This study provides a comprehensive analysis of service quality and empathy dimensions within Primary Health Centres (PHCs) in Kerala, India, to evaluate their impact on patient satisfaction. Using a descriptive and analytical research approach, primary data were collected from 400 patients across three districts—Malappuram, Ernakulam, and Thiruvananthapuram—using a stratified multi-stage sampling method. The study assesses critical service quality dimensions, including Tangibility, Reliability, Responsiveness, Assurance, Empathy, Accessibility, Communication, and Safety and Security. Statistical analysis reveals that empathy, a key driver of patient satisfaction, significantly shapes healthcare experiences alongside other dimensions like Accessibility and Safety. Demographic factors such as age, gender, and socio-economic status were found to influence patient perceptions, highlighting the need for tailored healthcare approaches. The findings underscore systemic challenges like infrastructure limitations, inconsistent grievance mechanisms, and inadequate provider-patient communication. Positive outcomes, including well-maintained facilities and competent staff, are offset by operational inefficiencies in service delivery. To address these gaps, the study recommends targeted interventions, including enhanced training in interpersonal skills, technological modernization, and strategies to improve Responsiveness, Assurance, and Empathy. This research contributes valuable insights into the strengths and weaknesses of Kerala’s PHCs, offering actionable recommendations for policymakers and healthcare administrators to enhance patient-centered care. By bridging critical gaps, PHCs can better align with India’s broader equitable and high-quality healthcare goals. Future studies could expand the scope to explore the qualitative perspectives of healthcare providers and assess the impact of proposed interventions on patient satisfaction.