Patient satisfaction surveys constrain the practice of medicine

Press Gainey is not going to like this one.

I have a lot of family and friends who work in hospitals. On occasion, they will complain about a poor patient satisfaction score they received. There are several sides to the story, of course, but from their perspective the reason for the low satisfaction score received is because of some intervention, or lack of intervention, they are required to do (or not do) at the doctor’s orders. In the field of medicine, and other fields where professional expertise is what the customer needs and is seeking out, customer satisfaction surveys may be working against the best interest of the patient.

“Doctors feel pressured by what patients may say about them afterward. The fear of bad patient-satisfaction scores, or negative reviews on online sites, may be creating a “Yelp effect” that drives doctors to provide care that patients don’t actually need.”1

Antibiotics are often the over-prescribed medication, but in the Emergency Room and other areas of medicine, like dental visits, where pain management is common, opioids are often the sought after medication by patients that drive their response to a patient satisfaction survey. Doctors and dentists are then in an uncomfortable position of not meeting their customer’s needs, but for the customer’s own good. The patient can then just shop for a doctor or dentist that will prescribe the sought after medication. Drug seeking patients

“Some healthcare providers now sadly believe2 that ER patients with honest pain complaints are the minority.”3

Part of the problem is actually caused by government-mandated programs.

In order for a health care provider or hospital to be certified to receive payment from government-funded programs like Medicare and Medicaid, the provider must collect patient experience data, i.e. patient satisfaction, through the Consumer Assessment of Healthcare Providers & Systems (CAHPS) program. Physicians, hospitals and other health care providers must have sufficient scores from the CAHPS surveys in order to remain in good standing within the program they participate.  They can incur fines, reductions in reimbursement, or be removed from the program if CAHPS scores are too low. There is a real financial incentive for doctors, hospitals and other medical service providers to do the things that patient expects to insure a sufficiently high rating on CAHPS, contributing to over prescription of antibiotics and opioids.  and In the U.S. we have been indoctrinated with They may be so tightly scheduled that they get decision fatigue; physicians write more prescriptions at the end of their workdays than they do at the start.

As The Hippocratic Oath infers, “First, do no harm,” ending the CAHPS program may be the first step in giving back to physicians the ability to practice their art without undue retribution.

Government funding of health care services has numerous unintended consequences, and CAHPS is just one of them. Ending CAHPS will not solve the over-prescription epidemic in this country, but it is a solid, small first step.

  1. The Yelping of The American Doctor
  2. (I Can’t Get no) Satisfaction, agraphia.net
  3. The Drug War Is Wrecking Our ER Departments

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