To the Editor:

In “Using Qualitative Self-Evaluation in Rating Physician Performance” (May 1998), the author emphasized the importance of performing patient surveys but not staff surveys to evaluate physician performance. I would argue that staff surveys are critical to any physician evaluation and that patient surveys of satisfaction with their physician are not only over-rated but probably useless.

In lay studies that have asked individuals to assign approval ratings to different professions, physicians in general have been rated lower than one would have expected. The interesting thing, though, is that individuals tend to exclude their own physicians from the low rankings.

In patient surveys that I have done, I have found this to hold true. Physician approval ratings fluctuate within a very narrow range. I attribute this to a “trust” factor. After patients have made the decision to commit their care to an individual physician, they place their trust in that physician. Because of this commitment of trust, patients will generally rate the physician in a reasonably consistent and favorable way. If patients cannot place their trust in the physician, they tend not to be patients of that physician.

Staff members, on the other hand, are much more objective on the strengths and weaknesses of the physicians they work with. They have had a chance to see us interact with many patients on many levels, and they are affected by our idiosyncrasies, and our egos. Staff satisfaction is essential to the success of any practice. As much as we might hate to admit it, staff members make generally good assessments on the quality and consistency of our practice.