Pressure is increasing on health care providers in the UK to demonstrate that they incorporate the views of users when planning and evaluating services. Most recently this has been seen in the commissioning of the National Patients' Experiences Survey. It is timely therefore to review the progress that has been made in trying to access the user's perspective. The aim of this paper is to assist individual service providers in planning their own strategy of user involvement and evaluation, based on an awareness of the current state of knowledge in this area. It reviews the results of research in the field of patient satisfaction over the last 20 years; summarises the main problems in the area, and suggests ways forward. Three main points emerge: the importance of developing and substantiating theory in this field to support study design; the need to exercise care if using quantitative methods and global satisfaction scores, until the process of evaluation is better understood, and the need to consider how a sensitive user-led agenda can be developed. The paper calls for a pause for reflection on the reason for our inquiry into user opinion, and for careful consideration of how we might best design studies to obtain information to fulfil this inquiry.