The definition of various aspects of decision making by Coulton and colleagues provides a framework for analysis of the characteristics and barriers to decision making. The emphasis in these aspects is on whether the patient has sufficient time, information, support and freedom from pressure and anxiety to promote effective decision making. In addition it is proposed that the same limitations on decision making by the patient have an impact on the social work intervention. It is suggested that where there is inhibition to the decision making process and when disagreements occur the social work intervention takes more time, including time in direct work with patient and family, time in consultation with hospital colleagues and time in supervision. Patient satisfaction with services given is often used as a measure of the quality of services. In health services satisfaction studies there is a general trend towards positive findings.