Metrics are a necessary evil. If we are going to “pay for performance,” we need a way to measure that performance. Some outcomes make sense to track, like hospital readmissions or infection rates. But do customer satisfaction surveys make sense for medicine?
This topic was brought to my attention by a colleague who mentioned an entire medical group asking not to be notified of their customer satisfaction scores. The group was only receiving negative feedback. This colleague herself had a negative review from a patient with a BMI of 35 who was upset she had been called overweight. Is this type of information actually helpful for anyone’s practice? Yes, it can be a powerful tool to learn from mistakes, but is the truth a mistake? What about in the cancer space? Is it fair to grade those clinicians who already have present poor prognoses? Does grading those clinicians do anything to improve outcomes?
I don’t think customer satisfaction has a place in medicine. First, we don’t have customers; we have patients. And the clinician-patient relationship should be like a child-parent relationship. You should be committed to their success, but you should not be your child’s best friend. You have to give tough love, and in the clinician-patient relationship, also remain objective. While a service is being provided, medicine is not a service industry. I say this as a community pharmacist where, despite being the most accessible health care clinician, all reimbursement is based on a product, not the clinical services we provide. There is a reason it is called the art of medicine. It takes a gifted clinician to make the science work.
Secondly, satisfaction surveys do not make sense because the patient should have a seat at the table of the interdisciplinary team. The patient should be active in the treatment care plan as much as reasonably possible. If they are part of the team, why are they in charge of rating the outcome subjectively? These same active patients are asking for our expertise. The clinician should not be penalized because the patient doesn’t like the result.
Furthermore, outside factors may impact the care a patient receives. Increasingly, the interference of insurance companies determines the course of treatment. Who gave them a medical license anyway? In the pharmaceutical space, the number of prior authorizations for drug therapy has gotten ridiculous. It’s hard to tell whether it’s an evidence-based or pure cost-saving measure. Besides insurance companies, other outside factors affect the course of treatment, including supply chain issues, backorders, and shipping delays. Still, clinicians are unfairly held accountable for the outcome.
Medicine can’t be distilled down to a drive-thru mentality where we see how fast we can process patients, because, one, errors can have dire consequences of loss of life or limb. Two, the quickest solution is not always the correct choice, morally or medically. Cookie cutter medicine doesn’t work. We can’t automate clinical treatment down to an algorithm. But a customer satisfaction survey assumes that everything can be optimized to be quick and efficient. And three, the patient (i.e., the grader) is not always correct. Not every patient with a fever needs an antibiotic, but urgent care clinicians are downgraded if a patient took the time to be seen and leaves without a prescription. Maybe it’s not the best course of action to prescribe a drug the patient has seen in a television commercial. Again, just like toddlers need to be told no when it’s not in their best interest, so do patients. And while some patients appreciate counseling against the use of codeine under age 18 due to the risk of being an ultrarapid metabolizer and subsequent respiratory depression, other patients file a corporate complaint because the difficult pharmacist is delaying/denying pain medication for a child.
Good medicine often involves interdisciplinary teams working together, which can throw a wrench in the timeline based on each individual’s availability. The reality is, the more steps involved in a process, the more likely there will be a delay in care. As a pharmacist, I need a prescriber to write a prescription for the drug, insurance to cover the cost, the manufacturer to produce it, and a distributor to deliver it to me. There are multiple places where a medication refill can be delayed. Despite the delays beyond my control, a customer satisfaction survey would evaluate more than I can mitigate.
While a service is being provided, medicine is not a service industry. So while we as clinicians want contented team members collaborating on our patient care teams, we don’t want to treat satisfied customers. So we must provide the tough love to tell that patient with a 35 BMI that some weight loss is warranted. Sticking to monitoring the overall health of our patients and not purely their happiness can accomplish this. After all, when patients join the team and see improvements in their health, that is the ultimate satisfaction.
Do you think patient satisfaction surveys are valuable in medicine? Share in the comments.
Emily Wetherholt, PharmD, BCACP, lives in Schaumburg, Illinois, with her husband, three active children, and dog. She is passionate about advancing the cause of pharmacists everywhere, serving on the Illinois Pharmacist Association Board of Directors. When she isn’t advocating for pharmacy, you can find her exercising with her Fit4Mom friends.
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