Mamun-Al-Mahtab, Nuzhat Choudhury, K.M. Mamun Murshed, Uttam Kumar Barua, Md. Mahbubur Rhman, K.M. Shahnoor Hossain, Rooh-e-Zakaria, Swati Munshi, Rima Afroza Alia, Shahrin Afroza, Md. Iftekhar Mahmud,
Bangladesh Primary Care Research Network (BPCRN), Dhaka, Bangladesh.

Address correspondence to:
Dr. Mamun-Al-Mahtab MSc (Gastroenterology, London), MD (Hepatology), FACG
Assistant Professor, Department of Hepatology
Bangabandhu Shiekh Mujib Medical University, Dhaka, Bangladesh
Phone: (880)-1711567275
Fax: (880)-2-8826840
Email: shwapnil@agni.com
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Satisfaction of patients is a very important part of any clinical practice. Although the primary goal is to ensure proper management; delivery of care in a manner that is satisfactory to patients is also very, if not equally, important in the current perspective (Edwards & Staniszewska, 2000; McDonald & Langford, 2000). Patient satisfaction is directly proportionate to the service delivered and any decline in the quality of service ultimately leads to dissatisfaction of the patients (McKinley & Roberts, 2002; Jackson & Kroenke, 2001). Studies have shown that physicians who are more focused on their patients benefit them more (Kiyohara et. al., 2001).

It is imperative that patient satisfaction surveys be carried out in the community or in a given facility, as successful implementation of the outcome of such studies ensures better patient satisfaction. Results of studies conducted elsewhere cannot be used as reference in another place, as socio-cultural background of patients is important in determining patient satisfaction (Xakellis & Bennett, 2001). The present study is the first of its kind conducted in Dhaka city and also in Bangladesh.

A cross sectional survey of 300 patients was carried out between May 2006 to June 2006 at three specialist practice chambers in three different areas of Dhaka city. In case of every chamber, the first one hundred consecutive patients who gave written consent to participate in the study were included. A special questionnaire was developed, to be used in the survey.

In all, 300 patients were included in the study. Patients were between 9 to 76 years of age. Of them 63% (189/300) were men and the rest 37% (111/300) women. Patients were mostly married [59% (177/300)] with higher secondary level of education [43% (129/300)]. Most patients were in service [47% (141/300)]. Females were mostly housewives [53.15% (59/111)] (Table 1).

Average waiting time for the patients was 15 minutes, against an expected waiting time of 10 minutes. 30% (90/300) patients were consulted within 10 minutes.

Patients preferred to watch television [71.33% (214/300)], read newspapers/magazines [25.33% (76/300)] or listen to music [3.33% (10/300)] while waiting to consult the physician (Table 2).

Patients had reservations about the presence of the chamber aid [56.67% (170/300)] and other persons [89% (267/300)] for reasons like lack of confidentiality 76.03% (203/267) and discomfort 23.97% (64/267). 47% (141/300) of patients also had an objection to receiving phone calls by the physician because of interference with the consultation process (Table 3).

Average consultation time was 10 minutes against patient expectation of 30 minutes. 22.33% (67/300) patients were consulted for a minimum 30 minutes or more.

The majority of patients were satisfied with the patience of the consulting physician [55.67% (167/300)], explanation by physician [59.33% (178/300)] and investigations advised [53.67% (161/300)], while 53.33% (160/300) patients had no comment about referral to other physicians (Table 4).

The expected average consultation fee was Bangladesh taka 100 (US$ 1.45) against an average consultation fee of Bangladesh taka 233 (US$ 3.20). 60% (180/300) of patients were satisfied with the service they received for their money (Table 5).

In today's clinical practice patients are partners in health care (Edwards & Staniszewska, 2000), and the reason why their expectations and satisfaction is considered crucial in ensuring delivery of quality health care.

It has been shown that socio-academic-economic background influences the level of patient satisfaction (Al-Doghaither & Saeed, 2000). Since the present study was conducted in Dhaka city and as the patients who participated in the study enjoy better socio-academic-economic status compared to the average population of the country, it is expected that their level of expectation would be higher.

Waiting time is very important in determining patient satisfaction. It may consume a major portion of any visit to a consultation chamber. Some studies have reported waiting times as long as 80.5 minutes (Xakellis & Bennett, 2001). Ideally there should be no waiting time in an ideal clinical practice set up. However for practical consideration it cannot be maintained in most cases, especially in a developing country like ours. It is established that hiring of a non-medical aid would help reduce patient waiting time (Grouse & Bishop, 2001). As is also seen in the current study, patients appreciate measures like availability of television, newspapers/magazines, music etc. in the waiting area to lessen their burden while waiting to consult physicians.

Contrary to this, patients appreciate long consultation sessions with physicians and this is one of the important factors determining patient satisfaction. There are reports of long consultation sessions of 24.66 and 27 minutes in the published literature (Kiyohara et. al., 2001; Xakellis & Bennett, 2001). In our case however, average duration of consultations was 10 minutes as opposed to 30 minutes expected by the patients.

It has been shown that effective communication between patient and physician improves patient satisfaction (Al-Doghaither et. al., 2000). It is also seen in the present work that patients expect patience and explanation about advised investigations, diagnosis, treatment and referral from their consulting physician. Sharing of such information between physician and patient will enhance patient satisfaction level.

Another important issue for patient satisfaction is privacy and confidentiality during consultation. As the present study was not conducted in any academic institute, under/post-graduate students were not present in the consultation chambers. However patients expressed reservation to the presence of any third person, including chamber aid, other than his/her attendant for reasons such as lack of confidentiality and discomfort. Patients also had reservation to receiving phone calls by the physicians during consultation as it interfered with the consultation process.

Cost of consultation is another major issue determining satisfaction of the patients. Although in the present work, the consultation fee was much higher than expected, the majority were ultimately satisfied with their value for money.

The study identifies a number of areas which are important for patient satisfaction and in other words for ensuring delivery of quality care.

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