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Opinions on Practice Management

Steven R. Feldman, MD, PhD

Communication as the Key to Patient Satisfaction

Steven R. Feldman, MD, PhD

Wednesday, February 11, 2009

A lawyer who does work related to medicine became quite animated when talking about patient satisfaction. "The world is different than it used to be," he said. "People just don't have as much family or friends close to them as they used to. They rely on their doctors more for that kind of support.  The doctors that patients love are the doctors who give them that support... family doctors that they grow to know.  The specialists, even if they are far more technically expert, don't always have that kind of relationship with their patients. And because of that, they are at much greater risk of getting sued. If patients think you really care about them, they are very unlikely to sue you. But if they think you're a jerk who drives a BMW and just cares about money, well then watch out."

Patient satisfaction isn't the only important outcome in healthcare, but patient satisfaction is, in and of itself, at least one important outcome of patient care. Research has begun to elucidate the factors that result in better patient satisfaction, and research has also begun to examine effects resulting from better patient satisfaction.

Factors that Drive Patient Satisfaction

Anderson et al. analyzed data from an online patient satisfaction survey website,, and found seven dimensions that were related to high levels of patient satisfaction: access, communication, personality of the doctor, quality of medical care processes, continuity of care, quality of healthcare facilities and office staff. Poor ratings were associated with comments about poor communication, poor coordination of care, poor interpersonal skills and barriers to access. In a further analysis of ratings specific to dermatology, high satisfaction was reported for timely test results, including patients in decision making, clear instructions, and how well the physician answered questions. The most common areas in need of improvement in dermatology were follow up, treatment success, and, not unexpectedly, time spent with the patient.

Other studies confirm the importance of communication in driving patient satisfaction. Krueger and colleagues found that insufficient communication was the primary cause of dissatisfaction in patients with psoriasis.3 Renzi et al. reported that higher patient satisfaction is associated with patients' perceptions of physician's interpersonal skills, concern for the patient's health, and quality of explanations and answers to questions.4

Patient Satisfaction Affects Other Outcomes

Poor physician-patient relationships are associated with the majority of lawsuits against physicians.5 Common complaints across medical specialties include miscommunication and poor patient education.6,7 High levels of respect towards patients, and returning phone calls are associated with fewer liability claims.8

Of course it is expected that better medical outcomes will result in better patient satisfaction.  The reciprocal relationship that patients who are more satisfied with their care will actually see more improvement in their disease may also hold true. In a prospective study of dermatology visits measuring patient satisfaction three days after the visit and health outcomes four weeks later, higher patient satisfaction was associated with better quality of life outcomes.9


Dermatologists didn't to become doctors in order to have unhappy patients. Of course we want to give patients the right diagnosis and the right treatment, but we also want them to be happy with their care too. Good communication is central to that. And it turns out that even if we were only devoted to giving patients the right diagnosis and the right treatment, we'd still need to be committed to good communication and high levels of satisfaction, because treatment isn't complete without good adherence (compliance). Patients who don't trust their doctors or who aren't satisfied with their care are less likely to use their medications.10

Victor Marks and colleagues described basic principles of service excellence for dermatologists.11 From a practical standpoint, commitment to excellence in every facet of the practice is needed.  Most important of all is that patients perceive that they have a caring doctor. Above all else, to achieve patient satisfaction, physicians must not only be caring, they must communicate that they are caring. At the very least, this involves looking patients in the eye, sitting down with them, making personal contact, taking time to make sure a patient's problems and concerns are addressed, and adequately educating patients about their condition and its treatment. 


  1. Anderson R, Barbara A, Feldman S.  What patients want: A content analysis of key qualities that influence patient satisfaction. J Med Pract Manage. 2007;22(5):255-261.
  2. Poulos GA, Brodell RT, Mostow EN. Improving quality and patient satisfaction in dermatology office practice. Arch Dermatol. 2008;144(2):263-265.
  3. Krueger G, Koo J, Lebwohl M, et al.  The impact of psoriasis on quality of life: results of a 1998 National Psoriasis Foundation patient-membership survey. Arch Dermatol. 2001;137:280-284.
  4. Renzi C, Abeni D, Picardi A, et al. Factors associated with patient satisfaction with care among dermatological outpatients. Br J Dermatol. 2001;145:617-623.
  5. Beckman HB, Markakis KM, Suchman AL, Frankel RM. The doctor-patient relationship and malpractice. Lessons from plaintiff depositions. Arch Intern Med 1994;154:1365-1370.
  6. Jimenez-Corona ME, Ponce-de-Leon-Rosales S, Rangel-Frausto S, Mohar-Betancourt A. Epidemiology of medical complaints in Mexico: identifying a general profile. Int J Qual Health Care 2006;18:220-223.
  7. Sweeney J, Brooks AM, Leahy A. Development of the Irish National Perception of Quality of Care Survey. Int J Qual Health Care 2003;15:163-168.
  8. Levinson W, Roter DL, Mullooly JP, Dull VT, Frankel RM. Physician-patient communication. The relationship with malpractice claims among primary care physicians and surgeons. JAMA 1997;277:553-559.
  9. Renzi C, Tabolli S, Picardi A, et al.  Effects of patient satisfaction with care on health-related quality of life: a prospective study. J Eur Acad Dermatol Venereol. 2005;19:712-18.
  10. Martin LR, Williams SL, Haskard KB, Dimatteo MR.  The challenge of patient adherence. Ther Clin Risk Manag. 2005;1:189-199.
  11. Marks VJ , Hutchison R, Todd M. Service excellence in dermatology. Semin Cutan Med Surg 2004;23:207-212.