Patient Satisfaction should never be 100%

Posted by Dike Drummond MD

patient-satisfaction-is-wrong-physician-coach-dike-drummond_optPatient Satisfaction should NEVER be 100%

Patient Satisfaction - or the "Patient Experience" is a key quality indicator for organizations and a potential bonus point for the individual physician.

AND it is a never ending ethical bind for doctors.

If your administration thinks you can run your practice like Disney and maintain 100% Patient Satisfaction, I know you are feeling inappropriate pressure to make everyone happy.

Are You Prepared for the Great Practice RESET of 2022?
Get the Tools and Support to Take Back Your Practice 
in the Wake of the Pandemic


The problem with comparing a visit to my healthcare provider to other customer experiences like:
- a massage
- or a meal
- or a hotel stay
- or a trip to Disney World

... is simple.

They are not comparable ... for heaven's sake.

If you think you can run a healthcare organization like Disney, you are setting up a battle between Patient Satisfaction on one side and Quality and Safety on the other.

If you think your goal is 100% Patient Satisfaction, then you clearly have never taken care of patients. 



In healthcare, 100% Patient Satisfaction is 

- Dangerous for the physician and the patient
I will be blunt here. If the average physician gives every patient exactly what they request, some will die inappropriately and you will be liable. At the same time, your Patient Satisfaction rating will be top notch.

- Unethical and a violation of "Primum Non Nocere"
Patients make dangerous and unethical requests of doctors all the time. When they don't get what they want, no matter how inappropriate it may be, they trash the doctor on the patient satisfaction survey AND Social Media.  

- If your employer expects this of you as a physician, it is a glaring sign of a physician leadership vacuum. 100% Patient Satisfaction is an impossible standard that will lead to blame, shame, physician burnout and unnecessary turnover.

If you are doing your job well ...
There will always be a small minority of patients who must leave disappointed 


Understand How Patient Satisfaction is Measured - It is NOT AN AVERAGE

Most doctors are under the mistaken assumption that when your patients are asked about their satisfaction with your care or their hospital stay, your personal rating is based on the AVERAGE of the scores they give you. This is completely inaccurate.

patient-satisfaction-press-ganey-never-100-percent-of-top_opt"Percentage of Top"

Your personal patient satisfaction rating is based on the percentage of patients who gave you the top score. 

Patient satisfaction surveys, such as Press Ganey, typically measure satisfaction on a five point scale where "5" is the Top Score. "5" usually corresponds to the words "Always", "Outstanding" or "Excellent". 

"Percentage of Top" in this situation - is the percentage of the total patient satisfaction scores where you are given a "5". 

If 10 of your patients gave you the following scores on a Press Ganey Survey
3 - 4 - 4 - 4 - 2 - 5 - 3 - 4 - 4 - 5

Your total is 38

Mean = 3.8 (not bad ... eh?)

Percentage of Top = 20% (abysmal by the way)

If you don't get a "5", it does not count. They throw everything but the "5"s in the trash and measure your patient satisfaction by your percentage of this top score.

A perfect patient satisfaction score is when 100% of your patients give you the top score of "5". 

(NOTE: For a much more detailed discussion of patient satisfaction scoring, please see the comment below by a reader who goes by "Setit Straight")


Why 100% Patient Satisfaction is Dangerous

Because patients make mistaken and dangerous requests. We are their highly trained expert consultant when it comes to healthcare. We are qualified to notice when their request is based on drug seeking, or TV ads or anecdotal experience. We can also tell if their assumptions are just plain wrong.

If we don't say "NO" and create a healthy boundary for the patient, someone is going to get hurt and we might get sued. 

Use this link for training on how to say no to inappropriate antibiotic requests

Use this link for the Universal Upset Patient Protocol

And this Catch 22 is extremely common. Not a day goes by in a primary care practice or ER without patients asking for things that we simply must refuse.

- They will not be satisfied
- We will not get a "5"
- It is necessary and completely consistent with all that is right about the process of becoming a doctor


Think about all the types of patient requests that are dangerous. Think of the situations where it is very important that we deny the patient's request - and risk them giving us less than 5 on the Press Ganey Survey.

Drug Seekers

Give them their oxycontin and they could die or kill others behind the wheel of a car or in any number of additional and tragic circumstances

Inappropriate Antibiotic Requests

If the recent emergence of fatal community acquired multi-drug resistant bacterial infections isn't reason enough to say no, how about allergic drug reactions.

Other inappropriate medication requests

The patient who requests a drug because of direct-to-consumer TV ads -- is setup to suffer a completely avoidable episode of anaphylaxis, Stevens–Johnson syndrome or worse.

Inappropriate tests

CT Scans for low back pain without radicular symptoms ... and both of us could go on and on here. How much radiation is too much?


This issue is causing the wrongful termination of good doctors

Complaints from drug seeking and other inappropriate patients should never result in a physician being fired. I am tired of seeing physicians fired because non-clinical leaders do not understand this issue. Let's look at this battle between patient satisfaction and and quality care and safety in some detail. Feel free to share this article with your non-physician administrators


If I ever meet a physician whose percentage of top is 100

I will immediately suspect 
- their ethics
- their clinical skill set
- their personal boundaries
and I will want to look very closely at their numbers to make sure they aren't just treating family members (that's a joke, BTW ;-)


patient-satisfaction-bean-counters-dike-drummond-the-happy-md_optAnd the Bean Counters Just Don't Understand 

Here is why this is such a kerfuffle these days.

There are BIG Bucks in patient satisfaction. Patient satisfaction is one of the key "quality" indicators payors are using to bonus physicians who get high marks. These bonus dollars are a sparkle in the eye of your CFO in this era of generally declining reimbursement.

The bean counters see the bonus dollars for patient satisfaction

They push for you to make everyone happy so you get the big checks



This is a job for physician leadership

  • We are in healthcare not the Patient Satisfaction business.

  • It is the physician's responsibility to tell non-physician administrators why their expectations of 100% satisfaction are inappropriate and dangerous.

  • It is the healthcare administrators responsibility to take this advice to heart and not make decisions only based on financial considerations

  • This is where your Physician Wellness Champion can make a big difference, running interference between the front-line providers and the C-suite.

This is not Disney, or Dominos Pizza or Verizon or the Ritz Carlton

We are dealing with sick, hurt, scared and dying people

patient-satisfaction-primum-non-nocere_optPrimum Non Nocere and the dollars be damned

If you are being pressured to hit unattainable patient satisfaction scores, this is a physician leadership issue. 

Who is your physician representative on the leadership team?

Tell them to get the bean counters off your back.

While you focus on making the patients who are not inappropriate as satisfied as you possibly can.




  • What inappropriate patient requests would you add to the short list above?
  • What pressure are you under to maximize patient satisfaction?
  • Have you been dinged or fired for complaints from inappropriate patients?


Tags: Physician Burnout, Physician Leadership