Thank you to Dr Whelan and colleagues for their constructive comments ^{Reference Whelan, Reddy and Andrews1} regarding the patient satisfaction scale, PatSat. ^{Reference Hansen, Vincent, Harris, David, Surafudheen and Kingdon2} The idea for this scale sprung from years of using home-made scales for the yearly appraisal in a flawed attempt to measure the individual doctor's performance in the eyes of the patient. PatSat is therefore uniquely focused on the relationship between the clinician and the individual patient.

As Whelan et al correctly point out, the patient/doctor relationship is only a part of a patient's overall satisfaction with the service, but PatSat provides an evidence-based fundament for the individual clinician to learn about the relative strengths and weaknesses of his or her practice. The idea is that the clinician then can, through supervision, target areas that need further improvement and build on his or her stronger points.

Whelan and colleagues also allude to the importance of treatment outcome and its possible relationship with patient satisfaction. In spite of inherent problems with patient satisfaction questionnaires, such as the ‘ceiling effect’ (patients often scoring their clinician at the very high end of the spectrum) and poor response rates, the majority of the existing literature on this issue points to a strong correlation between outcome and patient satisfaction, especially with the individual clinician. ^{Reference Day, Bentall, Roberts, Randall, Rogers and Cattell3}

The next step would be to investigate the correlation between commonly used, validated rating scales, e.g. the Hamilton Rating Scale for Depression (HRSD) and the Positive and Negative Syndrome Scale (PANSS), and patient satisfaction. In the PatSat scale the clinician has a direct way of testing and re-testing his or her personal impact on patients and the hope is therefore that this will provide an important avenue to improving outcomes for patients.