To measure the overall satisfaction of patients attending the dermatology service (in-person) at two healthcare institutions with postgraduate dermatology training in Bogotá during the period from November 1, 2024, to April 16, 2025.

1) To describe the sociodemographic characteristics of patients attended in the outpatient dermatology service (in-person) at two healthcare institutions in terms of age, gender, education level, residence, socioeconomic status, health insurance affiliation, type of consult, and recruitment site. 2) To describe the characteristics of the outpatient dermatology service points of care (in-person) at two healthcare institutions in terms of availability of restrooms and examination gowns in the doctor’s office, personnel present during care, and specialists’ attire. 3) To quantify the prevalence of overall satisfaction and the different domains of satisfaction among patients attended in the outpatient dermatology service (in-person) at two healthcare institutions in terms of interaction with the physician, verbal language, non-verbal language, waiting times, privacy, teaching activities, and infrastructure. 4) To identify the aspects with the highest and lowest satisfaction levels within the evaluated domains among patients attended in the outpatient dermatology service (in-person) at two healthcare institutions. 5) To compare sociodemographic characteristics, consult aspects, and evaluate domains according to patient satisfaction among those attended in the outpatient dermatology service (in-person) at two healthcare institutions. 6) To determine the association between sociodemographic characteristics, consultation aspects, and evaluated domains with the overall satisfaction level of patients attended in the outpatient dermatology service (in-person) at two healthcare institutions. 7) To propose strategies to improve patient satisfaction levels in the outpatient dermatology service (in-person) at two healthcare institutions.

For descriptive analysis of qualitative variables, absolute frequencies and percentages will be used. For quantitative variables, measures of central tendency will be applied according to normality tests for each variable unless the sample size exceeds 30, in which case a normal distribution will be assumed, and the mean and standard deviation will be reported.

For bivariate analysis, two cohorts will be formed based on overall patient satisfaction: Satisfied (Overall satisfaction = Very satisfied or satisfied) and Not satisfied (Overall satisfaction = Neutral, Dissatisfied, Very dissatisfied). To analyze differences between groups for qualitative variables (gender, education, residence, socioeconomic status, health insurance affiliation, consult type, recruitment site, service point characteristics, and satisfaction domains), Chi-Square or Fisher’s exact test will be applied, depending on sample size adequacy. For quantitative variables (age, number of persons in the doctor’s office), Student’s t-test or Mann-Whitney U test will be used based on normality tests, unless normality is assumed due to sample size, in which case only Student’s t-test will be used.

To identify factors associated with overall satisfaction, a multivariate logistic regression model will be built, with the number of predictors depending on the number of events in each satisfaction category. For this analysis, satisfaction-related variables will be dichotomized as “Satisfied” (including Very satisfied or Satisfied responses) and “Not Satisfied” (Neutral, Dissatisfied, Very dissatisfied). Initially, univariate logistic regression will estimate crude Odds Ratios (ORs) for each variable. Variables meeting significance criteria will be selected as candidates for the multivariate model, which will be adjusted by backward selection.

A p-value less than 0.05 will be considered statistically significant. Analyses will be performed using R software (version 4.5.0) and RStudio.

According to Resolution 8430 of 1993, this research is considered minimal risk as it involves only the completion of a survey.7 The ethical principles of respect, beneficence, justice, and protection of human dignity will be observed.

To maintain participant confidentiality and ensure proper data handling, the following measures will be taken: data will be collected and stored on the REDCap platform, which offers a high level of security and is specifically designed for managing sensitive data in clinical and biomedical research. REDCap anonymizes the database by assigning a numeric code to each patient to protect confidentiality during statistical analysis. It also keeps a reversible coding record linking the survey responses to the informed consent to allow data validation if needed. Dissemination of study results will use anonymized data to protect patient confidentiality. This study was conducted after obtaining approval from the Institutional Ethics Committees of Hospital Universitario San Ignacio and Hospital Universitario La Samaritana. STROBE statement adherence points have been respected in the study design.

Patients were divided in two groups according to satisfaction: Satisfaction group = 396 (Very satisfied and Satisfied) vs. No satisfaction group = 41 (Neutral, Unsatisfied, Highly unsatisfied). There were no differences in sociodemographic characteristics between groups, but there were statistically significant differences (p < 0.001) across all the domains. In the satisfied group, the aspects with the highest proportion of high satisfaction were physician behavior (336 [75.5%]), medical history-taking (333 [75.3%]), and physical examination (323 [72.7%]). Among unsatisfied patients, the highest satisfaction was related to the physician's self-introduction with name and title (17 [41.5%]), while the highest levels of dissatisfaction were related to bedside manner, physical examination, and medical interview. Approximately one-third of patients in this group reported high dissatisfaction with the physician's tone of voice (2 [4.1%]), not use of a white lab coat (14 [34.1%]), body language (13 [31.7%]), and the appointment scheduling process (13 [31.7%]). Less than half of the group (190 [43.5%] were highly satisfied with the clinical photographs, waiting room comfort, and the presence of students during medical interview (Table 2).

In the univariate logistic regression analysis, all variables were associated with overall satisfaction (p < 0.05). The final model (adjusted using backward selection) retained the variables with the strongest associations and clinical relevance.

After adjusting for the variables with the highest statistical significance, unsatisfactory bedside manner and the presence of students during medical interview decreased the likelihood of overall satisfaction (aOR = 0.01 [95% CI 0.00–0.04], p < 0.001; aOR = 0.13 [95% CI 0.04–0.42], p < 0.001, respectively). Likewise, specialists not using a white lab coat reduced the probability of satisfaction (aOR = 0.06 [95% CI 0.02–0.25], p < 0.001).

In conclusion, the probability of overall satisfaction was 39.82% when there was appropriate bedside manner, comfort during the physical examination, no students present in the doctor’s office, and the specialist wore a medical gown (Table 3).

The model showed good explanatory power (R2 = 0.52). The Hosmer-Lemeshow goodness-of-fit test could not be adequately calculated, possibly due to limitations in the number of observations.

Bedside manner was one of the best-rated aspects. Dissatisfaction with bedside manner (even when the patient is comfortable during physical exam, there is no students present, and the physician wears a white lab coat) reduced the likelihood of overall satisfaction by 99% (aOR = 0.01 [95% CI 0.00–0.04], p < 0.001). It has already been established that respect, empathy, and effective communication between physician and patient are central elements in building patient satisfaction.16,17

On the other hand, negative communication in the hospital environment, manifested as Rudeness, Disdain, and Aggression (RDA), is a recognized problem in healthcare systems that increases levels of stress, depression, and the intention to leave the profession among healthcare workers. It has also been associated with worse clinical outcomes, including mortality.18 Approximately 40% of physicians report that RDA significantly affects their workday, and 7% commit clinical errors for this reason, which can negatively impact patient satisfaction.16

Disrespectful behavior reduces the likelihood that patients will voice their concerns, ask questions, or even share relevant information. Poor communication skills reduce the probability that patients will understand the information and feel satisfied with the bedside manner.17

The hospital environment also affects physician behavior, especially since there is an institutional tendency to ignore problems of frustration, poor communication, and disrespect among healthcare professionals.18,19 These issues often occur in high-stress settings that can increase individual feelings of anxiety, insecurity, depression, aggression, narcissism, and even trigger a “survival mode” response that reduces empathy.16

Voice tone had the lowest percentage of high satisfaction (214 [49%]), and speech speed, although minimal, was the most dissatisfying component in this domain (17 [3.9%]). Previous studies have reported that physicians who speak quickly may convey more information, demonstrate attentiveness and care toward the patient, and even appear more persuasive, which is generally perceived as a positive factor in patient satisfaction (p < 0.01). It has also been shown that high-pitched tones reduce patient satisfaction (p < 0.001). However, both tone and speech speed become less relevant when the physician possesses strong professional credentials (degrees, academic training, recognized employment, etc.).21 Dissatisfaction with the professional's self-introduction with name and title was zero, compared to 66% (289) of patients who reported being highly satisfied in this area.

Non-verbal language was rated positively (272 [62.2%]). This aspect is positively associated with patients' sense of well-being, self-esteem, and social processes, even in the absence of other comfort strategies.22 Gestures such as nodding, maintaining eye contact, eyebrow movements, as well as the amount and location of physical contact, also influence patient satisfaction. However, in the present study, only the absence of a white lab coat had a significant impact on satisfaction, reducing its likelihood by 93.7% (aOR = 0.06 [95% CI 0.02–0.25], p < 0.001).23

There was an adequate level of satisfaction with the 20-minute consult (246 [56.3%]). Previous studies have reported satisfaction rates as high as 74% with consults lasting as little as 12.1 minutes (p < 0.001, r = 0.38), with a 0.04-point increase in satisfaction for each additional minute of consult time (p = 0.001 [95% CI 0.01–0.06]).24 A positive association has also been found in consultation lasting 9.85 ± 0.37 minutes (p = 0.005).

Efficient administrative processes ‒ such as fast appointment scheduling, quick billing procedures, and effective communication with administrative staff ‒ have been shown to increase patient satisfaction by 3.58 times (aOR = 3.59 [95% CI 2.36–5.42], p < 0.001).25 Although waiting time typically impacts overall satisfaction, in this study population, it was not statistically significant. Despite average waiting times of up to 64 minutes, 57% of patients reported being satisfied (p = 0.001).

Less than 50% (190) of patients reported being satisfied with privacy during the medical photographs. In the literature, most patients (79.2%) report satisfaction with medical photography, and many express contentment in contributing to research, particularly when institutional cameras are used. Taking photos with smartphones may cause distrust and be perceived as unprofessional, although one study reported a 79% acceptance rate for smartphone photography.26

Privacy can influence a patient's decision to allow physical examination or to share relevant information. In one study, 10% of patients declined a physical examination due to privacy concerns; closing doors or providing curtained areas increased the perceived privacy from 21% to 89%.27

The participation of students during the clinical interview decreased the likelihood of overall patient satisfaction by 87% (aOR = 0.13 [95% CI 0.04–0.42], p < 0.001). In the review by Mol et al. (2011), the presence of students did not affect patient satisfaction and was actually associated with benefits such as longer consult times, more thorough examinations, and improved patient education.28 Other studies have shown that patients report greater satisfaction when students are present, as they feel altruistic and believe they are contributing to the students’ education.28

Since the presence of students can limit a patient's willingness to share intimate or emotional issues, this may have influenced these results, particularly considering that many dermatological conditions are associated with feelings of stigmatization or embarrassment, often related to the anatomical location of the lesions.27

Paradoxically, discomfort during the physical examination was associated with a higher probability of overall satisfaction (aOR = 25.76 [95% CI 4.46–190.04], p = 0.001). Although this association may reflect a real phenomenon ‒ for example, that patients perceive thorough, uncomfortable examinations as indicators of careful medical attention ‒ it could also result from reporting bias or the limitations of sample size. Another possibility is that under conditions involving respectful bedside manner, presence of a physician wearing a white lab coat, and absence of students, discomfort becomes less relevant.

In patients with disabilities, studies have shown that 27% are not examined on the doctor’s office table, which is associated with a lower likelihood of rating the physician’s care and work positively (59% and 39%, respectively).29

The size of the doctor’s office is related to the patient’s sense of privacy; small spaces where patients can overhear other conversations reduce satisfaction from 36% to 14%.

An important strength of this study is that it evaluates a wide variety of aspects related to healthcare, providing a comprehensive context to understand this phenomenon. Additionally, the parameters of the multivariate regression model were adequate, suggesting that the variables used can discriminate between satisfied and dissatisfied patients.

However, several limitations must be considered, such as the cross-sectional nature of the study, which prevents establishing causal relationships. It is important to note that the measurement of satisfaction is subject to social biases, and the factors impacting it vary considerably across populations. For this reason, unusual outcomes, such as discomfort during physical exam, require verification through additional analyses, ideally using hierarchical models or sensitivity analyses.

Another limitation common to all studies evaluating satisfaction is the complexity of analyzing all possible factors related to satisfaction and appropriately measuring them to avoid collinearity issues. It is important to include aspects related to technology (virtual appointment scheduling, scheduling methods, preferred contact methods, use of medical instruments during consult, etc.), which are increasingly common in medical practice.

Analytical studies are recommended to assess the direction of causal relationships, as well as qualitative analyses to explore patients' subjective perceptions in depth, and even more so, experimental evaluations of educational interventions aimed at improving the relational competencies of physicians and students.