To the Editor In a recent issue of JAMA Internal Medicine, Martinez and colleagues1 demonstrated an association between antibiotic prescribing for treatment of respiratory tract infections (RTIs) and patient satisfaction scores in direct-to-consumer (DTC) telemedicine. Based on a patient satisfaction rating scale of 0 to 5, the authors dichotomized their primary outcome of patient satisfaction as 5 stars vs fewer than 5 stars; they found that 91% of patients prescribed antibiotics for treatment of RTI provided a 5-star rating compared with 73% of patients not prescribed antibiotics and 86% of patients given a nonantibiotic prescription. The authors concluded that “Few physicians achieved even the 50th percentile of satisfaction while maintaining low rates of antibiotic prescribing. To reach the top quartile, a physician had to prescribe antibiotics at least half the time.”1(1559)