Reviewer's report 
 Race, rank, and satisfaction in general OB/GYN clinics Title: 
 1  7 February 2005 Version: Date: 
 Mark G. Haviland Reviewer: 
Reviewer's report: 
General 
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I enjoyed and profited from reading this. I am more familiar with the general satisfaction (by 
race/ethnicity [r/e]) with health coverage and medical care literature than I am with specialty (e.g., OB-GYN) studies. I, nevertheless, have a few comments and questions. 
There is a fair amount of literature on health care satisfaction by r/e. You review little of this in the 
intro. I’d have guessed that you could have formulated several hypotheses in advance. (I expected, at the very least, that you’d link your findings to the literature in the discussion.) 
By and large, researchers can account for only a very small percentage of variance in global 
satisfaction measures. 
Dependent variable. Collapsing very satisfied and satisfied into a category named very satisfied does 
not seem reasonable to me. 
Relation does not appear in Tables 1 or 2. 
Rank. Do you have any data on problem type? Are higher ranking individuals/family members 
seeking help for different kinds of problems than lower ranking individuals? Different desires/expectations? Lower ranking individuals wishing for time off, medical “excuses,” presenting 
with vague symptoms/no physical findings (chronic pelvic pain)? 
Most of my experience is with (so-called) continuous satisfaction measures, so it’s hard for me to 
judge the level of satisfaction (compared to other reports). Despite my limits, I’d say that there are 
unusually high numbers of dissatisfied patients. 
I agree that satisfaction studies could benefit from standardization. Why, however, might one choose 
for a standard a single, three-point global satisfaction item, which is then collapsed (and mis-labeled) 
into two categories? Many studies use four, five, and seven-point scales and tap both global 
satisfaction and satisfaction with various aspects of coverage and care (and ordinary least squares 
regression). Clearly, one could make a case for two-point items (and logistic regression). Could you 
give examples in which approaching satisfaction this way has likely yielded “better” results or outline 
the limits of present standards and evaluations of these standards (CAHPS based studies, both 
substantive and measurement)? 
Power analysis. My impression is that in many satisfaction studies, more troubling that insufficient 
power is the capacity to judge very small differences to be statistically significant. 
Asian American/less satisfaction. There is a growing literature that Asian American’s lower ratings 
reflect different response tendencies v. less satisfaction with care. 
You might remind readers that satisfaction measures are imperfect substitutes for technical quality 
of care. 
I’m not quite sure why you wish to promote RHIP, “… we can only note that while rank should have 
its privileges… ” Why? 
 Accept after discretionary revisions What next?: 
 An article whose findings are important to those with closely related research Level of interest: 
interests 
 Acceptable Quality of written English: 
 No Statistical review: 
Declaration of competing interests: 
I declare that I have no competing interests.