satisfaction stem from various components of the consultation, in particular the affective
aspects (e.g. emotional support and understanding), the behavioural aspects (e.g.
prescribing, adequate explanation) and the competence (e.g. appropriateness of referral,
diagnosis) of the health professional. Ley (1989) also reported that satisfaction is
determined by the content of the consultation and that patients want to know as
much information as possible, even if this is bad news. For example, in studies looking at
cancer diagnosis, patients showed improved satisfaction if they were given a diagnosis of
cancer rather than if they were protected from this information.
Berry et al. (2003) explored the impact of making information more personal to the
patient on satisfaction. Participants were asked to read some information about medica-
tion and then to rate their satisfaction. Some were given personalized information such
as, ‘If you take this medicine, there is a substantial chance of you getting one or more of
its side effects’ whereas some were given non personalized information, ‘A substantial
proportion of people who take this medication get one or more of its side effects’. The
results showed that a more personalized style was related to greater satisfaction, lower
ratings of the risks of side effects and lower ratings of the risk to health.
Sala et al. (2002) explored the relationship between humour in consultation and
patient satisfaction. The authors coded recorded consultations for their humour content
and for the type of humour used. They then looked for differences between high and low
satisfaction rated consultations. The results showed that high satisfaction was related to
the use of more light humour, more humour that relieved tension, more self-effacing
humour and more positive-function humour. Patient satisfaction is increasingly used in
health care assessment as an indirect measure of health outcome based on the assump-
tion that a satisfied patient will be a more healthy patient. This has resulted in the
development of a multitude of patient satisfaction measures and a lack of agreement as
to what patient satisfaction actually is (see Fitzpatrick 1993). However, even though
there are problems with patient satisfaction, some studies suggest that aspects of
patient satisfaction may correlate with compliance with the advice given during the
consultation.Patient understanding
Several studies have also examined the extent to which patients understand the content
of the consultation. Boyle (1970) examined patients’ definitions of different illnesses and
reported that when given a checklist only 85 per cent correctly defined arthritis, 77 per
cent correctly defined jaundice, 52 per cent correctly defined palpitations and 80 per cent
correctly defined bronchitis. Boyle further examined patients’ perceptions of the location
of organs and found that only 42 per cent correctly located the heart, 20 per cent located
the stomach and 49 per cent located the liver. This suggests that understanding of
the content of the consultation may well be low. Further studies have examined the
understanding of illness in terms of causality and seriousness. Roth (1979) asked
patients what they thought peptic ulcers were caused by and found a variety of
responses, such as problems with teeth and gums, food, digestive problems or excessive
stomach acid. He also asked individuals what they thought caused lung cancer, and
found that although the understanding of the causality of lung cancer was high in terms78 HEALTH PSYCHOLOGY