Dear New England Journal of Medicine

24 Feb

In the January 19th edition of the New England Journal of Medicine, a ludicrous article about creating a Yelp for doctors by and for the University of Utah was published on the front page of the journal.  I have severe reservations about the use of customer service metrics on complex professional relationships such as medicine.  While improved communication and compassion can and should be improved in American medicine, I feel this has been over-emphasized and avoids addressing the real structural issues of health care.  This also contributes to the narcotic epidemic as doctors are afraid of displeasing patients who are often pain-seeking.  With life expectancy falling for the first time last year, we need to think harder and smarter about this.  Below is a satire applying patient satisfaction to the practice of law.

Dear Editor:

Suppose we transferred “patient-satisfaction” ratings on to the practice of law.   Affordable access to the legal system is a matter of life, death, or imprisonment.

The Justice Department would devise a rating system for all large group practices and courthouses based on “star ratings.” Lawyers and their practices would pay Press-Ganey to administer randomized surveys to assess “client-satisfaction.”

Even though law is a diverse field with many specialties, many types of clients (who may have pre-existing criminal records), and many kinds of cases with varying evidence-based practice, client satisfaction surveys rate the ability of their lawyer based on bedside manner, promptness, and cleanliness of their office. The general public would then judge the law firms’ courtroom outcomes independent of any case-client-evidence specifics.

Would anyone buy this? Would any lawyer sit still or justify this idea in a premier law journal?  Would we decide judicial elections and presidential nominations by their satisfaction scores?  Or would we evaluate judges by the opinions of their legal colleagues and local bar associations?

I find it incredible that there are those in medicine who would justify patient satisfaction scores and evaluation systems when they have caused so much havoc in public education and the lawyers who wrote these laws would never consent to them being imposed on their own profession. No nation’s health system has improved based using such metrics, and we should not kid ourselves that such feedback systems have anything to do with the real, unseen practices of medicine.  We deserve better or at least as much as attorneys deserve.


A working physician


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