Health surveys: Run the other way!!!

Sometimes when I get an unsolicited call about answering survey questions, I feel a karmic obligation to participate; after all, if everyone said no to everything, I would not have any data to analyze. So, for this very reason, I just got off the phone with a poor young woman conducting a survey who called me randomly. The survey had to do with healthcare delivery, and she had no idea what she was getting herself into. First, I queried her whom the survey was for. She proceeded to tell me that she did not have that information specifically, but gave me a general idea of who the customers tend to be. Then she launched into the survey questions.

Now, I realize that they all have to ask the same questions the same way in order not to bias the data. But man, who writes these questions? "What would you say is the reputation of the cardiac surgery program at thus-and-such a hospital in your area: a). good locally, 2). good locally and state-wide, 3). good locally, statewide and regionally, 4). good locally, statewide, regionally and nationally, 5). good locally, statewide, regionally, nationally and internationally, or 6). not good at all?" Well, what the heck do you mean by "reputation"? You mean what is the gossip about Dr. Smith in my community? Or do you mean what kind of care they provide in terms of timeliness, evidence, shared decision making, post-operative complications, what? Then came "if you or your family member needed a cardiac procedure, how comfortable would you be going to this facility? 1). very comfortable, 2). somewhat comfortable, 3). somewhat uncomfortable, and 4). not at all comfortable?" How the heck should I know? I have not researched all the local facilities, I have not checked on their outcomes, I have not interviewed all of their cardiac surgical teams (yes, including anesthesia), I do not know what their infection control track records are, and, most importantly, how willing they are to treat me as an individual rather than a source of income. And then, for every hospital she mentioned (and there were quite a few), she went through the same litany of meaningless questions.

And then she asked me if I am familiar with some of the well-known quality-rating organizations. And she included US News and World Report Hospital Ratings! And I don't even believe the CMS got it anywhere near right!!! Oy! What do the answers to these questions from someone who is not steeped in the data mean anyway? If researchers and providers have not arrived at the appropriate metrics for quality, how meaningful are the lay public's opinions on these matters?

And finally, a group of questions that let the cat out of the bag as to the purpose of the survey. She told me a story first, of a large regional medical center in the area building a new multi-million dollar state-of-the-art cardiac care facility. Sexy new equipment, individual patient rooms, targeted and individually-tailored treatment plans, all the buzzwords of the brave new world of medicine. And then she asks me would I be comfortable going to this facility. What am I supposed to say? I have no idea! How do I tell this poor child that the questions are written in an absurd way and smack of marketing? How do I explain to her that this facility will probably need to recoup their capital investment, and, therefore, has a conflict of interest when it comes to caring for me? How do I teach her that this is the problem with American medicine, this very over-reliance on reputations and expertise to tell us to over-indulge in interventionism at the expense of our health and budgets?

Anyway, I will not belabor this further. My advice to survey fielders: If you want to market to the gullible, go ahead and call people randomly and ask your market-building question. And if a person tells you she is a physician and a health services researcher to boot, run, don't walk, the other way.