The Problem With Patient Satisfaction As A Key Metric of Physician Performance

By

Leonard Zwelling

Satisfaction. What is it?

Simply stated it’s the absence of desire. It is also very rarely attained by humans. Everybody always wants something more, even if it is just to live another day. If any people should understand this, it ought to be oncologists. But do we?

My clinical sources have informed me that there is a big push at Anderson to increase the patient satisfaction scores measured through Press Ganey instruments. This has become a big issue in American medicine and certainly big business for Press Ganey. MD Anderson now has a vice president for patient experience who is encouraging the clinical faculty to be mindful of the perceptions of the patients of the quality of the care being delivered. But let’s tease that apart a bit.

It is reasonably safe to say that every patient has a different assessment of his or her satisfaction. I would venture that those patients with cancer in remission are more satisfied with their MD Anderson experience than those with a new recurrence even if the first patient’s doctor has a lousy bedside manner and the patient with the new recurrence is cared for by a saint. An older physician once told me that was the number one issue in patient satisfaction—the regression of the cancer.

That does not minimize the importance of the way the place looks, the ease of parking, the wait times and the friendliness of the faculty and staff. All of this counts. But does it count enough to make it a factor in how much MD Anderson is reimbursed for care? Apparently it does as a small percentage of the reimbursement from government sources is at risk depending on how patient satisfaction scores are tallied.

I recently was told of a brash encounter between a patient and a consulting physician. This is a senior faculty member of great clinical skill. Why should that ever happen?

There are many possible reasons. None of them are excuses, but let’s consider that the doctor may have had little sleep because he was up all night with sick patients. Perhaps he had a grant deadline for his only NIH RO1, the one that keeps his salary paid for and his bonus coming. Maybe he had three committee meetings that day and was not able to make rounds until after six. There are a host of maybes. I am not excusing his abruptness with a patient, but I would like to introduce a concept that I think is as important as patient satisfaction. That would be doctor satisfaction.

The last sixteen years at MD Anderson have been hard ones with both external and internal forces damaging the reputations of the leaders of Anderson and the civility of the work environment, not to mention interpersonal discourse. It has not been an easy time to build a career at Anderson, especially for those who care for patients and try to do some academic work as well.

So as a plea to the new administration let me be the first to advocate not only for patient satisfaction but also for doctor satisfaction. My guess is that if the new leadership takes care of the latter, the former will take care of itself.

Leonard Zwelling