satisfiED1If you asked 100 ED docs around the world what „patient satisfaction” means to them and their daily practice, you would likely get 100 different answers… Pose the same question to 100 emergency physicians in the U.S. and you’ll certainly get 200 angry eyeballs looking at you with disgust!

There is obviously nothing wrong with keeping your patients happy. It is quite important indeed. Nevertheless, when someone „incredibly brilliant” decides to make money by convincing an employer to cut your wages based on their crappy metrics, it turns into a caricature of a noble concept.

Chained by the patient satisfaction surveys docs in the American healthcare system tend to do the strangest things first. Why would one care about the Hippocratic oath if the hypocrisy of satisfaction scores (SS) governs our practice? Sadly enough it becomes nearly impossible to treat patients and „first do no harm” when at times you are dealing with demanding customers instead. Empowered by Dr. Google and their right to „100% satisfaction or money back” they insist on unncessary or even harmful tests and treatments. We, as physicians, are at loss both financially and morally when creating a vicious circle of over-testing, over-diagnosing and over-treating. We end up bankrupting the system and harming our patients when attempting to meet the absurd SS demands. (Oh yes – I deliberately chose the „SS” acronym as it is a deadly weapon).

One of the SS vampire companies promotes their business by insinuating they improve healthcare through enhanced patient experience. This particular business and alike have been on the market for over 30 years. Unfortunately it doesn’t look like they’ve accomplished much positive. According to the 2013 Commonwealth Fund International Health Policy Survey U.S. adults are the least happy patients compared to 10 other industrialized countries:

GEN - Satisfaction - 11 wealthy countries survey

To further blacken the picture the above survey of 20000 (twenty thousand) patients in Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the U.K., and the U.S., has shown that „U.S. adults are significantly more likely than their counterparts to forgo health care because of the cost, to have difficulty paying for care even when they have insurance, and to deal with time-consuming insurance issues”.

GEN - Satisfaction - 11 wealthy countries survey - cost

Isn’t it tragic? Heaviest healthcare spending among the industrialized countries and the American patients struggle more than elsewhere to stay happy and healthy?

Birth of SS surveys

While my annotations above might seem cynical and sarcastic to some, a ground-shaking study by Fenton et al. has shown that patient satisfaction links to higher health-care spending and INCREASED MORTALITY. They surveyed 50000 (fifty thousand) U.S. adults which is a nationally representative sample. „The study found that patients who were most satisfied had greater chances of being admitted to the hospital and had about 9 percent higher total health-care costs as well as 9 percent higher prescription drug expenditures. Most strikingly, death rates also were higher […]. More satisfied patients had better average physical and mental health status at baseline than less satisfied patients. The association between high patient satisfaction and an increased risk of dying was also stronger among healthier patients„. No matter how you look at it, rating doctors is bad for patients’ health and it’s quite unhealthy for the national budget.


In the end it’s time everyone admits that being able to sue doctors and give them crappy satisfaction scores doesn’t make patients truly happier nor healthier. Donald DuckNot a single honest soul benefits from tying physician wages and hospital reimbursements to the SS metrics. Instead of Affordable Care Acts the American patients need a reenactment of affordable care that first does no harm. Some could also use a gentle reminder that public yelling is barely acceptable for angry toddlers and feet stomping might get them plantar fasciitis… But that’s a different story…