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Satisfaction is a commonly measured factor in many articles about doctor patient communication. The simple equation being high satisfaction = good, low satisfaction = bad. However, as usual, life is not quite that straightforward. Many health messages are not particularly satisfying, even if a jury of health professionals would concur with them: the continuing craze for lifestyle advice, enhanced in the UK by a payment system reinforcing such doctor behaviour, being an obvious example.

Think of a friend who goes to her family doctor with a cough and is told to stop smoking, loose weight, have her cervix smeared, her breasts examined and cholesterol measured and is then told that she cannot have any cough mixture prescribed and to go to the chemist (drugstore) and buy some if she really wants it. To a large section of the community this may be profoundly unsatisfying, but to the majority of the medical profession this would now be seen as good practice and certainly lucrative.

There is an easy way for the medics to satisfy most of us patients, and that is to give us what we want. Most alternative therapies work on this principal. The traditional baked bean healing strategy works on the principal of the healer always having an answer and always satisfying the patient.

"My Dear I am glad you are improving, let us increase the dose of the Baked Beans."
"Don't worry that you have not improved lets us use the very special sun dried African Beans hand picked in the Kalahari."
"I am sure we can help you if we just cut the amount by a tiny portion."

i.e. Right dose or too much/too little or the wrong sort. Doctors are not immune from this behaviour, but they tend to be not as good at it as the alternative purveyors of health treatments.

The fact that we patients often want treatments such as unnecessary antibiotics, more of the doctor's time than they can spare, dubious operations etc. means that the medical goal of only satisfying patients is a poor one. Doctors need and usually have more integrity than that, but we can often find the subsequent stand off quite difficult.

Some facts about satisfaction are clear. Our satisfaction with the consultation is substantially influenced by the amount of information we are given. A 1998 review of over 40 studies of patient satisfaction showed that information provision by the doctor was positively associated with patient satisfaction, as was patient information giving, though high levels of closed questions seemed to produce more negative results.

Unsurprisingly, doctors' friendliness, courtesy and expression of warm and positive feelings in consultations were positively associated with patient satisfaction, whereas the expression of negative feelings (irritation, anger etc) was associated with dissatisfaction.

In a primary care study of 716 consultations involving a sore throat, Little and colleagues (1997) demonstrated that patients who were more satisfied got better more quickly, and satisfaction related strongly to how well the doctor dealt with the patient's concerns. They went on to point out that this was not easy.

So it seems that for doctors satisfying their patients is important because the evidence shows that satisfied patients are more likely to follow medical advice. There is little evidence that time makes much difference, but communication and style does. It seems true that warm friendly doctors are more likely to satisfy patients than cold businesslike ones. In the jargon 'positive affect' works well. It appears that doctors talking too much lowers our satisfaction, but the sense of being listened too and understood increases it. So it's really not difficult; we patients like doctors who smile at us, are friendly and actively listen to us and within this framework we will then accept some of the less pleasant health messages without getting fed up.