When I was in medical school and residency training there was, as far as I knew, no such thing as this notion of customer satisfaction in the practice of medicine. We were taught to be skilled and thorough in gathering data – medical history and physical examination – and to select the right diagnostic tests as we sought to discern the cause of a patient’s symptoms. The goal was to arrive at the correct diagnosis and prescribe treatment that was safe and effective. Ideally, it should also be cost-effective. If, in addition, a doctor happened to have a good “bedside manner,” that was icing on the cake.

Doctors didn’t think too much about whether their patients found them likable. We all have different personality styles. A patient who doesn’t care for one physician’s personality style will choose a different doctor – and promptly be replaced by someone who does like the first doctor. It all evens out.

Some patients really don’t care whether a physician even has much in the way of bedside manner, as long as he or she is diligent, thorough, and competent. Frankly, that’s the way I look at it when I’m a patient: if my doctor has the requisite knowledge and skill to figure out what’s wrong with me and what to do about it, I don’t care if he has the personality of a cigar store Indian.

Times have changed. Everyone is keenly focused on whether patients are satisfied as customers in the business of health care, and everyone wants to measure their satisfaction with the “patient experience.”

In many health care enterprises, doctors are financially rewarded for getting high scores on patient satisfaction surveys. And there’s nothing like money to influence behavior.

In 1990 I wrote an article for the trade publication Medical Economics entitled “Some Days I Feel Like I Work at K-Mart: How Consumerism Has Affected the Doctor-Patient Relationship.” This notion of customer satisfaction is now pervasive in medical practice, and if you want your doctor to be focused on the medicine and not worrying about getting her patients to think she is kind and caring, forget it. That’s the old paradigm.

There can’t be anything wrong with doctors being nice and patients liking them, can there? Of course not. So you can stop reading right now. Except for one thing. I think you’ve heard of it. It’s called the Law of Unintended Consequences. Because of this law, good intentions sometimes fail to produce good results.