Following the passage of the Affordable Care Act, Forbes Magazine published an article entitled “Why Rating Your Doctor is Bad for Your Health,” critiquing the Act for conditioning the payment of Medicare reimbursement fees to hospitals upon the ratings given to doctors in patient satisfaction surveys. The danger of such a system, Forbes suggested, is that “doctors, in order to get high ratings… over-prescribe and over-test… only to ‘satisfy’ [their] patients,” regardless of whether the prescription or test was safe or medically necessary. (Kai Falkenberg, “Why Rating Your Doctor is Bad for Your Health,” Forbes, Jan. 21, 2013.)
Decisions induced by patient satisfaction ratings, the article explained, can even “kill patients” if doctors, in the name of “getting a better rating,” begin to prescribe easy solutions instead of confronting patients with hard-to-swallow truths. For example, a doctor treating a patient with “fatty liver disease” — commonly caused by alcoholism, poor diet, or lack of exercise — might prescribe a diet pill with potentially dangerous side effects instead of encouraging difficult lifestyle changes.
As a new attorney, I was surprised to learn lawyers are also automatically enrolled in online services that allow clients to rate their attorneys. While updating my online profile, I considered whether the legal profession might have something to learn from medicine’s experience with customer satisfaction surveys.
An erroneous prescription in the medical field occurs when a physician gives advice to ensure a positive rating, instead of to ensure the health of the patient. Similar advice might be given by an attorney; a review of any online attorney ranking site will reveal that clients generally disfavor attorneys that do not appear to be “in their corner” or are too willing to “give in to the other side” by compromising or advocating settlement. Attorneys concerned about receiving a negative review due to their (perceived) overly conciliatory attitude, might be more likely to counsel their client to reject settlement offers — even if they would result in lower legal bills and better outcomes for their clients. A similarly motivated attorney might also be inclined to contest a motion they would otherwise agree to, even if it would drain judicial resources and threaten goodwill between the parties.
It is impossible to assess whether attorneys have made these or other similar satisfaction-motivated decisions with their attorney rating in mind. However, any time that factors other than the best interests of the client weigh on the mind of an attorney, the potential for an unjust result increases. To avoid such a result, the legal profession would be well served to pay close attention as the Affordable Care Act’s Medicare reimbursement program is fully implemented and how the medical field struggles to adopt a program focused on customer satisfaction while, at the same time, seeking to avoid the scourge of the “unnecessary test” or “easy prescription.”