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November 2020 Volume 4 Issue 6

RESEARCH LETTERS

Factors Influencing Patient Satisfaction in Dermatology

Abigail Cline, PhD, MD1, Tamar Gomolin, BSc2, Bijan Safai, MD1

1Department of Dermatology, New York Medical College School of Medicine, New York, NY
2New York Medical College School of Medicine, Valhalla, NY

Enhancing patient experience and
engagement may improve clinical
outcomes.1 Patient satisfaction often serves
as a proxy for quality of medicine, with
physicians evaluated and reimbursed based

on patient satisfaction scores. In the field of
dermatology, patient satisfaction plays a
very important role since traditional markers
of quality, such as mortality and hospital
readmission rates, are not reasonable
measures of patient care. Patient
satisfaction scores are one of the most
accessible markers insurance companies

ABSTRACT

Background: Patient satisfaction is a proxy for healthcare quality, with physicians evaluated and
reimbursed based on patient satisfaction scores. Despite the growing influence of patient satisfaction,
factors that impact patient satisfaction in dermatology remain unclear.

Methods: We analyzed 225 responses to an online survey evaluating patient expectations,
willingness, and satisfaction regarding dermatology appointments. Patient willingness and satisfaction
were measured on a 1-5 Likert scale.

Results: Respondents were most willing to discuss their condition and to be examined with a
dermatoscope. Respondents were least willing to wear a patient gown without underwear and to be
photographed. Highly satisfying factors included a written treatment plan, provider medication
recommendations, and use of gloves during physical exams. Highly dissatisfying factors included
waiting 60 minutes, taking off underwear with a patient gown, and being photographed with a
cellphone.

Patient willingness and satisfaction differed significantly by gender and age. Male respondents
reported less satisfaction than female respondents if a nurse explained the treatment plan. Older
respondents were significantly more willing to change into a patient gown, to be photographed, to be
examined with a dermatoscope, and to undergo a biopsy than younger respondents. Older and
female respondents preferred written plans, wh ile younger and male respondents preferred verbal
plans. Younger respondents reported higher satisfaction with an email follow-up compared to older
respondents, who preferred a phone call.

Conclusion: These findings may represent relatively easy ways to improve patient satisfaction
scores. Further insight into factors affecting patient satisfaction may enhance patient experience and
engagement, thereby improving clinical outcomes.

INTRODUCTION

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and prospective patients can use to evaluate
dermatologists. The field of dermatology
recognizes the importance of patient
satisfaction, with the American Board of
Dermatology encouraging the collection of
patient satisfaction survey data during the
Maintenance of Certification process.2

Despite the growing research in patients’
perceptions of their visits, factors that
enhance patient satisfaction remain unclear.
While one study found that a patient’s
perception of the character of the physician
directly affects patient satisfaction scores,
others have found that environmental factors
such as the physician spending a few more
minutes with the patient and even the
physician sitting down when talking to
patients, were relatively easy ways to
improve satisfaction scores.3-6 However,
many of these previous studies were limited
by their research methods. One was limited
to online patient reviews, which may select
towards very positive or negative opinions.4
Others were limited to reviews concerning
only one dermatology clinic or one hospital
system.5,6

The goal of this study is evaluate factors
related to patient satisfaction with
dermatology clinic appointments.
Respondents completed a survey assessing
patient expectations, willingness, and
satisfaction regarding dermatology
appointments. To objectively understand
factors affecting patient satisfaction,
respondents were surveyed independent of
their dermatological care using an online
survey platform.

After institutional review board approval, an
online survey was distributed to individuals
older than 18 years-of-age who reported

having seen a dermatologist within the past
year and having a working knowledge of
English. Overall, 225 participants completed
the survey via REDcap (Nashville, TN), after
recruitment through Amazon's Mechanical
Turk (Amazon, Seattle, WA), an online
crowdsourcing platform extensively used by
psychologists for participant recruitment.7
The survey evaluated patient satisfaction
using a 1 (no satisfaction) to 5 (a lot of
satisfaction) Likert scale. Results were
analyzed overall, by age (18-39 years old
versus 40 and older), and by gender (female
versus male). Statistics included χ2 tests and
Student’s t-tests.

A total of 225 subjects completed the survey
(Table 1). Results were analyzed overall,
and by demographic groups, including age
(18-39 years old versus 40 and older) and
gender (female versus male). Overall,
satisfaction declined with longer wait times
(p<0.001), changing into a patient gown
before meeting the dermatologist (p<0.001),
and removing underwear (p<0.001) (Table
1). Older patients preferred changing into a
gown before meeting the dermatologist,
while younger patients preferred the
dermatologist to present them with the
choice to wear a gown (p<0.05). Older
patients also showed a strong preference
toward keeping underwear on compared to
younger patients (p<0.05). Female patients
preferred to be given the choice whether to
change into a gown (p<0.05) and to keep
underwear on (p<0.001) as compared to
male patients.

Satisfaction was higher with use of gloves
as compared to bare hands (p<0.001) and
with taking pictures using a camera as
compared to a cellphone (p<0.001) (Table
1). Older respondents reported higher
satisfaction with whole body examination

METHODS

RESULTS

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Table 1. Factors Related Patient Satisfaction Before, During, and After the Clinic Visit

Satisfaction Factors Before the Visit

Overall
(n=225)

Age 18-39
(n=152)

Age >40
(n=73)

Female
(n=140)

Male
(n=85)

10 min wait 3.0* 3.0 3.0 3.1 3.0

30 min wait 1.9* 1.9 1.8 1.9 1.9

60 min wait 1.5* 1.5 1.3 1.5 1.5

Putting on patient gown before meeting the
dermatologist

2.7 2.6* 2.9* 2.8 2.7

Patient decides whether to put on patient gown 3.7* 3.7 3.7 3.8* 3.5*

Keeping underwear on with patient gown 3.7* 3.6* 3.9* 3.9* 3.3*

Removing underwear with patient gown 2.0 2.1 1.9 2.0 2.2

Satisfaction Factors During the Visit
Overall Age 18-39 Age >40 Female Male

Examining only the area of concern 3.4 3.5* 3.2* 3.3 3.5

Examining the whole body 3.3 3.2* 3.6* 3.4 3.2

Touching the skin with bare hands 2.4* 2.3 2.5 2.3 2.5

Touching the skin with gloves 4.0* 3.9 4.1 4.0 3.9

Examining with dermatoscope 3.9 3.7* 4.1* 3.9 3.9

Taking pictures with cellphone 2.1* 2.3* 1.9* 2.0* 2.3*

Taking pictures with camera 3.3* 3.2* 3.6* 3.4 3.3

Performing a skin biopsy 3.5 3.4* 3.8* 3.6 3.4

Satisfaction Factors After the Visit
Overall Age 18-39 Age >40 Female Male

Patient medication recommendations 3.8* 3.8 3.8 3.8 3.6

Physician medication recommendations 4.1* 4.0* 4.3* 4.2 4.0

Verbal treatment plan 4.3 4.2* 4.5* 4.3 4.2

Written treatment plan 4.3 4.2* 4.5* 4.3 4.2

Scheduled follow-up 3.9* 3.8* 4.1* 4.0* 3.8*

Follow-up as needed 3.4* 3.5* 3.2* 3.3 3.6

Calling the patient after the appointment 3.9 3.8 4.0 3.9 3.8

Emailing the patient after the appointment 3.9 4.0 3.8 4.0 3.8

(p<0.01), use of dermatoscope (p<0.05),
and skin biopsies as compared to younger
ones (p<0.05). Younger patients reported
higher satisfaction having only the area of
concern examined (p<0.05) and having
pictures taken with a cellphone (p<0.05) as
compared to older patients. Male
respondents reported higher satisfaction
with having pictures taken with a cellphone
as compared to female respondents
(p<0.05).

Satisfaction was higher when physicians
presented definitive medication
recommendations as compared to offering
patients a range of medication options
(p<0.001) and was higher when follow-ups
were scheduled in advance as compared to
being left to occur as needed (p<0.001)
(Table 1). Older respondents preferred
verbal (p<0.05) and written (p<0.01)
instructions, and scheduled follow-ups
(p<0.05) as compared to younger patients.
Younger respondents preferred scheduling a

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follow-up as needed (p<0.05). Female
patients preferred scheduled follow-ups
(p<0.05) as compared to male patients.

Overall, the highest satisfying factors
included verbal instructions, written
instructions, and definitive medication
recommendations. Factors rated as the
most satisfying differed by age and gender.
Older and female patients preferred written
instructions, while younger and male
respondents preferred verbal instructions.
Factors related to dissatisfaction did not
differ by age or gender. Factors related to
dissatisfaction included long wait times,
underwear removal, pictures taken using a
cellphone, and use of bare hands during the
exam.

These results may elucidate relatively
simple ways to improve patient satisfaction
scores. Patient satisfaction differed
significantly by gender and age, thereby
making it more difficult to implement general
measures for quality improvement.
Limitations of this study include the potential
for sampling bias associated with the use of
an online survey sample. Nonetheless, this
study does overcome common limitations of
previous research: the data is not
constrained to self-selected online patient
reviews, the results are not limited to one
dermatological clinic or hospital system, and
patients are not being surveyed immediately
after appointments, where added pressure
can affect responses.5,6,8

Taking these findings in a holistic way may
shed light on broader principles that
clinicians can apply in myriad heretofore
undiscussed areas of their practice. It is
important to realize that these preferences
do not exist as isolated data points, but as
markers illustrating broader trends in patient

desires. For example, the universal
preferences for photography using a
dedicated camera rather than a cellphone
and for a physician’s use of gloves are both
consistent with a patient desire for an
encounter that is more formal than casual.
Similarly, the clear preference patients have
against removing underwear is consistent
with feelings of physical and psychological
vulnerability that is oft discussed by medical
ethicists, but perhaps not adequately
addressed by practitioners. The cognizant
physician may then extrapolate from this to
find other things in the examination or
treatment routine that may be improved
upon.

By contrast, the marked differences relating
to how treatment plans are communicated
are illustrative of the very real and significant
differences in preferred communication
styles that other disciplines have long
recognized.9 It is perhaps of less
significance exactly which demographic
groups showed which preferences, than it is
that such variation in preferences exists,
affects satisfaction, and ought to be
accommodated.

These findings point to relatively easy ways
to improve patient satisfaction scores.
Although, the influence of patient experience
on overall quality of care is complex and
context-dependent, improvements in this
realm can be made without jeopardizing
other measures of quality. Dermatologists
can implement these straightforward
changes to enhance patient experience, with
the goal of improving clinical outcomes.

Conflict of Interest Disclosures: None

Funding: None

DISCUSSION

CONCLUSION

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November 2020 Volume 4 Issue 6

Corresponding Author:
Abigail Cline, PhD, MD
Department of Dermatology
Metropolitan Hospital
1901 First Avenue
New York, NY 10029
Phone: 336-671-9027
Email: aecline25@gmail.com

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https://www.abderm.org/diplomates/fulfilling-moc-requirements/moc-requirements.aspx#SA
https://www.abderm.org/diplomates/fulfilling-moc-requirements/moc-requirements.aspx#SA