Purpose ' This paper aims to review the patient satisfaction literature, specifically meta-analyses, which critically analyses its theory and use; then to present evidence for perceived service quality as a separate and more advanced construct. Design/methodology/approach ' Papers that judiciously review the development and application of patient satisfaction were identified; along with studies addressing the conceptual and methodological deficiencies associated with the concept; and the current perceived service quality theory. Findings ' Patient satisfaction has been extensively studied and considerable effort has gone into developing survey instruments to measure it. However, most reviews have been critical of its use, since there is rarely any theoretical or conceptual development of the patient satisfaction concept. The construct has little standardisation, low reliability and uncertain validity. It continues to be used interchangeably with, and as a proxy for, perceived service quality, which is a conceptually different and superior construct. Practical implications ' The persistent use of patient satisfaction to evaluate the client's perception of the quality of a health service is seriously flawed. The key to solving this dilemma may be for the healthcare sector to focus on perceived health service quality by considering the specific concepts and models that can be found in the services marketing literature. This literature offers more advanced consumer theories which are better differentiated and tested than existing healthcare satisfaction models. Originality/value ' The paper points out that there is an urgent need for differentiation and standardisation of satisfaction and service quality definitions and constructs, and argues for research to focus on measuring perceived health service quality.