Is "All 5's!" the way to go? - a podcast by Scott Selinger

This is Scott Selinger and welcome to another edge-of-your-seat-amazing talking blogpost - ABC’s for ECP’s, the podcast on behalf of the Northern California’s chapter of the American College of Physicians Council of Early Career Physicians.  Today I’d like to talk a little bit about this new world of patient satisfaction scores.I really like my new car.  I got it a few months ago and it’s been working great.  But then a few weeks ago I folded the back seat down and now it won’t come back up.  So like most men, I hit it a few times and then decided to take it to the dealership.  It was a pretty easy, seamless process of getting in and out but there were a few snags.  For instance, they told me I needed a new part and they’d call when they got it in - but that didn’t happen and when I called 2 weeks later I found out that the part I needed had been there for 10 days.  And then there was the little issue of the fact that when I got the car home, the seat was still broken.  I brought it back, saw a different service advisor, who apologized profusely, and they got it fixed the same day.  The kicker was, every time I was there, I was reminded before I left that “by the way you might be getting a survey …” at which point I cut them off and just gave them a thumbs up and said “all 5’s guys!” because I really wasn’t interested in hearing the spiel – the surveys they send out are based on top box scoring, so if they get anything except a 5 out of 5, they get dinged, even if they had nothing to do with the dissatisfying issue.This is getting to my main point about patient satisfaction surveys and its effect on us as physicians.  This is something I slowly started hearing more about towards the end of residency, but at the time the satisfaction scores at the resident clinic were abysmal and we felt sort of resigned to that because a lot of the dissatisfying factors were systems issues beyond our control.  That’s if you can imagine patients being dissatisfied by frequently seeing random doctors, long wait times, bedside manners that were still under construction, and frequently being told that they didn’t need antibiotics for their cold or opioid pain medications for their headache. But now that I’m out practicing, I’m realizing how huge an issue this is.  I’m still trying to figure out when someone needs steroids and when they need antibiotics or the best way to convince them they need to quit smoking or lose weight and honestly, sometimes this weighs on my mind especially when I have someone demanding something I know is unreasonable.  With all the money that is tied to patient satisfaction scores between Medicare reimbursements based on it as well as organizations and practitioners trying to maintain patient loyalty and the insurance money that comes along with it, it’s no wonder it frequently feels like our profession is starting to more resemble that of the service industry, but saddled with the complexities of human health.  To tie back to the car problem I had, a colleague of a colleague now routinely, in her follow up emails to her patients, has a little tagline at the bottom talking about what they should do if they get a survey!  Patient satisfaction scores are now commonly being tied to physician pay and advancement or retention at their current job, the theory being to incentivize us to make that extra effort to make sure our patients are satisfied by their medical care.And in theory this sounds great because why shouldn’t patients have an exceptional experience every time?  Why should they expect any different of us than they do of their mechanics (and I don’t mean to pick on mechanics - I’m just still a little miffed at mine).  Well, there may be a few reasons, just because our profession is a little different than many others in the service industry.A study[1] just published a few weeks ago in the Journal of Patient Preferences and

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