In their article, Abtahi et al. point out that patient satisfaction surveys are increasingly being used to measure health-care quality for purposes that include determining hospital and clinician compensation. Such utilization of patient satisfaction surveys has been prominently criticized, in both the news media and the medical literature, for potentially jeopardizing patient health by incentivizing excessive and noncredible health care. That criticism has been supported by empirical findings indicating that patients generally have a bias against scientifically credible health care, that more extensive health care is associated with the highest patient satisfaction ratings, that more extensive health care is associated with worse outcomes(including elevated rates of patient mortality), and that such associations are not accounted for by the severity of the health problems.

In keeping with a long list of prior scientific findings, the results reported by Abtahi et al. indicate that such utilization of patient satisfaction surveys is misdirected even if it does not jeopardize patient health. Patient satisfaction is a very poor measure of health-care quality because it is significantly affected by a wide array of irrelevant factors. In fact, previous findings have indicated that “a substantial part of the variance {in patient satisfaction} is on the patient level, while only a minor part of the variance is at the hospital and department levels.”

Abtahi et al. found that patient satisfaction is influenced by the psychology of the patient. This observation is consistent with a variety of previous findings indicating that the patient’s psychological makeup is actually a better predictor of his/her satisfaction with general medical care than is his/her general medical health.

Abtahi et al. referenced prior studies indicating that patient satisfaction is also influenced by their expectations, age, sex, marital status, race, education, insurance coverage, employment status, and socioeconomic status as well as whether someone else is blamed for causing the injury, whether financial compensation is being sought for health problems, and whether a lawyer has been hired because of health claims. These referenced studies also indicate that patient satisfaction is not associated with objective indications of the quality of health care.