According to the new WSJ/Harris poll, about three-quarters of Americans believe patient satisfaction surveys as one of the most reliable indicators of care quality -- more reliable than frequency of preventive tests or independent assessments by watchdog groups or independent medical boards. Last week, I went to the doctor for a lingering cold. I waited for about 75 minutes, was ushered into the physician's office, spent about 45 seconds telling him my symptoms, 90 or so seconds having my lungs listened to and my ears peered at, and another 60 or so seconds being written a prescription for an antibiotic and told to come back if I wasn't better in 10 days. So what information do I have to evaluate the session? Well, length of wait, I guess. Friendliness of physician. Number of awards on his desk -- and there were lots. Amount of time he spent listening to my symptoms and examining me. Whether or not he confidently named off a probable bacteria and corresponding antibiotic. And that's about it. Now, the length of the wait has nothing to do with the quality of the care. Nor does his friendliness, except insofar as it encourages me to more fully recount my concerns. The awards on his desk have nothing to do with my visit, but they certainly make me feel more confident, and most behavioral studies suggest that such artifacts would create an "anchoring" effect that would lead me to evaluate my physician more positively. The time he spent actually working with me was minimal, but I have no reason to believe he neglected to do anything necessary. I'm glad he confidently prescribed something but I have no idea if I needed it, or if it was the right prescription, or if it was the causal factor in recovery or just happened to coincide with the end of my cold. Patient evaluations are, without doubt, the easiest way to evaluate care. They require no extra spending on the part of the insurers, and many of us are already habituated to looking at user reviews of everything from books to restaurants. Doctors offices are a very small leap. But are they sufficient? Not in any way that I can see. Patients don't have anywhere near the expertise or the information to evaluate medical care. What they would really be doing is evaluating the quality of the experience, which is not the same thing, and can in fact be quite misleading. Worse, it could incentivize everything from overtreatment -- doctors get better ratings if they do something -- to a cottage industry in meaningless awards that could be displayed on doctor's desks. It's well and good to have patients evaluate wait times and bedside manner, but asking them to evaluate medical care -- which, according to this poll, most folks think a fine idea -- could really prove rather destructive.
