Journal of General Internal Medicine

, Volume 17, Issue 11, pp 817–824

Unmet expectations for care and the patient-physician relationship

  • Robert A. Bell
  • Richard L. Kravitz
  • David Thom
  • Edward Krupat
  • Rahman Azari
Original Articles

DOI: 10.1046/j.1525-1497.2002.10319.x

Cite this article as:
Bell, R.A., Kravitz, R.L., Thom, D. et al. J GEN INTERN MED (2002) 17: 817. doi:10.1046/j.1525-1497.2002.10319.x


OBJECTIVE: To profile patients likely to have unmet expectations for care, examine the effects of such expectations, and investigate how physicians’ responses to patients’ requests affect the development of unfulfilled expectations.

DESIGN: Patient and physician questionnaires were administered before and after outpatient visits. A follow-up telephone survey was administered 2 weeks post visit.

SETTING: The offices of 45 family practice, internal medicine, and cardiology physicians.

PATIENTS: Nine hundred nine adults reporting a health problem or concern.

MEASUREMENTS AND MAIN RESULTS: Before their visits, patients rated their general health and trust in the index physician. After the visit, patients reported upon 8 types of unmet expectations and any request they made. Two weeks thereafter, patients rated their visit satisfaction, improvement, and intention to adhere to the physician’s advice. They also reported any postvisit health system contacts. Overall, 11.6% of patients reported ≥1 unmet expectation. Visits in which a patient held an unmet expectation were rated by physicians as less satisfying and more effortful. At follow-up, patients who perceived an unmet expectation for care also reported less satisfaction with their visits, less improvement, and weaker intentions to adhere. Patients with an unmet expectation related to clinical resource allocation had more postvisit health system contacts. Unmet expectations were typically reported by a patient whose request for a resource was not fulfilled.

CONCLUSIONS: Unmet expectations adversely affect patients and physicians alike. Physicians’ nonfulfillment of patients’ requests plays a significant role in patients’ beliefs that their physicians did not meet their expectations for care.

Key words

unmet expectationsresidual expectationspatient satisfactionadherencephysician-patient communication

Copyright information

© Society of General Internal Medicine 2002

Authors and Affiliations

  • Robert A. Bell
    • 1
  • Richard L. Kravitz
    • 2
  • David Thom
    • 3
  • Edward Krupat
    • 4
  • Rahman Azari
    • 5
  1. 1.Received from the Department of CommunicationUniversity of California-DavisDavis
  2. 2.U.C. Davis Center for Health Services Research in Primary CareUniversity of California-Davis Medical CenterSacramento
  3. 3.the Division of Family and Community MedicineStanford University Medical SchoolPalo Alto
  4. 4.Massachusetts College of Pharmacy and Health SciencesBoston
  5. 5.the Department of Statistics, and the U.C.D. Center for Health Services Research in Primary CareUniversity of California-DavisDavis