To the Editor:

I agree that patient satisfaction surveys tend to produce physician approval ratings that fluctuate within a narrow range (see “Staff surveys tell more than patient surveys,” September 1998, and “Using Qualitative Self-Evaluation in Rating Physician Performance,” May 1998). The validity of patient surveys comes when the responses are reproduced from many different patients over time. I also agree that staff members are in an ideal position to assess a physician's activities, but I have two concerns about this.

Evaluations by only a few staff members may be skewed by lack of objectivity (for example, a staff member holding a grudge against a physician, or a staff member being overly loyal to a particular physician). On the other hand, even a truly objective evaluation has its complications, in that it could be misconstrued by the physician and create difficulties in staff relationships.

Like a good marriage, a good partnership, even a good CQI project, productive performance evaluations cannot happen unless all parties are experienced in the give and take of constructive criticism. Until you know your personnel can handle that, it may be unwise to incorporate staff evaluations of physician performance.