We know well that not all tests and few medications are benign. Complications from contrast dye are real, and only time will tell how many cancers we have created in the name of comprehensive testing and patient satisfaction.

Prescription opiate addiction is rampant. Few patients understand this. Rather than follow the path of least resistance, I believe that we and our patients would be better off having a conversation about why a test or a prescription will not help the situation and may possibly be harmful.

Some doctors may claim that they risk economic damage or dismissal if satisfaction scores are low. I don’t believe that extra testing fixes that. We all cluster in a relatively narrow range for patient satisfaction. If one moves from 75% to 85% satisfaction, the resulting change in percentile ranking is enormous. We have all seen our scores vary significantly quarter to quarter absent significant change in our behavior. It is the consistently low performers who are at risk, and I contend that this has nothing to do with testing and opiate prescriptions and everything to do with quality communication and pleasant bedside manner.

I have no doubt that these patient satisfaction scores are a boondoggle. The accuracy for any one provider is suspect. So I try to focus on the patient and not the score. I am stingy with opiate prescriptions for patients who have chronic pain. I am not a big user of tests. I frequently have discussions with patients regarding touchy issues such as weight loss, smoking cessation, drinking cessation, and compliance with medications.

I believe my scores are not adversely affected by this. If the scores are affected, I don’t care anyway because, for me, patient satisfaction ends when someone wants me to do something that is not medically necessary. I am not a sales clerk. There is a skill in telling a fat guy to lose weight without calling him tubby. The patients needs to know that you are on their side. At the first hint of a paternalistic tone, all they hear is LA LA LA LA.

If we show our genuine concern and make the patient feel we are on their team, satisfaction will follow every time. And we may reignite a bit of the enthusiasm of the third-year medical student in all of us.

Dr. Baehren lives in Ottawa Hills, Ohio. He practices emergency medicine and is an assistant professor at the University of Toledo Medical Center. Your feedback is welcome at David.Baehren@utoledo.edu.