Measuring doctors' performance: patient feedback questionnaires fail to make the grade

Questionnaires intended to provide essential patient feedback on doctors' performance are often poorly designed, ask ambiguous questions and fail to do their job properly.

As a result, patients' views are not being heard effectively or efficiently, despite acknowledgement by the Chief Medical Officer, Professor Sir Liam Donaldson in Good Doctors Safer Patients, that they should be an essential component of the ongoing regulation of doctors.

A study, What do you think of your doctor? A review of questionnaires for gathering patients' feedback on their doctor, by independent healthcare experts the Picker Institute, reviewed a selection of questionnaires currently being used to gather feedback from patients on individual doctors, including those used by GPs to gain additional contract points under the Quality and Outcomes Framework.  

The review looked at how questionnaires were developed, the wording they used, the topics covered, such as communication, interpersonal skills and patient engagement, how they were administered and the thoroughness with which they had been tested for validity and reliability.

Professor Janet Askham, director of research at the Picker Institute, said: "Many questionnaires fell short of the ideal.  We found important topics, such as patient engagement, were often overlooked, inconsistently covered or badly worded.

"To achieve credible results, questionnaires must accurately reflect issues patients feel are important, such as the desire to be more involved in treatment decisions, helped with self-care and treated with dignity, empathy and respect.

"Patients are being asked to play an increasing role in providing feedback on healthcare delivery, but to enable them to do so the process must be taken more seriously.  We hope this work will be seen as a helpful guide in working towards that goal."

The Picker Institute makes a number of key recommendations, including:

• The development of questionnaires that focus more on patient engagement and include a fuller range of questions
• Further research on what topics it is appropriate to ask patients to provide feedback, including aspects of a doctors' technical competence
• The development of questionnaires that tackle specific conditions or specialties
• Closer examination of the best ways to administer feedback surveys in clinical settings

Professor Askham added:  "High quality patient feedback is important and those in the business of assessing doctors need to recognise what makes a good questionnaire.

"Questionnaire design and development requires expertise, time and money and, although we reviewed some of the best questionnaires available, this research has demonstrated just how poor some can be.  Patient feedback is vital - it deserves the best."

The Picker Institute team reviewed 10 questionnaires being used by regulatory bodies in the UK, the US and Canada.

Notes to editors

1. For a copy of the report, What do you think of your doctor?, please visit

2. To speak to Professor Janet Askham, please contact Sarah Claridge

3. The Picker Institute works with patients, professionals and policy makers to promote understanding of the patient's perspective at all levels of healthcare policy and practice.  It undertakes a unique combination of research, development and policy activities which together work to make patients' views count.  It is an independent, not for profit research and development institute with charitable status.  It believes all patients deserve high quality healthcare and their views and experiences should drive improvement efforts.  Further details are available on its website at

For further information, please contact: Sarah Claridge, Communications Manager, Picker Institute Europe.  Tel: 01865 208140 or email

Alternatively, please contact Alison Dewar, tel: 07801 234261

or email

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