© Cambridge University Press 2007. The concept of satisfaction There are three distinct reasons why we are interested in patient satisfaction. Firstly, the concept of patient satisfaction enables us to view healthcare services from the patient’s point of view. Secondly, patient satisfaction provides a practical means of identifying problems in the processes of care, that is, how care is provided, so that such problems can be addressed and services improved. In this applied use of the term, patient satisfaction is normally listed alongside five other dimensions whereby quality of health services should be assessed: access; relevance to need; effectiveness; equity; and efficiency. A third purpose, related to the second, is to contribute to the formal evaluation of health services (Sitzia & Wood, 1997). Although the theoretical and conceptual clarity of the term ‘satisfaction’ is generally agreed to be poor, the general emphasis of approaches is upon some form of discrepancy between the patient’s expectations and actual experience. The concept of patient satisfaction reflects increasing emphasis upon the patient as ‘customer’, concerned to judge the value of a service. However it can be argued that the idea of patient as customer has some limitations: patients often do not feel like customers when seeking solutions to problems concerning their own bodies and wellbeing, being rather more intimately concerned in the product than the metaphor of customer implies (Hudak et al., 2003). There is a tension in the vast array of evidence regarding patient satisfaction.