In the early 1930s the practice of medicine was akin to the Model A. The Model A, first built in 1928, was certainly destined to change the world. But in retrospect, the technology was very basic. New medical discoveries, such as insulin, were being made. But there was much to learn. Surgery carried a significant mortality, and death from infections such as TB was expected by both patients and physicians. Innovations loitered on the horizon while patients died of illnesses we can easily cure or prevent today as we drive around in our cars equipped with collision avoidance systems, Bluetooth, and GPS.

Patrick Taylor has written a series of books about a GP who practices in rural Ireland. I am currently reading “A Dublin Student Doctor.” His story captures the trials and thrills of being a medical student in 1930s Ireland. He does a beautiful job of portraying the wide-eyed enthusiasm and sometimes trepidation in the medical students. The fear of senior physicians, the excitement of the diagnostic process, and the disdain for the brown-nosing student are brought to life through his characters.

Much of this is and will always be so. What I found most interesting is the way that physicians interacted with their patients then. On rounds, patients were referred to by their initials, even in their presence. Given names were never used, and physicians avoided creating personal connections with patients. Conversations were strictly clinical. Nobody asked the patients if they were satisfied.

Our interactions with patients have changed quite a bit since then. Patient autonomy is king, and we don’t keep patients at arm’s length as much. Patients are included in decision making, and we don’t shield them from bad news. And we want them to be satisfied. These are fantastic changes, and we are all better for them. Yet I believe, in this digital age, that we are being pulled away from our patients by technology.

In the fast pace of emergency care, the path of least resistance seems to be to order tests first and ask questions later. We spend an inordinate amount of time at computers pecking away or trying to log back into programs that maddeningly evict us because of 5 minutes of inactivity. We spend less time truly communicating with our patients. What is odd to me is the fact that patients equate all this testing with good doctoring.

Patients, of course, have no clue that little skill is required to click off a bunch of tests and then pronounce good health 3 hours later. A recent article in Forbes Magazine suggests that the push for patient satisfaction is actually bad for patients. A good argument is made that in the name of patient satisfaction, higher scores, and higher reimbursement physicians are ordering more tests and prescribing more medication. Thanks to our federal government and the push for satisfaction measures, this is the law of unintended consequences in action.

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.