Introduction This study aims at assessing the level of patient communication satisfaction and its impact on patient adherence among public hospitals in Ethiopia. Methods The study employed a cross-sectional design. Data were obtained using Communication Assessment Tool (CAT) and the Adherence to Refills and Medication Scale (ARMS) administered to 381 patients asking them to evaluate satisfaction with physician-patient communication and report their level of adherence respectively. Both descriptive and inferential statistics were computed. Accordingly, the study used correlation, independent samples t -test, one-way ANOVA, and linear regression to show causal relationships among factors in physician-patient communication and their effect on adherence. Results The findings revealed that the total mean score for communication satisfaction was M = 2.69, showing that the majority of participants were dissatisfied with the physician-patient communication. Further, age and frequency of visits were significantly associated with communication satisfaction, while sex, place of residence, employment, educational level, and marital status failed to produce a systematic effect. The correlation between patient satisfaction with communication scores on the CAT questionnaire was significantly correlated with pharmaceutical adherence (ARMS score) (r = 0.316, p < 0.001), indicating that when patients were satisfied with communication, the level of adherence increased. The regression coefficient also showed that positive relationship was found between communication satisfaction and adherence (b = 1.85, t = 9.759, p < 0.05), indicating that with better quality of communication, the level of adherence also increased. Conclusion The majority of participants were found to be dissatisfied with the physician-patient communication. The more satisfied the patient is with communication the better their adherence.