We sought to identify key qualities of healthcare that influence patient appraisal of satisfaction with primary care. An Internet survey of patients was used to collect anonymous ratings of physicians on several dimensions of healthcare experiences, as well as comments about aspects of care that were excellent and those that could be improved. Qualitative data analysis was used to discern content clusters and relate them to high and low ratings of patient satisfaction. Content analysis revealed that patients perceive and value at least seven domains of healthcare in defining outstanding quality (access, communication, personality and demeanor of provider, quality of medical care processes, care continuity, quality of the healthcare facilities, and office staff. All seven were cited as reasons for rating physicians as excellent, while four domains (communication, care coordination, interpersonal skills, and barriers to access) drove negative ratings. We conclude that patient satisfaction ratings are highly influenced by a core of communication and follow-up care. Physicians who do not possess these traits will not likely attain high ratings, while having these core traits does not necessarily ensure high patient satisfaction.