Why do patients keep looking at satisfaction scores?
There's an interesting post on Emergency Physicians Monthly outlining why Healthgrades failed to be a useful resource in helping patients avoid a particularly incompetent physician. In this post, I’m not going to address Healthgrades’ specific actions, but I think it's worthwhile to consider why patient ratings are so commonly used.
As the case of Dr. Duntsch demonstrates, patient ratings are not an ideal proxy for quality. Yet patients still use ratings to make health care-related decisions. Is this primarily because ratings sites like Healthgrades encourage patients to use ratings, as the author implies? Absolutely not. Patients use “invalid” quality data (like ratings) to make health care decisions because they have no access to “valid” quality data (e.g. procedure volume and outcomes). To anyone who doubts that patients want to take advantage of more sophisticated metrics, consider this thought experiment: suppose a patient were going to undergo a difficult and invasive surgery and the patient had the choice of choosing to know either 1) the relevant case volumes and success rates of surgeon candidates or 2) patient satisfaction scores for the same surgeons, which set of information would the patient choose? I'd be hard pressed to think of any patient who would prefer to know patient satisfaction scores.
How did the health care industry come to witness this vacuum of the most meaningful quality information? Medical lobbyists such as the American Medical Association have frequently pushed to block policies aimed at increasing transparency. Patients are a loosely knit group and as such, have little effective leverage in shaping these policies; however, members of the medical community do have clout. As pointed out earlier, rather than complaining about the fallibility of patient ratings, the medical community should push for the release of physician-level quality metrics, obviating the heavy reliance on patient satisfaction scores. For a first step, how about pushing for access to the National Practitioner Databank? That databank has data that even professionals might find useful in making decisions about their own medical care.
One way or another, patients will find ways to make judgments about the quality of a professional’s services -- after all, it could be a matter of life and death. Why shouldn’t the medical community be proactive about helping patients make more informed choices?