Press Ganey, a little-known company based out of South Bend, Indiana, is the leading provider of patient satisfaction surveys for human hospitals and physicians. These surveys are used on both small- and large-scale levels to evaluate the performance of doctors, providing leverage for compensation (or penalty, as it may be).
Hospitals and doctors' offices can use the information generated from the surveys to gauge where their employees stand with regard to the opinions of their clientele. Government offices will also use the information from these surveys to evaluate how to dole out reimbursement for certain programs such as Medicare. Higher scores translate to more revenue; lower scores lead to budget cuts and salary decreases.
The company’s website states that “everything we do is driven by our unwavering focus on helping our clients transform the patient experience.” Patients answer questions about their providers with the goal of making the sum total of their healthcare more enjoyable and efficient. Doctors then learn what they do well and what areas they can improve upon. Sounds like a proverbial “win-win” situation, right?
Unfortunately, physicians have raised their concerns that it’s unfair to base their performance ratings solely on the results of such surveys, as patients tend to consistently score them lower when they feel they are are actually practicing better and more efficient medicine. Conversely, their scores rise when they practice what they consider subpar care, designed to placate people's wants/needs, but not what is in their best interests.
Doctors feel the overriding mantra is “the patient is a customer, and the customer is always right,” moving medicine from scientific based to a service based profession.
When doctors fail to recommend additional testing, do not offer admission to the hospital, or refuse to prescribe antibiotics or strong pain medications for minor health issues, people become angry and consistently rate their doctors lower. When physicians suggest that persistent knee pain may be related to a patient being overweight, they are subsequently scored poorly. When they tell a parent their smoking could be contributing to their child’s worsening asthma, it is received as an insult, causing poor results on the surveys.
Doctors claim their survey scores are reliably higher when they prescribe antibiotics or narcotic medications for patients, even where they truly feel those treatments are not warranted. Even worse, doctors are moving towards placating patients with these unnecessary prescriptions with the specific intention of achieving higher scores for fear of loss of job security and/or pay cuts.
When I discovered this phenomenon, I immediately wondered, “Could this somehow relate to my career as a veterinary oncologist?”
At first glance, I would answer that, no, I am exempt from such issues. Superficially, I do not feel as though I’m working towards the goal of achieving any specific rating or score from my clients. Whether a client agrees with my recommendation or not, it doesn’t influence my decision to make it. I take pride in my profession, with the noble foundation that I’m here to protect and help animals at all times.
The sad part occurred when I really began to dissect the differences and I discovered that, unfortunately, I’m not exempt from the madness.
In looking at the examples set forth by disillusioned doctors, I too could easily recall cases where I’ve felt forced to treat a pet with antibiotics because an owner would not agree to a test to examine for infection.
I could offer up instances where I’ve reduced the dosage of a particular chemotherapy drug because an owner has asked me to do so out of fear of a poor reaction from their pet.
I’ve agreed to add on appointment after appointment, even when I’ve felt on the brink of exhaustion, just to keep my hospital managers happy and my job secure.
I’ve seen appointments where owners do not bring their pets along, knowing it really is not in their best interests, but also knowing I need to keep everyone happy, including my bosses.
Conversely, I can think of many instances where I’ve definitely made owners upset with a refusal to prescribe a particular medication, or with my brutal honesty about their pet’s diagnosis and prognosis.
I’ve lost clients to other oncologists because I’ve stopped offering treatment for their pet when I think their quality of life is poor.
I’ve even had one owner be angry with me when my prediction that their dog would likely succumb to it’s cancer within a few short months turned out to be wrong and their pet was alive and well over a year out from it’s diagnosis.
In some instances, what I’m describing has no particular relevance to the activities described by the human doctors above. In many others, the parallels are astonishing. I wonder how many of my colleagues would have similar stories to tell?
The most interesting aspect of doctors being evaluated on a ratings based system is that the most satisfied patients do not appear to be the healthiest patients. A study looking at the results of surveys for physicians reported the most satisfied human medical patients were also the ones who spent the most money on their healthcare and prescription drugs. They were more likely to be admitted to the hospital, incur the largest healthcare bills, and also the most likely to die. If the most satisfied and happiest patients truly had the best doctors, wouldn’t they be healthier in the long run?
Truthfully, patients, whether two-legged or four-legged, are not always the best equipped to judge what is best for their health. This isn’t to say you shouldn’t be an active participant in your pet’s care, rather that the best outcome would be expected when the veterinarian and owner work together in an open and honest forum.
We should be able to practice our craft with the knowledge that we are the best equipped to make recommendations for the care of our patients, free from worry about a negative review for not making a particular recommendation.
Lets save the Yelp-like reviews for our entertainment and dining preferences, and not our doctors.
Dr. Joanne Intile