WHY ARE SICKER PATIENTS LESS SATISFIED WITH THEIR MEDICAL-CARE - TESTS OF 2 EXPLANATORY MODELS

Two explanations were tested for why patients who are less healthy ten d to he less satisfied with their medical care than healthier patients . The explanations were (a) that poor health produces dissatisfaction directly and (b) that poor health produces dissatisfaction through the mediating effect of physicians' behavior. Two studies are presented t hat measured patients' health status, patients' satisfaction with care , and their physicians' communication as recorded on audiotape. In Stu dy 1, 114 patients had first visits with rheumatologists; in Study 3, 649 patients had continuing-care visits with physicians in internal an d family medicine. Causal modeling revealed that the first study suppo rted the direct explanation. The second study also supported the direc t explanation, as well as the mediation explanation with respect to th e physician's use of social conversation.