Family physician and addiction medicine specialist Aleksandra Zgierska, MD, PhD, often treats patients referred to her by primary care colleagues concerned about their patients’ growing reliance on opioid analgesics.

Caring for these patients raises clinical questions that even the most skilled physicians have trouble answering. But recently, Dr. Zgierska has considered another question as she wonders how to proceed with treatment: Will using her best medical judgment harm her patient-satisfaction rating?

“If I feel the patient is not an appropriate candidate for opioids, I should say no,” she says. “But in the back of my mind, the question can arise, ‘What will the patient do with that?’ Especially since the No. 1 question on our patient-satisfaction survey is, ‘Are you happy with the way the physician treated your pain?’ ”

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