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Practice Management | Jan/Feb 2024

Patient Satisfaction Does Not Equal Patient Experience

Understanding the difference between the two in refractive surgery.

About 10 years ago, I had foot surgery at a prestigious private hospital in Milan. Reflecting on my initial postoperative visit, I distinctly remember the experience from my perspective as a patient. The entrance to the registration area required navigating several steps, a challenge while on crutches. During registration, I drew a number and endured a 20-minute wait to complete the check-in and payment process. Instructions followed on how to locate the examination room. It was situated on a different floor in another wing of the hospital, thus requiring more walking. After reaching the destination, I had a lengthy wait of around 1.5 hours before finally meeting the doctor, who displayed a rather ordinary bedside manner.

During the wait, I struck up a conversation with an elderly woman who was also awaiting a postoperative appointment. My question to her was direct, “Considering I paid approximately €5,000 from my own pocket for this surgery, in addition to what my private insurance covered, why does my experience mirror that of a public hospital?” Her response was simple yet revealing: “I’ve never really given it much thought. I always assumed that paying privately guaranteed only my choice of doctor and appointment date.”

Her words struck me. As an American who has adapted to European life, I am continually astonished by the slow integration of customer service concepts into European medical practice. Years ago, when public and private hospitals offered similar technologies, choosing a doctor and a date might have sufficed. Today, however, when technological advances differ significantly among institutions and more doctors are operating in private practice, patients have more choices. Lacking the expertise to assess surgical skills critically, patients tend to judge quality based on other, more easily discernible attributes.

This shift is particularly evident in refractive surgery—both corneal and lens-based procedures. As surgical technologies have evolved and outcomes have improved, the emphasis of care has expanded beyond improving visual acuity to enhancing the overall patient experience. This raises a pertinent question: Are patient satisfaction and patient experience synonymous?

Understanding Patient Satisfaction

Understanding patient satisfaction involves recognizing it as an end result and answering questions such as the following:

  • Was the patient happy with their surgical outcome?
  • Would they recommend the surgery to others?
  • Were their expectations met?

These questions can gauge a patient’s postoperative feelings to determine if their desired outcomes were achieved. In refractive surgery, satisfaction often correlates directly with visual outcomes. A patient’s dependence on corrective lenses may be eliminated or significantly reduced, which can achieve a high level of satisfaction.

Satisfaction, however, is also shaped by the patient’s initial expectations. For instance, a patient who anticipates having 20/20 UCVA postoperatively but achieves 20/25 UCVA may be less satisfied than someone who expected 20/40 UCVA and achieves 20/25 UCVA. Similarly, a patient hoping for complete spectacle independence who needs glasses to read fine print or in low light might not view the surgery as wholly successful. Thus, effectively managing and aligning expectations preoperatively is crucial.

Although patient satisfaction offers valuable feedback, it captures only a fraction of the overall picture. Patient experience presents a more holistic approach. It reflects their journey from initial consideration of surgery to postoperative follow-up visits and beyond. Patient experience covers a broad spectrum of factors:

  • How accessible information is online;
  • Whether scheduling appointments is easy;
  • If staff is courteous and well informed;
  • Whether the costs, benefits, and risks of surgery were clearly explained;
  • How comfortable the patient was during the procedure; and
  • If postoperative care instructions were easy to comprehend and follow.

In the context of refractive surgery, the patient experience also encompasses the surgical center’s ambiance, the empathy demonstrated by the surgeon and staff, the efficiency of the visit, the thoroughness with which procedures and their benefits were explained, the clarity of the informed consent process, the timeliness of appointments, and the availability of the surgeon or staff for postoperative questions.


Patient satisfaction may indicate their happiness with the surgical outcome. Patient experience indicates whether the process was smooth and satisfying from beginning to end. Understanding the difference between the two is pivotal for several reasons.

Continuous improvement. High satisfaction levels might reflect successful surgical outcomes. Delving into the patient experience can uncover areas for improvement that satisfaction scores alone may not reveal.

Patient retention and referrals. A positive experience increases the likelihood that patients will return for future eye care and recommend the clinic or surgeon to others.

Holistic care. Emphasizing the patient experience enables clinics and surgeons to adopt a more patient-centered approach, which helps each patient feel valued, informed, and cared for throughout their health care journey.

Economic benefits. Cultivating a positive patient experience can increase patient retention and referrals. This can prove more economically advantageous for clinics than focusing solely on acquiring new patients through other channels.


Practitioners can adopt the following strategies to bridge the gap between patient satisfaction and experience effectively.

Setting expectations. Conversations are customized to each patient to illuminate the real-life value of procedures. Potential outcomes, risks, and benefits are clearly articulated to prevent postoperative dissatisfaction due to unreasonable expectations.

Feedback loops. Feedback on patient satisfaction and experience is collected routinely and used to identify areas for improvement.

Comprehensive training. From reception through postoperative appointments, all team members are aware of their crucial role in delivering an exceptional patient experience.

Personalized care. The uniqueness of each patient’s needs and concerns is acknowledged. The journey is tailored to the individual.


Foot surgery completely alleviated my pain, and I was satisfied with the outcome. My overall experience, however, left much to be desired. I believe that numerous other orthopedic surgeons in Milan are capable of delivering a similar outcome. If one could have offered more value for my investment (ie, a better patient experience), however, they would have been my preferred choice. The focus of any surgeon should not be solely on outcomes. The patient journey is equally important.

Refractive surgery patients have options regarding their care providers. We should honor their trust by delivering a personalized, individualized, and positive patient experience.

Amanda Cardwell Carones, MPH