In a move towards a more informed understanding of the concept of satisfaction, this paper aims to explore how 30 dermatology patients describe what it meant to them to be either satisfied or very satisfied with their healthcare. This was undertaken using in-depth interviews and the findings suggest that participants clearly differentiated between being satisfied or very satisfied with healthcare. While for some participants, being satisfied with healthcare was described in terms of care being adequate or average, for others it meant that there were aspects of healthcare that could be improved, or that something was missing and that optimal care was not achieved. Care and management had been 'acceptable' or 'sufficient' but not 'outstanding.' In contrast, being very satisfied with particular aspects of healthcare was described in ways that suggested that the service was not only more than adequate, but ranged from 'better than average' to 'outstanding', i.e. optimal care had been provided. This observation of a 'continuum of satisfaction' has specific and important implications for the future analysis and presentation of patient satisfaction surveys. It is suggested that attention to the differences between the two constructs provides a useful means to highlighting areas of patient concern and that researchers reporting the results of patient satisfaction surveys should cease to collapse them.