By Brian L. Grant MD
Until reading this interesting Forbes article, I had never heard of the Press Ganey company and their ratings for hospitals and doctors. I am familiar with online ratings such as those on Healthgrades.com.
Ratings are problematic to the degree that they may reflect low sample sizes. Especially when responding is optional, those most likely to rate the quality of their medical care may be patients with complaints. And satisfaction with care may be correlated with important issues like listening, time spent, and other behaviors important to patients.
However, one is not guaranteed the best care from a doctor who has great demeanor and a brusque physician may have great clinical judgment and provide better care and outcome in many situations.
To those physicians who complain that the surveys force bad behaviors on their part, one can only bow one’s head in shame.
Integrity means doing the right thing regardless of whether one is not being watched, or in this case, when one is being watched and scored. If the scores are flawed, so be it. It does not justify over-prescribing or any other actions that do not further the right medical decisions and care.
Nobody ever said that doing the right thing is always easy. But really colleagues, is it that hard to say no to a few extra dollars based upon flawed ratings? Is it really that hard to say no to an administrator trying to tell you how to practice medicine? Is it really that hard, if all else fails, to find another job?
The comments in this online article add more color to this interesting topic.
I had to deal with Pres-Ganey ratings when I was in practive with the Highline Medical Group. The administration connected the results to salary. The scores were based upon data from amazingly few respondents. Can you imagine that your income will be affected by a total of 4 respondents in a month? I repeatedly explained in meetings that the scores were statistically meaningless. I believe that every salaried physician agreed with me. Yet the administration attempted to defend their practice. I believe that many good physicians left the group due to this. Pres-Ganey falls short in every way imaginable. I could write volumes about this sore subject.
Dr. Grant, do you practice medicine? If so, do you work in a hospital or other large organizational setting? Your comments do not sound reality based….and are considerably condescending. I think a lot of us have done the best we can for decades to practice with integrity. And, yes, I hold to your definition of integrity. But I’m done with standing firm and refusing x-rays I don’t think are necessary and having to deal with the fallout afterwards. I have a family to feed.
As with most things, the truth is somewhere in between the extremes. We’ve all been patients and, speaking for myself, I’ve had some lousy Drs and some great ones. I would have loved to have had the the chance to give feedback via a questionnaire. However, I was involved in Medical Admin. part time about 10 years ago, when our multi-specialty clinic got involved in AMGA an organization of clinics. We used something similar to the Press Ganey ratings. The problems I saw included these: 1. We generally knew who the ‘bad actors’ were, and the ratings usually just confirmed what we knew, 2. We didn’t have a strong program for helping people raise ratings, so even Drs who ‘bought in’ to the idea weren’t clear about what to do to improve ratings, 3. It increased some Drs’ sense of vulnerability to problem patients, and less inclined to properly confront a patient with an agenda, like opioids or disability, 4. We didn’t sample randomly (our administration decided it would take too many resources), so everyone knew when ratings week was. One savvy Dr called it “sweeps week”-in reference to TV ratings weeks- and openly said he will be exceedingly nice to every patient during that week, and do anything they asked, as long as it wouldn’t hurt them– maybe a bigger script for pain meds, an extra week off work for an injury, more tests, and referrals, etc. She was a very good doc, and whether she actually did so is unclear. I think she was making the point that we could not intrude on her “space” and not expect her to react. I think Dr Benbow’s comments above are reasonable given this atmosphere. 5. One last one… How often do administrators get paid based on staff ratings of them?
In general, we’ve known forever that when you create an external incentive for a behavior, you’ll have a powerful effect . Just look at the effects of disability compensation on disability claims.
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