Customer satisfaction is relevant, but only because hospitals have put so much emphasis on it.
But regardless, nobody can get these drugs without a doctor writing a script, so there is plenty of blame to go around.
Through a strange series of events (extreme sports hobbies) I became friends with a group of doctors, none of them participating in anything very special or that could be seen as a career height. Most really just starting out after the hell that is med school.
They spoke of pretty regular outreach of gifts from pharma. Mainly in the form of fancy retreats (like to Hawaii - note, we were based in SoCal at the time) with pretty extravagant dinners and fancy boating stuff. These were, according to them, always filled with the brim with others like them to the point it got to be quite frankly boring, annoying, and a nuisance. No matter how hard they tried to ignore the unsolicited outreach, it wouldn't stop coming.
Just some anecdata tho.
Well, if I had to make an educated guess, they really did cross their fingers and nobody seems to be investigating/enforcing otherwise and they're getting away with it - because I'm telling you, first hand... it's happening, quite frequently, at least on the West Coast.
https://lowninstitute.org/industry-payments-to-doctors-opioi...