For a recent study, investigators queried patients visiting an emergency department with abdominal pain about their confidence in the doctor’s diagnosis and their overall satisfaction with the “patient experience.”

Confidence and satisfaction were low (shockingly low, I thought) when the doctor took a history and examined the patient but ordered no tests, which surely reflects the physician’s belief that the diagnosis was simple and straightforward. Both confidence and satisfaction rose steadily as the number of tests increased, with the highest levels reached when the evaluation included a CAT scan.

What this study demonstrated, however, was something that emergency physicians already knew intuitively. Abdominal pain is the single most common reason for visits to the emergency department. Many CAT scans are performed. How many of them are really necessary? How many are performed in the pursuit of diagnostic certainty? (And how useful is it to raise diagnostic certainty from 93% to 97%?) How many are ordered because the doctor is afraid of being sued if she misses something? How many are ordered because it will improve customer satisfaction? How would we know?

What we do know, however, is that CAT scans are expensive and expose patients to radiation and sometimes to intravenous contrast agents that occasionally cause harmful reactions.

I don’t know about you, but I want my doctor to order a CAT scan only if it is really necessary, and certainly not because he thinks I will have more confidence in his diagnosis and a higher level of satisfaction with the “patient experience” if he orders more tests.

Doctors now live and work in a world in which health care managers worship at the altar of customer satisfaction. There are serious problems with how patients’ satisfaction is measured and how the results are interpreted. We are just beginning to understand these problems.

Yet, at a time when we should still be very concerned about our ability to define and measure patient satisfaction, to figure out what to do with the results when we do measure it, and to prevent unintended consequences, the federal government is already implementing a system that will financially punish hospitals that don’t get high scores.

None of us should be surprised that public policy is being formulated and implemented without good science to support it. But we should be worried.

Dr. Solomon teaches emergency medicine to the residents at Allegheny General Hospital in Pittsburgh and is Medical Editor in Chief of ACEP News. He is a social critic and political pundit and blogs at www.bobsolomon.blogspot.com.