Letter to the editor.

Re: the article--"Low Patient Satisfaction Scores: The Five Stages of Response" by Joseph R. Twanmoh, MD, FACEP, that appeared in the September/October 2006, 32(5) issue of The Physician Executive.

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The denial that most providers go into over these satisfaction scores is very real and, despite the scores' flaws, I DO believe they provide significant insight into how the non-medical public perceives us within the facility/health care arena.

My version of your car/garage story is kind of the reverse. I live in a relatively rural area of Northern Baltimore County. The nearest (and most convenient) gas station is one I have stopped patronizing because I noticed that many little things--pumps out of order, handles broken, hoses taped, etc.--were clearly evident.

I am certainly unable to judge the purity and quality of their petroleum products, BUT if the things I can see appear substandard, it makes me quite nervous to consider the state of those more important things I CANNOT see or evaluate directly.

At any rate, I did appreciate your article and, while I directly appreciate its application to the emergency department, I believe it also raises important issues for medicine as a whole--i.e., the patients are watching and they don't often like what they see AND they are often correct from their viewpoint.

Thank you.

Bob Roby, MD

Parkton, Maryland