Editorial Commentary: Causes of Patient Dissatisfaction May Be Modifiable

Adapting Tolstoy, "Satisfied patients are all alike; every dissatisfied patient is dissatisfied in their own way." We need to learn the reasons why patients are dissatisfied. Whereas happy patients receive the same procedures for similar indications as unhappy patients, evidence supports a clear association between negative psychological function and worse preoperative and postoperative patient-reported outcome measures. Thus, the unhappy patient might be where we can make most improvement in patient care. The first step could be to standardize reasons for patient displeasure, such as adverse events, poor patient-reported outcomes, failure to meet the patient acceptable symptomatic state, failure to return to sport or work at the same level, or failure to meet patient's expectations. Next, when possible, modifiable factors should be addressed preoperatively. Next, we should evaluate whether addressing modifiable factors (i.e., depression or smoking) improves outcome. Clinicians should be mindful of patient psychosocial and refer for treatment of modifiable factors when possible.