Purpose of the study: Patient satisfaction is an important element for patient claims. What is the correlation between patient satisfaction and clinical scores?

Material and methods: An independent investigator reviewed the files of patients who underwent exclusive Chopart arthodesis from 1990 to 2000 and who had at least one-year follow-up. Nineteen patients were reviewed using the AOFAS scale. Patient satisfaction as assessed with two scales, a numerical scale from 1 to 10 and a verbal scale noted 1 to 4. Correlations were made with the perception of the disability due to the operation.

Results: Fourteen patients exhibited good correlation between the clinical outcome and their level of satisfaction. Five displayed clear divergence: three poor clinical scores with a high level of satisfaction and two good clinical scores in unsatisfied patients.

Discussion: The mean scores were around 6/10. Clinical assessment and satisfaction noted on a scale of 10 gave good agreement: the way satisfaction is approached and the patient’s expression of satisfaction may have an important impact. A visual scale with no semantic connotation would be les subject to interpretation since the assessment is made on a numerical scale independently of psychological implications. Conversely, the disability/satisfaction relationship was scored on a four-point scale and demonstrated rather good agreement as did the relationship between disability and clinical score. Five patients exhibited significant divergence showing that the cultural element and collateral factors (comorbid conditions) could be involved.

Conclusion: Establishing a pertinent satisfaction scale is a difficult task because the correlation with the clinical outcome is imperfect. This analysis demonstrated that less than satisfactory objective results can be associated with an acceptable level of satisfaction (three patients in this series). This situation is observed in patients aged over 60 years who grew up in an environment where the physician was to be respected and where complaining was not acceptable. This is a cultural factor. Poor appreciations which contrast with a rather average clinical result are related to collateral conditions which explain such behavior. Patient satisfaction is a multifactorial phenomenon. Reliable information collection before the operation should be helpful in allowing the patient to fine-tune expectations concerning the surgical outcome and the reservations to be expressed.

Purpose of the study: Why is a surgery patient satisfied, or not satisfied? What is the basis of the patient’s perception of the surgical result and what criteria does a patient use to decide to undergo surgery and then to consider the result satisfactory or not?

Material and methods: All patients consulting a surgeon in the orthopedic and traumatology surgery department during the month of April 2002 received an anonymous questionnaire. The inclusion criteria were an open orthopedic or traumatologic surgical procedure performed by the consulting surgeon, the last procedure performed being considered. Patient satisfaction being multifactorial, several associated factors were tested: pain, comfort, operating room, personnel, anesthesia.

Results: Twenty-five questionnaires were collected. One questionnaire was eliminated because of missing data. Operations were undertaken for medical reasons, rarely patient comfort. Postoperative patient satisfaction depended on the patient-physician relationship, and secondarily on outcome. Responses to open questions illustrated that the key element was a quality relationship with the physician.

Discussion: This survey had a methodological bias: non-responders often avoid mentioning poor outcome. In this survey, non-responders were non-consulting patients who were not tested. The remarkable fact was that the surgeon was the key to patient satisfaction, more than the result of the operation. The way information was delivered had a primordial importance: the patients expected to be given honest and pertinent information.

Conclusion: The feeling of competence and the information delivered are certainly two of the most important points in the patient-surgeon relationship. They are the cement leading to a confident relationship. Information delivery has a personal aspect which each surgeon must manage honestly. The obligation of information delivery is necessary from a regulatory point of view. But it is most important to keep in mind that the way information is delivered is an important aspect which can be assessed via an internal audit. The British National Health Service has demonstrated the usefulness of such audits and the publication of the results as well as the impact on the clientele.