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Patient Experience Journal Patient Experience Journal
Manuscript 1813
Doctor behaviors that impact patient satisfaction Doctor behaviors that impact patient satisfaction
Bryan Lilly
Michael J. Tippins
Katharine Tippins
Julia Lilly
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Part of the Medicine and Health Sciences Commons, and the Social and Behavioral Sciences
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Patient Experience Journal
Volume 10, Issue 2 – 2023, pp. 103-112
Patient Experience Journal, Volume 10, Issue 2
© The Author(s), 2023. Published in association with The Beryl Institute.
Downloaded from www.pxjournal.org 103
Research
Doctor behaviors that impact patient satisfaction
Bryan Lilly, University of Wisconsin Oshkosh, lilly@uwosh.edu
Michael J. Tippins, University of Wisconsin Oshkosh, tippins@uwosh.edu
Katharine Tippins, University of Wisconsin Madison, tippinske@gmail.com
Julia Lilly, Indiana University Bloomington, jlilly7899@gmail.com
Abstract
Patient satisfaction with their doctor is an essential component of healthcare that impacts both patient health outcomes
and fiscal success of healthcare organizations. This study identifies doctor behaviors that act as drivers of patient
satisfaction when doctor expertise is set aside and determines the importance of these behaviors between different age
groups. Survey data were gathered from two samples, one comprising younger adults at a mid-size Midwestern university
(n=100) and one comprising older adults from a national market research survey panel provider (n=187). Subjects were
asked to rate their satisfaction with their doctors from 0-100 and rate the importance of 21 doctor behaviors from 1-5.
Results support evaluating patients’ overall views with their doctors separately from their views of their doctors when
ignoring doctors’ expertise, as three unique doctor behaviors were identified when ignoring the doctors’ expertise (i.e.,
not rushed, long-term relationship, and being fun). Results also support the existence of age-related patient satisfaction
drivers. Unique satisfaction drivers among younger patients include not rushing the interaction, being fun, conveying a
caring demeanor, and protecting patient privacy. Conversely, unique satisfaction drivers among older patients include
listening, conveying friendliness, building long-term relationships, and seeking patient input. Findings indicate that
expertise-independent doctor behaviors are quantifiable and demonstrate clear patterns of importance in terms of
patient satisfaction to different age groups. They also align with prior research findings that behaviors traditionally
classified as “soft skills” like smiling and active listening are important attributes when considering patient satisfaction.
Keywords
Patient experience, patient satisfaction, patient-centered care, perceptions of doctors, doctor behaviors.
Introduction
Many factors contribute to whether patients’ experiences
with their doctors lead them to view their doctors
positively or negatively. Doctors and healthcare
organizations cannot influence all of these factors, and
healthcare organizations may even prioritize different
factors that drive efficiencies which are at odds with
creating patient experiences that lead to positive views of
their doctors. We acknowledge the multidimensional
nature of patient satisfaction1 and accept that satisfaction
within the healthcare context derives from factors that
doctors can and cannot affect. That said, even in the
presence of uncontrollable factors, doctors may find it
useful to identify factors they can affect and that improve
patient satisfaction. This research builds on existing work
that focuses on the patient experience with their doctor,
and specifically work that identifies doctor behaviors that
impact patient satisfaction with their doctor.
While some disagreement exists as to what constitutes
patient satisfaction, continued advancement of this
research is important from both a healthcare provider
financial perspective and a patient health outcome
perspective. For instance, Snyder suggests that satisfied
patients are more loyal, which helps to increase revenues
and margins.2 Additionally, past research indicates a strong
relationship between patient satisfaction and patient views
of the quality of doctor-patient communications,3 doctor
trustworthiness,4 and being treated with dignity.5,6 And
most importantly, higher levels of patient satisfaction are
more likely to result in follow through with treatment
recommendations, resulting in improved health
outcomes.7 Thus, understanding the subtleties that turn a
patient’s healthcare visit into a satisfactory experience
versus an unsatisfactory one is messy but nonetheless
worthy of study.
Given the many benefits of increasing patient satisfaction
(e.g., long-term financial performance of healthcare
providers, favorable patient health outcomes), the need to
gain additional insights that provide prescriptive
recommendations to doctors is justified. To start, we state
three objectives for our work. We then briefly elaborate on
doctor behaviors that have been linked to patient
satisfaction in prior studies. We then focus on our
empirical investigation and end with a discussion of the
implications and limitations of our work.
Doctor behaviors that impact patient satisfaction, Lilly et al.
104 Patient Experience Journal, Volume 10, Issue 2 – 2023
The three objectives are:
1. First, we suggest why it may help to separate patients’
views of doctor expertise from overall views of the
doctor, so that we can examine ‘expertise-ignored’
views of doctors.
2. Second, we explore the impact of patient age on the
connection between doctor behaviors and patient
satisfaction. If younger patients are satisfied by some
doctor behaviors, but older patients are satisfied by
other behaviors, then recommended behaviors should
vary across patient ages.
3. Third, based on both objectives above, we empirically
examine how expertise-ignored views of doctors are
related to behaviors that affect satisfaction, comparing
younger adults to older adults. Our empirical
examination includes identifying a core subset of
behaviors that explain most variation in patient
satisfaction. Understanding these core behaviors may
help doctors prioritize their efforts to make patients
more satisfied, so they become more efficient and
effective in driving satisfaction.
Doctor Behaviors
We first identified doctor behaviors linked to patient
satisfaction through a review of existing academic
literature.8-21 This literature presents the rationales and
underlying theories that link doctor behaviors to patient
satisfaction. We recognize that articles vary in terms of
focusing on patient satisfaction with a doctor, patient
satisfaction with a visit to a doctor, and patient satisfaction
with doctor-patient interactions. The distinction between
these satisfaction targets is interesting but the theoretical
rationales and measures across articles are similar to each
other. Thus, in an effort to be inclusive in identifying
factors, we drew from all of these focuses of satisfaction.
In addition to academic articles, we examined practice-
oriented articles that provide experience-driven intuitions
about doctor behaviors that drive patient satisfaction.22-29
Some of these past works include factors reflected in
HCAHPS and Press Ganey surveys.11,13,15,16
Table 1 lists the behavioral factors we identified across
articles. Many of these factors were identified in multiple
articles, with descriptions of factors varying slightly across
articles. Thus, we have not attempted to attribute each
factor to particular articles. The table provides descriptions
that reflect how these factors were generally presented
across articles. While our goal is to focus on doctor
behaviors, we acknowledge this research measures patient
perceptions of doctor behaviors. To illustrate the
distinction, whether a doctor asks questions is a doctor’s
behavior, but regardless of whether a doctor asks
questions, the factor reflects whether patients believe or
recall that a doctor asked questions. This comingling of
perception and reality, which can result in selective
distortion, is a well-known and much studied topic within
the social sciences,30,31 as well as within the healthcare
context.32 We retained items discussed in the literature as
reflecting more than one behavior, provided the item was
presented as reflecting a narrow set of specific behaviors.
For example, doctor friendliness encompasses behaviors that
include the initial greeting, eye contact, and projecting a
sentiment that the patient is an individual human being,
not a number. Conversely, we excluded items discussed in
Table 1. Doctor behaviors identified in the existing literature
Behavior
Description
Accessible
Is accessible across days and/or at different times of the day
Asks questions
Asks patients questions about their health
Bedside manner
Has compassion/empathy for patients’ worries or pains
Cares about individual
Seems to genuinely care about patients as individual people
Checks for understanding
Checks to make sure patients understand recommendations or treatments
Clear without jargon
Talks clearly and avoids jargon
Expertise
Exhibits high expertise in his or her area of practice
Explains how and why
Explains healthy behaviors; how and why they work
Explains options
Explains treatment option pros/cons and how they address patients’ health needs
Friendly
Is friendly (e.g., warm greeting, good eye contact, not curt or dismissive)
Fun
Is fun (smiles, upbeat, sense of humor, colorful attire under lab-coat, etc.)
Instructions
Gives good instructions about follow-up care
Listens
Is a good listener
Long-term relationship
Is good at working with patients over time
Makes referrals
Can make good referrals to specialists when patients’ health needs are beyond his or her area
Not rushed
Is not rushed during patients’ visit
Protects privacy
Protects patients’ privacy and personal information
Reviews history
Reviews patients’ medical history plus updates they provide
Seeks input
Seeks patients’ input and includes them in decisions about treatments
Sits near patient
Sits near patients instead of standing when they visit his or her office
Works as team
Works well as a team with other health care providers that see patients
Doctor behaviors that impact patient satisfaction, Lilly et al.
Patient Experience Journal, Volume 10, Issue 2 – 2023 105
the literature as being higher-order factors that reflect a
broad array of doctor behaviors. For example, we
excluded trust in the doctor. While trust affects patient
satisfaction, trust may reflect patients’ views of many
diverse doctor behaviors.
Of the 21 behaviors identified, all but one was culled from
our study of existing research. Fun is the only behavior
included in the table that was not identified through our
healthcare literature search. While fun may seem
incongruous with the healthcare setting, the seriousness of
the patient setting may actually be a reason for expecting
fun to be important. Specifically, research in both
academic and practice domains has found that fun
sometimes affects satisfaction in challenging environments
outside of healthcare. For example, Yohn states that,
“Great service providers make it fun to work with them.
They recognize that their clients are stressed out enough
by everything else they have going on, so they work hard
to make interactions with them something their clients
look forward to.”29 In addition, Karl and Peluchette
provide an example from Southwest Airlines to illustrate
how travelers’ worries are counteracted by infusing fun
into the service experience.21 Finally, fun has been linked
to feelings of “release from a burden” that may be desired
in the context of a patient visiting a physician.33
Physician Expertise
A patient’s primary reason to seek healthcare, and to rely
on specific healthcare providers is likely to be their
perception that healthcare providers have strong expertise.
Nevertheless, as seen from the list of behaviors in Table 1,
the doctor’s ability to provide a ‘human touch’ is very
important to patients. We suggest that the contrast of
expertise versus other behaviors may be important to
consider. Reflecting on the Hierarchy of Effects model, we
expect that a doctor’s expertise aligns with a cognitive
reaction to the doctor’s service, whereas other behaviors
largely align with an affective reaction to the doctor’s
service.34 Put simply, we hypothesize that cognitive and
affective reactions to doctor behaviors both impact patient
satisfaction. As an example of viewing expertise and other
behaviors as both being important, Elrod and Fortenberry
state that healthcare providers must develop their skills
[cognitive lever] and appeal emotionally to their target
audiences [affective lever].35
Notably, satisfaction is sometimes best assessed by
considering cognitive and affective parts separately. For
example, employee satisfaction with jobs and customer
satisfaction with mobile communications have been
assessed so that satisfaction is partitioned into cognitive
and affective components.36, 37 In terms of healthcare,
research focusing on links between doctor behaviors and
patient affective satisfaction may be suppressed when
using a global satisfaction measure, and thus should
sometimes be assessed by itself.
A related issue is that service provider expertise can have
halo effects. For example, a study of financial services
found that customer views of service provider expertise
can have halo effects that make it challenging to
understand how consumers form perceptions of affective
dimensions of service provider trust.38 Given the points
above, it may help to examine patient satisfaction in two
ways: assessing patient views of doctors while including
expertise and assessing patient views of doctors while
excluding expertise.
Age
Another issue to consider is patient age. We limit the
scope of our inquiry to adults because doctor-patient
dynamics with children involves parents or other
caregivers, which introduce regulatory and multi-person
complexities that warrant a separate study. Focusing on
adults, younger adults often differ from older adults in
terms of their health care situations and their health
concerns. Indeed, certain illnesses are more prevalent
among younger versus older age groups, and age groups
have been used to categorize treatment approaches.39
Another study on dental care also found motivation
differences when comparing younger to older patients,
with older patients placing higher value on social
benefits.40 Age-related differences in satisfaction metrics
are also noted in areas beyond healthcare. For example,
prior research in retail settings has found that service
quality elements affect satisfaction more highly among
younger (versus older) consumers, perhaps partly because
younger adults are less able to regulate their emotional
responses to service deficiencies,41,42 and service efficiency
tends to be valued more by older (versus younger)
consumers.43 Another age difference is that, across
multiple product categories, satisfaction often rises among
consumers age 55 and older, because older people were
raised during times when services were less available, and
thus their benchmark for good service is lower than the
benchmark possessed by younger people.44 Given the
existence of these age-related differences, we suggest that
it makes sense to consider the potential for younger
patients to differ from older patients with respect to how
they respond to various doctor behaviors.
Empirical Investigation
Based on the ideas above related to physician expertise, we
consider separating patients’ overall views of their doctors
from their views of their doctors regardless of doctors’
expertise. If expertise-ignored satisfaction with doctors is
unique from overall satisfaction, then doctors can focus on
better understanding that domain of patient satisfaction
and increase their ability to improve patient satisfaction.
This approach reflects the view that patients lack medical
experience and thus may misjudge doctor expertise. 45
Thus, parsing expertise from the baseline model seems
Doctor behaviors that impact patient satisfaction, Lilly et al.
106 Patient Experience Journal, Volume 10, Issue 2 – 2023
reasonable, if for no other reason to eliminate another
level of uncertainty.
We also consider age. Specifically, do younger and older
adults differ from each other in terms of which doctor
behaviors impact their views of doctor, when doctor
expertise is ignored? For instance, suppose some doctor
behaviors impact younger adult satisfaction, yet other
behaviors impact older adult satisfaction. In these cases,
doctors can be more prepared to engage with all patients
(younger and older), based on having more knowledge
about how patients across age ranges become satisfied.
Methods
Samples
We gathered data from two samples. Our first sample
comprised younger adults who were enrolled in an
introductory business course at a mid-size Midwestern
university. Subject ages range from 19-22 years. Usable
data were collected from 100 of these younger adult
subjects. Our second sample comprised older adults who
participate as panelists for a national panel-provider that
has fielded market research surveys for over 10 years in
over 20 countries. Usable data were collected from 187 of
these older adult subjects. Approximately 77% of these
older adults were 65-74 years old, 17% were 75-84 years
old, and 6% were 85 years old or older. For both younger
and older samples, data were not used if surveys were
completed in an unusual amount of time (i.e., under five
minutes or over 20 minutes), and data were not used if
open-ended responses were nonsensical. A small portion
of data were discarded based on these validity checks.
Primary
Measures
Surveys were used and subjects were asked to think of a
doctor they viewed positively, and another doctor they
viewed negatively (or at least less positively). Subjects were
advised to consider general practitioners and specialists.
For the doctor viewed positively, and for the doctor
viewed negatively (or at least less positively), subjects were
asked to rate “How good is this doctor?” using a scale of
zero (extremely bad) to one hundred (extremely good).
Subjects were then instructed to momentarily ignore the
doctor’s medical expertise and again rate the doctor, using
the same zero to one hundred scale. This funnel approach
enables a comparison of overall views to views ignoring
expertise, and thus a comparison of whether satisfaction
drivers are identical when considering overall views to
views that ignore expertise. For each doctor, subjects also
rated the doctor behaviors listed in Table 1, and subjects
received the descriptions provided in Table 1. Subjects
rated all of these doctor behaviors using a scale of
one (strongly disagree) to five (strongly agree). Subjects
were then asked to provide qualitative comments,
identifying at least one thing doctors do that make a
patient experience more positive, and one thing doctors do
that make a patient experience more negative. The practice
of including a qualitative component in health research has
been found to be useful in prior studies, including studies
aimed at understanding healthcare needs of older
adults.46,47
Procedures
Institutional Review Board guidelines were followed and
approval was secured to ensure that no subject medical
information was jeopardized and that subjects were fully
aware of the purpose of their voluntary participation in the
study. An initial draft of the survey was pilot tested and
the survey was then modified (data from pilot test subjects
were discarded). New data were then collected during
2022, after COVID-19 limitations had largely subsided.
The survey was taken online by all subjects.
Results: First Research Objective
Ultimately, results support evaluating patients’ overall
views with their doctors separately from their views of
their doctors when ignoring doctors’ expertise. This
conclusion is made based on taking three analysis steps.
For step 1 we compare average patient ratings of doctors
when including expertise, to average patient ratings when
ignoring expertise. For step 2 we examine subjects’ open-
ended comments. In step 3 we compare two statistical
models to see if the correlations between doctor behaviors
and patient views of doctors differ when patient views
include expertise (model 1) versus when patient views
ignore doctor expertise (model 2).
For our first step noted above, Table 2 shows average
patient ratings of doctors, which reflect a scale of zero
(extremely bad) to one hundred (extremely good). The
importance of examining averages is to see whether clear
differences exist between expertise-including ratings and
expertise-ignored ratings. Averages are very similar to each
other (72.25 versus 70.60), casting doubt on whether it is
useful to separate patient views of doctors when including
versus ignoring doctor expertise. For reporting
completeness, Table 2 also shows the average scores for
subject ratings of doctor behaviors. As a cautionary note,
keep in mind these averages reflect 574 observations,
based on 100 younger adult observations of doctors they
view positively, 100 younger adult observations of doctors
they view negatively (or less positively), 187 older adult
observations of doctors they view positively, and 187 older
adult observations of doctors they view negatively (or less
positively). Thus, assuming most doctors in real life are
viewed positively, these averages should be lower than
normal because they are based on an equal number of
doctors viewed positively and viewed negatively (or less
positively). (Note: for audiences that wish to use these
results as a benchmark for positively viewed doctors only,
Table 5 separates ratings more granularly.)
Doctor behaviors that impact patient satisfaction, Lilly et al.
Patient Experience Journal, Volume 10, Issue 2 – 2023 107
For step 2 in evaluating whether it is useful to examine
patient views of doctors when ignoring doctor expertise,
we considered the subjects’ open-ended comments. These
comments support using a separate view of doctors, based
on ignoring doctors’ expertise. As seen in Table 3, some
patients clearly think of expertise as being important but
being very different from other considerations.
Step 3 in our assessment further supports the validity of
considering patient views of doctors when ignoring doctor
expertise. As noted above, in this step we compared two
models to see if doctor behaviors that best align with
overall satisfaction (model 1) are the same behaviors that
best align with overall satisfaction when ignoring doctor
expertise (model 2). Results are below in Table 4.
The left side of Table 4 shows doctor behaviors that are
collectively most useful in predicting patient views of
doctors overall (i.e., including doctor expertise). Results
are based on conducting a stepwise backwards regression,
using patients’ overall views of doctors as the dependent
variable, and using all 21 doctor behaviors as independent
Table 2. Average ratings of doctors overall and doctor behaviors, across all subjects
Overall rating of doctor, scale is 0-100
Including medical expertise, scale is 0 (extremely bad) to 100 (extremely good)
72.25
Ignoring medical expertise, scale is 0 (extremely bad) to 100 (extremely good)
70.60
Ratings of doctor behaviors, scale is 1 (strongly disagree) to 5 (strongly agree)
Accessible (Is accessible across days and/or at different times of day)
3.33
Asks questions (Asks me questions about my health)
3.82
Bedside manner (Has compassion/empathy about my worries or pains, good bedside manner)
3.64
Caring (Seems to genuinely care about me as a person)
3.65
Checks I understand (Checks to make sure I understand recommendations or treatments)
3.72
Clear no jargon (Talks clearly and avoids jargon)
3.95
Expertise (Exhibits high expertise in his or her area of practice)
4.11
Explains how why (Explains healthy behaviors; how and why they work)
3.68
Explains options (Explains treatment option pros/cons and how they address my health needs)
3.78
Friendly (e.g., warm greeting, good eye contact, not curt or dismissive)
3.80
Fun (smiles, upbeat, good sense of humor, colorful attire under lab-coat, etc.)
3.45
Instructions (Gives good instructions about follow-up care)
3.80
Listens (Is a good listener)
3.67
Long-term (Is good at working with patients over time; long-term doctor-patient relationships)
3.76
Makes referrals (makes good referrals to specialists when my health needs are beyond his or her area)
3.80
Not rushed (Is not rushed during my visit)
3.53
Protects privacy (Protects my privacy and personal information)
4.20
Reviews history (Reviews my medical history plus updates I provide)
3.97
Seeks my input (Seeks my input and includes me in decisions about treatments)
3.59
Sits near me (Sits near me instead of standing when I visit his or her office)
3.64
Team (Works well as a team with other health care providers that see patients)
3.71
Table 3. Sample comments that illustrate that patients’ views of doctors are often shaped by factors other than
expertise
“No one is perfect! Sometimes the doctor with the most expertise is the best on the job even when cranky!”
“My husband was eventually diagnosed with ALS. I was there for all appointments. The Dr. did not address any of my questions. He may
have an M.D. degree, but he was not a physician.”
“The doctor didn't get to know me personally. He had NO bedside manner, but I went to him because of his skill with knee surgery.”
“Everyone wants to feel like a person of value. Even if a doctor has great expertise, a patient can feel anxious in their care if they don't
connect with their patients.”
“Listen to your patient. I know you are busy but take some time and empathize with them. Sometimes you are the only outside person
they see. We already know that you are a good professional - be a good human too.”
“I love that my doctor knows my name and remembers my children and grandchildren. He takes his time and listens to what I have to
say. He asks about my current meds and if I think they are doing enough. He doesn't overbook. Most of the time, I don't even sign in. I
show up and get taken right in. If I get sick and can't get to the office, they have stayed open late and waited for me.”
“Listening is the most important thing there is. Handwashing too.”
“Sick and tired of them looking at my white hair, calling me ‘sweetie’ and saying, ‘Well you know you are getting older dear.’ Sick of
condescending attitudes.”
“My father was a physician. Personality is everything. Most doctors today seem more interested in checking boxes than checking my
health.”
Doctor behaviors that impact patient satisfaction, Lilly et al.
108 Patient Experience Journal, Volume 10, Issue 2 – 2023
variables. The backwards regression technique is especially
suited to reducing a large set of predictors. The technique
involves assessing a full model with all predictors,
examining the significance of all coefficients, and if one or
more coefficients are not significant, removing the non-
significant predictor that contributes least to the overall
model, and conducting the model again. This process is
repeated to sequentially remove the least predictive factor
until all variables in the model are significant. We used
SPSS version 28 for this analysis. We used one tailed p-
values, given the doctor behaviors are expected to
contribute toward positive views of doctors (i.e., two tailed
p-values would be appropriate if our views were non-
directional, meaning increases in doctor behaviors were
expected to change patient views of doctors via an increase
or decrease in these views).
The right side of Table 4 shows results based on using the
same analysis except using the dependent variable that is
patient views of doctors while ignoring doctor expertise.
As seen via the orange fill-color, four of the 21 doctor
behaviors are significant predictors of both domains of
patient views of doctors (i.e., including doctor expertise
versus ignoring doctor expertise). However, as seen via the
green fill-color, four doctor behaviors are unique
predictors of overall patient views of their doctors
including expertise, and three different doctor behaviors
are unique predictors of patient views of their doctors
when ignoring the doctors’ expertise.
In concert, results support our first objective. We conclude
that, at least in some settings, it may be useful to consider
patients’ overall views of doctors while ignoring doctor
expertise. The similar means reported in the top rows of
Table 2 (72.25 and 70.60) are interesting and run counter
to this conclusion, but these means tell only part of the
story. Results collectively indicate that even if patients’
average overall views are about the same for the two
domains (views including doctor expertise versus views
ignoring doctor expertise), efforts to improve patient
satisfaction to some extent hinge on different doctor
behaviors. When looking beyond doctor expertise, doctors
and hospital administrators seeking to improve patient
satisfaction with their doctors should pay attention to
whether doctors behave in a non-rushed fashion, whether
doctors demonstrate a desire to work with patients over
time (long-term), and whether doctors engage in fun
behaviors such as smiling, demonstrating a good sense of
humor, and wearing colorful attire under their lab-coat.
These factors are important satisfaction drivers that could
be undetected when satisfaction is measured with a view
that includes doctor expertise.
Results: Second Research Objective
Results also support the conclusion that younger and older
adults differ from each other in terms of doctor behaviors
that impact their views of doctors when ignoring doctor
expertise. First, we show averages for younger adults and
for older adults in Table 5.
Compared to results shown in Table 2, results shown in
Table 5 may be more useful for doctors and hospital
administrators seeking to use suitable benchmarks for
evaluating their own patient feedback. Interestingly, the
only average below 4.0 across all groupings is the doctor’s
accessibility (see row with all cells having green fill-color).
From Table 5, when looking at doctors viewed negatively
(or less positively), the highest averages are for protecting
privacy (younger adults: 4.11 and older adults: 3.76), and
Table 4. Regression results using data from all subjects: younger adults and older adults. Left table reveals doctor
behaviors significantly related to overall patient views of doctors while including expertise (model 1). Right table
reveals doctor behaviors significantly related to overall view of doctors while ignoring expertise (model 2).
Dependent variable: overall view with expertise:
R2 = 0.663
Dependent variable: overall view ignoring expertise:
R2 = 0.675
Behavior
Unstandardized
coefficient
p-value
(1-tailed)
Behavior
Unstandardized
coefficient
p-value
(1-tailed)
Constant
-9.775
0.001
(Constant)
-10.365
0.000
Reviews history
4.599
0.000
Reviews history
4.642
0.000
Instructions
3.492
0.000
Instructions
2.891
0.003
Friendly
2.602
0.003
Friendly
4.733
0.000
Listens
2.416
0.007
Listens
2.429
0.010
Explains options
3.050
0.001
Not rushed
2.753
0.001
Caring
2.028
0.027
Long-term
1.922
0.011
Expertise
1.811
0.024
Fun
2.229
0.034
Referrals
1.417
0.050
Doctor behaviors that impact patient satisfaction, Lilly et al.
Patient Experience Journal, Volume 10, Issue 2 – 2023 109
then for doctor expertise (younger adults: 3.91 and older
adults: 3.61). These averages indicate that younger adults
and older adults are similar in some ways. The relatively
high averages for doctor expertise is also interesting
because it reaffirms that a doctor might be viewed as
having high expertise, and yet still get viewed negatively.
Table 6 then shows two more regression models. We again
used the backwards regression process described above.
However, continuing from our prior results, the
dependent variable for Table 6 is the patient views of
doctors when ignoring doctor expertise, and comparing
younger adults (left) to older adults (right). As before,
orange fill-color indicates doctor behaviors that are
significant predictors in both models, and green fill-color
indicates doctor behaviors that are significant predictors in
only one model. The presence of the different predictors
supports the main conclusion that age differences matter.
For each model, doctor behaviors are listed in descending
order of regression coefficients.
For both younger and older adults, results indicate that
doctors should make sure to review patients’ medical
history with them and should give good instructions about
follow-up care. For younger adults specifically, doctors
should consider engaging in behaviors that demonstrate
fun (as appropriate; we suspect patients are less attracted
to fun behaviors when they have major medical concerns),
not being rushed, caring, and protecting privacy. While
visiting with older adults, doctors should consider
engaging in behaviors that focus more on listening, being
friendly (which may be an older person’s version of fun),
stressing long-term relations, and seeking patient input.
These age differences are intuitive in some ways, for
example older adults (versus younger adults) are more
likely to see doctors frequently, and thus may have more
interest in a long-term relationship and in wanting to have
a dialog with their doctors (which connects to listening
and seeking patient input).
Discussion
Conclusions and recommendations
Prior studies have linked patient satisfaction with
improved health outcomes, increased patient loyalty, and
stronger financial results for healthcare organizations.2,7
One set of factors that drive patient satisfaction is doctor
characteristics. Importantly, while patients value doctors’
Table 5. Average ratings among younger adults (YA) and older adults (OA), for doctors viewed positively (+) and
for doctors viewed negatively/less-positively (-)
YA +
YA -
OA +
OA -
Overall rating of doctor, scale is 0-100
Including medical expertise, scale is 0 (extremely bad) to 100 (extremely good)
87.41
54.71
89.60
56.18
Ignoring medical expertise, scale is 0 (extremely bad) to 100 (extremely good)
85.05
50.78
89.95
54.13
Ratings of doctor behaviors, scale is 1 (strongly disagree) to 5 (strongly agree)
Accessible (Is accessible across days and/or at different times of day)
3.81
2.81
3.82
2.85
Asks questions (Asks me questions about my health)
4.66
3.44
4.39
3.01
Bedside manner (Has compassion/empathy about my worries or pains, good bedside
manner)
4.72
2.96
4.41
2.67
Caring (Seems to genuinely care about me as a person)
4.65
2.96
4.39
2.74
Checks I understand (Checks to make sure I understand recommendations or treatments)
4.58
3.23
4.27
2.97
Clear no jargon (Talks clearly and avoids jargon)
4.56
3.46
4.54
3.30
Expertise (Exhibits high expertise in his or her area of practice)
4.78
3.91
4.35
3.61
Explains how why (Explains healthy behaviors; how and why they work)
4.57
3.35
4.14
2.91
Explains options (Explains treatment option pros/cons and how they address my health
needs)
4.65
3.25
4.36
3.00
Friendly (e.g., warm greeting, good eye contact, not curt or dismissive)
4.79
3.07
4.59
2.87
Fun (smiles, upbeat, good sense of humor, colorful attire under lab-coat, etc.)
4.51
2.87
4.13
2.50
Instructions (Gives good instructions about follow-up care)
4.51
3.26
4.42
3.09
Listens (Is a good listener)
4.69
3.13
4.45
2.65
Long-term (Is good at working with patients over time; long-term doctor-patient
relationships)
4.66
3.12
4.35
3.03
Make referrals (makes good referrals to specialists when my health needs are beyond his
or her area)
4.47
3.35
4.25
3.23
Not rushed (Is not rushed during my visit)
4.43
2.70
4.31
2.73
Protects privacy (Protects my privacy and personal information)
4.73
4.11
4.40
3.76
Reviews history (Reviews my medical history plus updates I provide)
4.69
3.57
4.45
3.30
Seeks my input (Seeks my input and includes me in decisions about treatments)
4.50
3.03
4.21
2.77
Sits near me (Sits near me instead of standing when I visit his or her office)
4.18
3.16
4.27
2.99
Team (Works well as a team with other health care providers that see patients)
4.42
3.33
4.14
3.10
Doctor behaviors that impact patient satisfaction, Lilly et al.
110 Patient Experience Journal, Volume 10, Issue 2 – 2023
medical expertise, they also value soft skill behaviors such
as being accessible, listening, treating patients as
individuals, and being friendly.2,9,11,23,25 As doctors and
healthcare organizations work to improve the patient
experience, our study reinforces the importance of these
doctor behaviors. Our study also moves this research area
forward by providing additional ideas that suggest when
and why some of these doctor behaviors add value. Given
the prior research in this area plus our empirical findings,
we offer three main conclusions and corresponding
recommendations. These ideas may be useful for training
newly minted doctors on how to interact with patients.
This type of training has already been found to be
effective, 48 perhaps because “medical school curricula
often emphasize the teaching of medical facts and
procedures…”.49
First, we conclude that while a doctor’s expertise is
amazingly important, this expertise can potentially become
a crutch or hindrance for doctors and administrators who
seek to improve patient views of doctors. Specifically,
when patients ignore their doctors’ expertise, the
importance of several doctor behaviors become more
apparent. Therefore, we recommend allocating at least
some attention to measuring patient views of doctors
when ignoring doctor expertise. Furthermore, we
recommend encouraging doctors to engage in behaviors
listed in Table 6, paying special attention to reviewing
history and giving good instructions about follow-up care,
which are important to both younger adult patients and
older adult patients.
Second, we conclude that fun is an important doctor
behavior. The usefulness of fun has been substantiated in
settings beyond healthcare, even where such settings may
be stressful.21,33 On the practical side, we recommend
doctors recognize that smiling, being upbeat,
demonstrating a sense of humor and even wearing colorful
attire under lab-coats will sometimes positively impact
patients’ views of them. We appreciate the need for
caution when behaving in a fun manner, and that patients
with major health concerns may view fun as being
inappropriate. On the theoretical side, we recommend
including fun as a service provider factor and
differentiating it from friendliness in models that aim to
understand patient satisfaction. We also recommend that
future research should explore the construct of fun more
fully in healthcare settings.
Third, we conclude that patient age is a useful
demographic to consider when working to improve
patients’ views of their doctors. For example, among
younger adults, fun behaviors are perhaps the strongest
driver of whether patients view doctors favorably when
ignoring doctor expertise (i.e., the 5.803 coefficient in
Table 6 is the largest behavior coefficient). However,
among older adults, friendliness rather than fun becomes a
key driver of patient views. We recommend doctors
consider the relative importance of fun versus friendliness,
being more upbeat and fun with younger (and healthy)
patients, and perhaps ‘mellowing’ this behavior to a
friendly stance when working with older adults. We also
suggest doctors demonstrate listening, again particularly
for older adults, as we found listening to be the strongest
driver of patient views among these subjects (i.e., the 5.496
coefficient in Table 6), and as reported via one sample
quote in Table 3, “Listen to your patient. I know you are
busy but take some time and empathize with them.
Sometimes you are the only outside person they see. We
already know that you are a good professional - be a good
human too.”
Limitations
Our work has several limitations that are important to
recognize. First, patient satisfaction with the healthcare
system is essential, and doctor behaviors are only one type
of factor that affects this broader satisfaction. Other
drivers of patient satisfaction include issues such as the
Table 6. Regression results comparing younger adults (left) to older adults (right)
Younger adult sample only. Dependent variable:
overall view ignoring expertise:
R2 = 0.621.
Older adult sample only. Dependent variable: overall
view ignoring expertise:
R2 = 0.749.
Behavior
Unstandardized
coefficient
p-value
(1-tailed)
Behavior
Unstandardized
coefficient
p-value (1-
tailed)
Constant
-14.985
0.010
Constant
-11.534
0.000
Fun
5.803
0.000
Listens
5.496
0.000
Not rushed
3.533
0.003
Friendly
5.339
0.000
Reviews history
3.369
0.027
Reviews history
4.738
0.000
Instructions
3.186
0.020
Long-term
2.747
0.014
Caring
2.842
0.046
Seeks my input
2.204
0.024
Protects privacy
2.667
0.046
Instructions
2.107
0.041
Doctor behaviors that impact patient satisfaction, Lilly et al.
Patient Experience Journal, Volume 10, Issue 2 – 2023 111
affordability of healthcare,50 the likeability of the
receptionist and other support staff members, the
convenience of the healthcare provider’s location,22
whether patients can access their information from a
smartphone,23 appointment reminders,26 and even the
quality of bed linen.10 We view our focus on doctor
behaviors as one useful area to explore, while recognizing
other areas are also important.
Second, we limited the scope of our research to standard,
in-person practices. For example, we did not ask patients
to consider online interactions with doctors, which are
becoming more common.51 Also, we did not include
doctor behaviors that are less standard, an example being
whether a doctor is “willing to use unconventional
approaches” such as herbal medicine.50
A third limitation of our study is that we used survey
measures of the patient experience. While survey measures
are commonly employed and have advantages, a wider
variety of methods can be useful in evaluating patient
experiences.52
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