In a patient population with serious, debilitating chronic disease, the present study tested the hypothesis that a significant amount of variance in patient satisfaction ratings of provider behavior would be explained by patients' current assessment of their health and their social circumstances. More favorable patient ratings of the art, technical quality and efficacy of their care givers were found to be significantly associated with more positive general health perceptions, fewer days spent in bed due to health problems and lower scores on a widely used depression scale, as well as with age and ethnic background. These data provide evidence indicating that patient satisfaction measures are sensitive to and confounded by patients' perceived health, view of life and social circumstances. It is suggested that if patient satisfaction ratings are to be used as indicators of the quality of health care delivery, there is a need to account for the variance attributable to measurable psychological, social and demographic factors.