Patient-Satisfaction Surveys on a Scale of 0 to 10: Improving Health Care, or Leading It Astray?

Patient-satisfaction surveys can call attention to the importance of treating patients with dignity and respect, but good ratings depend more on manipulable patient perceptions than on good medicine.

The current institutional focus on patient satisfaction and on surveys designed to assess this could eventually compromise the quality of health care while simultaneously raising its cost. We begin this paper with an overview of the concept of patient satisfaction, which remains poorly and variously defined. Next, we trace the evolution of patient-satisfaction surveys, including both their useful and problematic aspects. We then describe the effects of these surveys, the most troubling of which may be their influence on the behavior of health professionals. The pursuit of high patient-satisfaction scores may actually lead health professionals and institutions to practice bad medicine by honoring patient requests for unnecessary and even harmful treatments. Patient satisfaction is important, especially when it is a response to being treated with dignity and respect, and patient-satisfaction surveys have a valuable place in evaluating health care. Nonetheless, some uses and consequences of these surveys may actively mislead health care.

Our critique of patient-satisfaction surveys takes into consideration three different ways patients may be “satisfied.” First is the provision of medically necessary care that actually improves their outcomes. The second concerns interventions that patients or families want but that are medically unnecessary and may negatively affect health outcomes. The third category—comprising factors that are less likely to affect health outcomes but may certainly contribute to a sense of dignity and well-being—includes “humanistic” aspects of health care, such as good communication and treating patients with respect, as well as peripheral aspects, such as convenient parking and designer hospital gowns. These distinctions are important as we explore patient satisfaction and its implications.