Patient satisfaction is defined as the extent to which patients perceive their general health care and medical needs are being met . Most health care providers are aware of the great importance of patient satisfaction in facilitating the provider–patient relationship. Different instruments have been used to measure satisfaction [2, 3]. Recently, there has been an increased effort to use patient satisfaction as one of the several measures of the overall quality of health care [1, 2], and with the approval of the Affordable Care Act (ACA) in the United States, patient satisfaction is now tied to reimbursement in some cases .
The clinician’s ability to explain, listen, and empathize is thought not only to impact patient satisfaction and experience of care but also to affect functional health outcomes [4, 5]. However, there is growing evidence that other factors outside the doctor–patient relationship influence patient satisfaction [6, 7].
Several studies have looked at patient’s satisfaction in psychiatric settings [8,9,10,11,12]. Kelstrup et al. sent 274 German patients a questionnaire concerning satisfaction with psychiatric treatment 1 month after their discharge from a psychiatric hospital. Patients, who were diagnosed as suffering from affective disorders or from reactive psychoses, were more satisfied than patients with schizophrenia, paranoia, or with transitory adjustment reactions. Patients who had no personality disorder diagnosis and patients with character neurosis were more satisfied than patients with antisocial or borderline personality disorders. Patients on antidepressant medication were much more satisfied than other patients . More recently, Gebhardt et al. evaluated 113 German patients at time of discharge from a psychiatric hospital. They found that patient satisfaction was dependent on symptom severity, global functioning at discharge, pharmacologic disturbances during treatment, and on the diagnostic group . An Indian study of 60 individuals utilized a cross-sectional study design to evaluate patient satisfaction in an outpatient setting utilizing the patient satisfaction questionnaire. They also found that patient’s satisfaction was correlated to illness severity .
A review of 6 randomized trials of participants with major depression treated with various antidepressant medication found a correlation between patient satisfaction and patient improvement in depressive symptoms . Other studies have noted patient satisfaction correlated to disease type, age, educational level, level of anxiety, and pain level [12, 14, 15]. Many of these factors are out of a providers control on an initial visit; however, improving a provider’s ability to empathically communicate could be a way to impact patient satisfaction despite comorbidities and treatment outcomes [4, 5, 14].
The concept of mentalizing was introduced as a theoretical model in the 1970s . However, more recently the concept of “theory of mind” has matured through neurobiological studies (mirror neurons theory) and developmental psychology . Mentalization, at a very basic level, is defined as an ability to hold another’s mind within one’s own . It comes from a well-defined concept of “empathy” described in psychoanalytic literature by Greenson et al. [18, 19]. The ability to communicate empathically is an important skill in every doctor–patient interaction, including those devoted primarily to prescribing and monitoring medication. Empathetic communication can increase the patient’s perception that they are being understood and getting their needs met, thus improving the patient’s satisfaction with the encounter [4, 5, 20, 22].
This study sought to examine Patient’s Satisfaction Questionnaire (PSQ-18) measures and their relationship to depression and anxiety symptom severity (as assessed with the PHQ-9 and GAD-7). A secondary aim of the study was to assess the impact of physician mentalization training on PSQ-18 outcomes. We hypothesized that the more depressed and anxious the patient, the lower their average provider satisfaction rating. We also hypothesized that provider empathy training based on teaching basic skills of mentalization could improve empathic communication, thus improving patient satisfaction scores.