Patient satisfaction requires theoretical foundation
In her editorial on the 'usefulness' of measures of patient satisfaction Haggerty uses a common sense definition of satisfaction, i.e. " a judgment about whether expectations were met."  Haggerty qualifies this seemingly one-way influence by quoting the Health Technology Assessment review which highlighted that patient satisfaction is influenced by varying standards, different expectations, the patient's disposition, time since care, and previous experience. 
I think there are more many questions around defining satisfaction; some of these were raised more than thirty years ago.  First, some believe there is still a lack of consensus on the definition of the concept of satisfaction,  and secondly, that satisfaction is a multidimensional concept determined by a variety of factors.  Thirdly, many satisfaction studies lack a conceptual or theoretical basis. [6-9] Consequently different researchers have argued that satisfaction studies should not be used to allocate resources. [10-14]
Furthermore, patients are unlikely to evaluate care in terms of satisfaction as highlighted by Staniszewska and Ahmed.  Without identifying the theoretical foundation of the concept of (patient) satisfaction it is debatable how we can link it usefully to the quality of the services provided.
Prof. Edwin van Teijlingen
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Competing interests: None declared