Patient Satisfaction as a Quality Metric Promotes Bad Medicine—Reply

In Reply Dr Wexler is concerned that efforts to curtail unnecessary antibiotic use may lead to lower patient satisfaction with care. Our study, which did not measure patients’ experiences of care, does not address this concern directly.¹ However, the intent of our intervention was to influence clinicians and patients in a way that might improve both antibiotic stewardship and patient experience. By publicly posting clinicians’ personal commitments to provide evidence-based care, we sought to enlist patients and clinicians in support of a common goal. Public commitments justify our future actions to others, leading naturally to understanding rather than dissatisfaction.² And, people who show consistency with their public commitments are evaluated more positively than those who do not.³