriage of medical science with the art of communication. No computer program is capable performing the art of communication. No patient satisfaction survey measures the performance of good medical science. Patients would have to be educated to the level beyond medical school to achieve that.

So what in deed does the survey of patient satisfaction measure? It measures the physician's efforts to neutralize the political climate and the financial and social stresses brought on us all by the health care industry. The patient satisfaction score is no more a measure of good medical care than the number of Olympic gold medals is a measure of the health of this nations population.