Journal of General Internal Medicine

, Volume 11, Issue 8, pp 470–474 | Cite as

Meeting walk-in patients’ expectations for testing effects on satisfaction

  • Gregory W. Froehlich
  • H. Gilbert Welch
Original Articles


OBJECTIVE: To examine the relation between meeting expectations for tests and visit satisfaction in walk-in patients.

DESIGN: Survey of patients before and after the visit.

SETTING: Walk-in medical clinic at a Veterans Affairs Medical Center.

PATIENTS: 143 male veterans were eligible for this study: 128 agreed to participate; 109 completed both questionnaires.

MEASUREMENTS: Before the visit, we measured health status, baseline satisfaction with care, and expectations for common tests. After the visit, we measured visit-specific satisfaction, patient perception of provider interpersonal behavior (provider humanism), and patient report of whether specific tests were received. Logistic regression was used to determine the effect of meeting expectations for tests while controlling for other factors.

RESULTS: Of all patients, 62% expected one or more tests, nearly as many as expected a medication or a diagnosis. In multivariate analysis restricted to those expecting tests, provider humanism was the sole significant predictor of visit-specific satisfaction (odds ratio [OR] 6.4; 95% confidence interval [CI] 1.6, 26.1). The proportion of expectations for testing that were met was not significantly associated with satisfaction (OR 1.05; 95% CI 0.92, 1.21).

CONCLUSIONS: Meeting patient expectations for tests does not have an important effect on satisfaction. Even in the walk-in setting, patient perception of the providers’ interpersonal behavior was a more important factor in satisfaction with the visit. Physicians who order tests solely to improve patient satisfaction may be able to reduce unnecessary testing without decreasing patient satisfaction.

Key words

patient satisfaction physician-patient relationships ambulatory care diagnostic tests patient expectations 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Larsen DE, Rootman I. Physician role performance and patient satisfaction. Soc Sci Med. 1976;10:29–32.PubMedCrossRefGoogle Scholar
  2. 2.
    Gau DW, Gau GS. Patient satisfaction. J R Coll Gen Pract. 1986;36:227–8. Letter.PubMedGoogle Scholar
  3. 3.
    Barsky AJ. Wyshak G, Latham KS, Klerman GL. Hypochondriacal patients, their physicians, and their medical care. J Gen Intern Med. 1991;6:413–9.PubMedCrossRefGoogle Scholar
  4. 4.
    Miller WL. Routine, ceremony, or drama: an exploratory field study of the primary care clinical encounter. J Fam Pract. 1992;34:289–96.PubMedGoogle Scholar
  5. 5.
    Eisenberg JM. Physician utilization. The state of research about physician’s practice patterns. Med Care. 1985;23:461–83.PubMedCrossRefGoogle Scholar
  6. 6.
    Woolf SH, Kamerow DB. Testing for uncommon conditions. The heroic search for positive results. Arch Intern Med. 1990;150:2451–8.PubMedCrossRefGoogle Scholar
  7. 7.
    Becker LA, Green LA, Beaufait D, Kirk J, Froom J, Freeman WL. Use of CT scans for the investigation of headache: a report from ASPN, pt 1. J Fam Pract. 1993;37:129–34.PubMedGoogle Scholar
  8. 8.
    Ware JE, Davies AR. Behavioral consequences of consumer dissatisfaction with medical care. Eval Program Plann. 1983;6:291–7.PubMedCrossRefGoogle Scholar
  9. 9.
    Ware JE, Davies AR, Stewart AL. The measurement and meaning of patient satisfaction. Health Med Care Serv Rev. 1978;1:1–14.PubMedGoogle Scholar
  10. 10.
    Becker MH, Maiman LA. Strategies for enhancing patient compliance. J Community Health. 1980;6:113–25.PubMedCrossRefGoogle Scholar
  11. 11.
    Marquis MS. Davies AR, Ware JE. Patient satisfaction and change in medical care provider: a longitudinal study. Med Care. 1983;21:821–9.PubMedCrossRefGoogle Scholar
  12. 12.
    Pascoe GC. Patient satisfaction in primary health care: a literature review and analysis. Eval Program Plann. 1983;6:185–210.PubMedCrossRefGoogle Scholar
  13. 13.
    Miller RH, Williams PC, Napolitana G, Schmied J. Malpractice: a case-control study of claimants. J Gen Intern Med. 1990;5:244–8.PubMedGoogle Scholar
  14. 14.
    Joos SK, Hickam DH, Borders LM. Patients’ desires and satisfaction in genera] medicine clinics. Public Health Rep. 1993;108:751–9.PubMedGoogle Scholar
  15. 15.
    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
  16. 16.
    Robbins JA, Bertakis KD, Helms LH, Azari R, Callahan EJ. Creten DA. The influence of physician practice behaviors on patient satisfaction. Fam Med. 1993;25:17–20.PubMedGoogle Scholar
  17. 17.
    Kravitz RL, Cope DW, Bhrany V, Leake B. Internal medicine patients’ expectations for care during office visits. J Gen Intern Med. 1994;9:75–81.PubMedGoogle Scholar
  18. 18.
    Eisenthal S, Koopman C, Stoeckle JD. The nature of patients’ requests for physicians’ help. Acad Med. 1990;65:401–5.PubMedCrossRefGoogle Scholar
  19. 19.
    Rubin HR. Gandek B. Rogers RH, Kosinski M. McHorney CA, Ware JE. Patients’ ratings of outpatient visits in different practice settings. Results from the Medical Outcomes Study. JAMA. 1993;270:835–40.PubMedCrossRefGoogle Scholar
  20. 20.
    Lochman JE. Factors related to patients’ satisfaction with their medical care. J Community Health. 1983;9:91–109.PubMedCrossRefGoogle Scholar
  21. 21.
    Hall JA, Milburn MA, Epstein AM. A causal model of health status and satisfaction with medical care. Med Care. 1993;31:84–94.PubMedCrossRefGoogle Scholar
  22. 22.
    Ware JE, Nelson EC. Sherbourne CD. Stewart AL. Preliminary tests of a 6-item general health survey: a patient application. In: Stewart AL, Ware JE, eds. Measuring Function and Well-Being: The Medical Outcomes Study Approach. Durham, NC: Duke University Press: 1992;291–303.Google Scholar
  23. 23.
    Ware JE, Snyder MK, Wright WR. Davies AR. Defining and measuring patient satisfaction with medical care. Eval Program Plann. 1983;6:247–63.PubMedCrossRefGoogle Scholar
  24. 24.
    Weaver MJ. Ow CL. Walker DJ, Degenhardt EF. A questionnaire for patients’ evaluations of their physicians’ humanistic behaviors. J Gen Intern Med. 1993;8:135–9.PubMedGoogle Scholar
  25. 25.
    Stata Statistical Software: Release 4.0 College Station, Tex: Stata Corporation: 1995.Google Scholar
  26. 26.
    Stump TE. Dexter PR. Tierney WM, Wolinsky FD. Measuring patient satisfaction with physicians among older and diseased adults in a primary care municipal outpatient setting. An examination of three instruments. Med Care. 1995;33:958–72.PubMedCrossRefGoogle Scholar
  27. 27.
    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
  28. 28.
    Like R. Zyzanski SJ. Patient satisfaction with the clinical encounter: social psychological determinants. Soc Sci Med. 1987;24:351–7.PubMedCrossRefGoogle Scholar
  29. 29.
    Sanchez-Menegay C. Hudes ES. Cummings SR. Patient expectations and satisfaction with medical care for upper respiratory infections. J Gen Intern Med. 1992;7:432–4.PubMedGoogle Scholar
  30. 30.
    Sox HC. Margulies I. Sox CH. Psychologically mediated effects of diagnostic tests. Ann Intern Med. 1981;95:680–5.PubMedGoogle Scholar
  31. 31.
    Deyo RA. Diehl AK, Rosenthal M. Reducing roentgenography use. Can patient expectations be altered? Arch Intern Med. 1987;147:141–5.PubMedCrossRefGoogle Scholar
  32. 32.
    GIVIO Investigators. Impact of follow-up testing on survival and health-related quality of life in breast cancer patients. A multi-center randomized controlled trial. JAMA. 1994;271:1587–92.CrossRefGoogle Scholar
  33. 33.
    Ware JE, Hays RD. Methods for measuring patient satisfaction with specific medical encounters. Med Care. 1988;26:393–402.PubMedCrossRefGoogle Scholar
  34. 34.
    Nightingale SD, Yarnold PR. Greenberg MS. Sympathy, empathy, and physician resource utilization. J Gen Intern Med. 1991;6:420–3.CrossRefGoogle Scholar
  35. 35.
    Uhlmann RF. Inui TS. Carter WB. Patient requests and expectations. Definitions and clinical applications. Med Care. 1984;22:681–5.PubMedCrossRefGoogle Scholar

Copyright information

© the Society of General Internal Medicine 1996

Authors and Affiliations

  • Gregory W. Froehlich
    • 2
  • H. Gilbert Welch
    • 2
    • 1
  1. 1.the Center for the Evaluative Clinical SciencesDartmouth Medical SchoolHanover
  2. 2.Department of Veterans Affairs Medical CenterVA Outcomes Group (11 IB)White River Junction

Personalised recommendations