Disability and patient satisfaction with medical care.

The effect of patients' health status on their satisfaction with medical care should be well understood before individual providers of care are evaluated using patient satisfaction as a criterion. This paper examines how disability is associated with patients' dissatisfaction with medical care services provided by doctors in primary care. Measures of patient satisfaction developed by Roghmann and his colleagues using multidimensional scaling (MDS) were included in a survey of 1,245 respondents living in the London Borough of Lambeth. The measures included attitudes toward the medical profession (general satisfaction) and satisfaction with patients' own provider or regular source of care (specific satisfaction). Disability was assessed using a British version of the Sickness Impact Profile. Consistent with findings from other studies, the majority of respondents expressed satisfaction with most aspects of care, except for doctor availability in an emergency, preventive teaching, and aspects of communication. Replication of the MDS analysis on this study population yielded an overall measure of general satisfaction, and three submeasures of specific satisfaction labelled access, quality, and recent experience. These dimensions also emerged from a content analysis of responses to an open-ended question. Respondents with a higher level of disability were more likely to be dissatisfied with all three aspects of specific satisfaction. Other social and medical factors, such as sex, social class, medical conditions, self-rating of health, social support, and adverse life events, were significantly related to one or more measures of specific satisfaction. Because disability can influence satisfaction with medical care received from specific doctors or practice settings, attempts to use satisfaction measures for evaluating specific services or providers should distinguish between patient groups with different physical and psychosocial disabilities. Multidimensional satisfaction measures with both positively and negatively worded items anchored to recent and specific consultations would prove more reliable, valid, and useful in future studies.