Patient satisfaction

The CMAJ commentary by Detsky and Shaul1 on incentives to improve patient satisfaction is both thought provoking and relevant to day-to-day practice.

Yankelovich2 points out that despite better methods of measuring public opinion, little is known about how to improve its quality. Although information has become widely available, it plays only a limited role in shaping public opinion. Opinion polls can be misleading because they do not distinguish between people’s immediate reactions and their thoughtful, considered judgments. Patient satisfaction surveys often fail to even measure, let alone correct for, the nature, severity and intractability of the conditions for which care is received. This is a particular problem for teaching hospitals, where the most difficult and complex cases are concentrated.

Undue emphasis on patient satisfaction may make providing services to those most in need impossible for fear of negative repercussions. Added to this is the growing list of for-profit websites that allow anonymous public postings. Many institutions have established patient relations units whose actions are often seen by treating physicians as barriers to following best practices.

At the same time as mandating assessments of patient satisfaction, governments have expressed increasing unwillingness to pay for medically unnecessary measures that would increase satisfaction, such as imaging studies for low-back pain.