Advertisement

Journal of General Internal Medicine

, Volume 9, Issue 2, pp 75–81 | Cite as

Internal medicine patients’ expectations for care during office visits

  • Richard L. Kravitz
  • Dennis W. Cope
  • Vinni Bhrany
  • Barbara Leake
Original Articles

Abstract

Objective: To describe internal medicine patients’ expectations for care during office visits and to examine the relationship between fulfillment of expectations for care and visit satisfaction.

Design: Survey of patients and their physicians.

Setting: The internal medicine practice of faculty and housestaff at a large academic center in Southern California.

Patients: 396 patients aged 18 to 65 years were approached in the clinic waiting room prior to their scheduled visits; 337 (85% ) agreed to participate and 304 (77%) turned in completed questionnaires. Postvisit physician surveys were received in 88% of the cases.

Main measurements: The patients’ previsit reports of the elements of care they thought necessary for their physicians to provide; the patients’ and physicians’ postvisit reports of the elements of care actually provided; and the patients’ satisfaction with care.

Results: Among 28 specific elements of care, seven were considered necessary by a majority of the patients (examination of the eyes/ears/nose/throat, lungs, heart, and abdomen; blood testing; prognostic counseling; and discussion of patients’ own ideas about management). A higher number of elements of care were thought necessary by patients who were nonwhite and had not completed college. Up to 38% of the patients reported not receiving elements of care they had considered necessary; specific agreement between physicians and patients about care not received ranged from 63% to 100%. Not receiving certain “necessary” elements of care was associated with lower visit satisfaction.

Conclusion: Internal medicine patients at the center studied had specific expectations for the content of their physician visits. However, they routinely failed to receive some of the items they thought necessary. Unless patients’ expectations are carefully elicited and dealt with, the physician-patient relationship may be adversely affected.

Key words

patient expectations satisfaction office visits ambulatory care physician-patient relationship 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Lazare A, Eisenthal S, Sasserman L. The customer approach to patienthood. Arch Gen Psychiatry. 1975;32:553–8.PubMedGoogle Scholar
  2. 2.
    Brody DS, Miller SM, Lehrman CE, Smith DG, Caputo C. Patient perception of involvement in medical care: relationship to illness attitudes and outcomes. J Gen Intern Med. 1989;4:506–11.PubMedCrossRefGoogle Scholar
  3. 3.
    Greenfield S, Kaplan S, Ware J Jr. Expanding patient involvement in care. Ann Intern Med. 1985;102:520–8.PubMedGoogle Scholar
  4. 4.
    Greenfield S, Kaplan SH, Ware JE Jr, Yano EM, Frank HJL. Patients’ participation in medical care: effects on blood sugar control and quality of life in diabetes. J Gen Intern Med. 1988;3:448–57.PubMedCrossRefGoogle Scholar
  5. 5.
    Weiss BD, Sent JH. Patient satisfaction survey instrument for use in health maintenance organizations. Med Care. 1990;28:434–45.PubMedCrossRefGoogle Scholar
  6. 6.
    Eisenberg JM. Physician utilization: the state of research about physicians’ practice patterns. Med Care. 1985;23:461–83.PubMedCrossRefGoogle Scholar
  7. 7.
    Woolf SH, Kamerow DB. Testing for uncommon conditions: the heroic search for positive test results. Arch Intern Med. 1990;150:2451–8.PubMedCrossRefGoogle Scholar
  8. 8.
    Lazare A, Eisenthal S, Frank A. Clinician/patient relations II. Conflict and negotiation. In: Lazare A (ed). Outpatient Psychiatry: Diagnosis and Treatment. Second edition. Baltimore: Williams and Wilkins, 1989; 137–52.Google Scholar
  9. 9.
    Uhlmann RF, Inui TS, Carter WB. Patient requests and expectations: definitions and clinical applications. Med Care. 1984;22:681–5.PubMedCrossRefGoogle Scholar
  10. 10.
    Brody DS, Miller SM, Lerman CE, Smith DG, Lazaro CG, Blum MJ. The relationship between patients’ satisfaction with their physicians and perceptions about interventions they desired and received. Med Care. 1989;27:1027–35.PubMedCrossRefGoogle Scholar
  11. 11.
    Brown JB, Adams ME. Patients as reliable reporters of medical care process. Recall of ambulatory encounter events. Med Care. 1992;30:400–11.PubMedCrossRefGoogle Scholar
  12. 12.
    Greenfield S, Nelson EC, Zubkoff M, et al. Variations in resource utilization among medical specialties and systems of care. Results from the Medical Outcomes Study. JAMA. 1992;267:1624–30.PubMedCrossRefGoogle Scholar
  13. 13.
    Stewart AL, Ware JE Jr, Sherbourne CD, Wells KB. Health prescriptions, energy/fatigue, and health distress measures. In: Stewart AL, Ware JE Jr (eds). Measuring Functioning and Well Being. Durham, NC: Duke University Press, 1992.Google Scholar
  14. 14.
    Ware JE Jr, Hays RD. Methods for measuring patient satisfaction with specific medical encounters. Med Care. 1988;26:393–402.PubMedCrossRefGoogle Scholar
  15. 15.
    Hosner DW, Lemeshow S. Applied Logistic Regression. New York: John Wiley and Sons, 1989.Google Scholar
  16. 16.
    Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33:159–74.PubMedCrossRefGoogle Scholar
  17. 17.
    Spiro HM. Delayed diagnosis of disease. JAMA. 1985;253:2258.PubMedCrossRefGoogle Scholar
  18. 18.
    Uhlmann RF, Carter WB, Inui TS. Fulfillment of patient requests in a general medicine clinic. Am J Public Health. 1984;74:257–8.PubMedCrossRefGoogle Scholar
  19. 19.
    Deyo RA, Diehl AK, Rosenthal M. Reducing roentgenography use: can patient expectations be altered? Arch Intern Med. 1987;147:141–5.PubMedCrossRefGoogle Scholar
  20. 20.
    Fitzgerald FT. Physical diagnosis versus modern technology. A review. West J Med. 1990;152:377–82.PubMedGoogle Scholar
  21. 21.
    Parker SC, Kroboth FJ. Practical problems of conducting patient satisfaction surveys. J Gen Intern Med. 1991;6:430–5.PubMedCrossRefGoogle Scholar

Copyright information

© Society of General Internal Medicine 1994

Authors and Affiliations

  • Richard L. Kravitz
    • 1
    • 2
  • Dennis W. Cope
    • 1
  • Vinni Bhrany
    • 1
  • Barbara Leake
    • 1
  1. 1.the Division of General Internal Medicine and Health Services ResearchUCLALos Angeles
  2. 2.the Health Program, RandSanta Monica

Personalised recommendations