Two big measures are starting to change the physician payment environment more and more. Quality and patient satisfaction are now becoming the key factors in determining incentive pay for doctors. A new survey found that "66% of employers incorporated quality measures into determining an annual incentive, and 62% used patient satisfaction". Wow. Talk about jumping off a cliff into the unknown. Of course, the term quality is very difficult to define (read the book Zen and the Art of Motorcycle Maintenance). If a doctor spends 15 minutes just going through all the prompted protocols (colonoscopy, immunizations, etc) and neglects to discuss what the patient is really there for then that isn't a quality visit, is it? And it sure won't make the patient satisfactions scores look so good either. And how about patient satisfaction surveys? I really think we physicians should treat our patients with respect. We should listen and empathize with them. However, if someone is demanding narcotics or an MRI (when it isn't appropriate) then how will they grade me? No, something is very wrong with this trend. Very wrong.