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Journal of General Internal Medicine

, Volume 19, Issue 11, pp 1080–1087 | Cite as

Do unmet expectations for specific tests, referrals, and new medications reduce patients’ satisfaction?

  • B. Mitchell Peck
  • Peter A. Ubel
  • Debra L. Roter
  • Susan Dorr Goold
  • David A. Asch
  • Amy S. Jeffreys
  • Steven C. Grambow
  • James A. Tulsky
Original Articles

Abstract

BACKGROUND: Patient-centered care requires clinicians to recognize and act on patients’ expectations. However, relatively little is known about the specific expectations patients bring to the primary care visit.

OBJECTIVE: To describe the nature and prevalence of patients’ specific expectations for tests, referrals, and new medications, and to examine the relationship between fulfillment of these expectations and patient satisfaction.

DESIGN: Prospective cohort study.

SETTING: VA general medicine clinic.

PATIENTS/PARTICIPANTS: Two hundred fifty-three adult male outpatients seeing their primary care provider for a scheduled visit.

MEASUREMENTS AND MAIN RESULTS: Fifty-six percent of patients reported at least 1 expectation for a test, referral, or new medication. Thirty-one percent had 1 expectation, while 25% had 2 or more expectations. Expectations were evenly distributed among tests, referrals, and new medications (37%, 30%, and 33%, respectively). Half of the patients who expressed an expectation did not receive one or more of the desired tests, referrals, or new medications. Nevertheless, satisfaction was very high (median of 1.5 for visit-specific satisfaction on a 1 to 5 scale, with 1 representing “excellent”). Satisfaction was not related to whether expectations were met or unmet, except that patients who did not receive desired medications reported lower satisfaction.

CONCLUSIONS: Patients’ expectations are varied and often vague. Clinicians trying to implement the values of patient-centered care must be prepared to elicit, identify, and address many expectations.

Key words

patient expectations patient satisfaction veterans 

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References

  1. 1.
    Greenfield S, Kaplan SH, Ware JE Jr. Expanding patient involvement in care: effects on patient outcomes. Ann Intern Med. 1985;102:520–8.PubMedGoogle Scholar
  2. 2.
    Greenfield S, Kaplan SH, Ware JE, Yano EM, Frank HJL. Patient participation in medical care: effect on blood sugar and quality of life in diabetes. J Gen Intern Med. 1988;3:448–57.PubMedCrossRefGoogle Scholar
  3. 3.
    Krupat E, Bell RA, Kravitz RL, Thom D, Azari R. When physicians and patients think alike: patient-centered beliefs and their impact on satisfaction and trust. J Fam Pract. 2001;50:1057–62.PubMedGoogle Scholar
  4. 4.
    Kroenke K. Patient expectations for care: how hidden is the agenda? May Clin Proc. 1998;73:191–3.Google Scholar
  5. 5.
    Zemencuk JK, Feightner JW, Hayward RA, Skarupski KA, Katz SJ. Patients’ desires and expectations for medical care in primary care clinics. J Gen Intern Med. 1998;13:273–6.PubMedCrossRefGoogle Scholar
  6. 6.
    Hafferty FW, Light DW. Professional dynamics and the changing nature of medical work. J Health Soc Behav. 1995;35:132–53.CrossRefGoogle Scholar
  7. 7.
    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
  8. 8.
    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.PubMedCrossRefGoogle Scholar
  9. 9.
    Kravitz RL, Callahan EJ, Azari R, Antonius D, Lewis CE. Assessing patients’ expectations in ambulatory medical practice. J Gen Intern Med. 1997;12:67–72.PubMedCrossRefGoogle Scholar
  10. 10.
    Joos SK, Hickam DH, Borders LM. Patients’ desires and satisfaction in general medicine clinics. Public Health Rep. 1993;108:751–9.PubMedGoogle Scholar
  11. 11.
    Uhlmann R, Inui T, Pecoraro R, Carter W. Relationship of patient request fulfillment to compliance, glycemic control, and other health care outcomes in insulin-dependent diabetes. J Gen Intern Med. 1988;3:458–63.PubMedCrossRefGoogle Scholar
  12. 12.
    Eisenthal S, Emery R, Lazare A, Udin H. ‘Adherence’ and the negotiated approach to patienthood. Arch Gen Psych. 1979;36:393–8.Google Scholar
  13. 13.
    Soh G. Patient satisfaction with physician care. Hawaii Med J. 1991;50:149–52.PubMedGoogle Scholar
  14. 14.
    Hickson GB, Clayton EW, Entman SS, et al. Obstetricians’ prior malpractice experience and patients’ satisfaction with care. JAMA. 1994;272:1583–7.PubMedCrossRefGoogle Scholar
  15. 15.
    Marquis MS, Davies AR, Ware JE Jr. Patient satisfaction and change in medical care provider: a longitudinal study. Med Care. 1983;21:821–9.PubMedCrossRefGoogle Scholar
  16. 16.
    Cleary PD, McNeil BJ. Patient satisfaction as an indicator of quality care. Inquiry. 1988;25:25–36.PubMedGoogle Scholar
  17. 17.
    Uhlmann R, Inui T, Carter W. Patient requests and expectations: definitions and clinical applications. Med Care. 1984;22:681–5.PubMedCrossRefGoogle Scholar
  18. 18.
    Kravitz RL, Bell RA, Franz CE. A taxonomy of requests by patients (TORP): a new system for understanding clinical negotiation in office practice. J Fam Pract. 1999;48:872–8.PubMedGoogle Scholar
  19. 19.
    Brody H. The Healer’s Power. New Haven, Conn: Yale University Press; 1992.Google Scholar
  20. 20.
    Vanderford ML, Stein T, Sheeler R, Skochelak S. Communication challenges for experienced clinicians: topics for an advanced communication curriculum. Health Commun. 2001;13:261–84.PubMedCrossRefGoogle Scholar
  21. 21.
    Vieder JN, Krafchick MA, Kovach AC, Galluzzi KE. Physician-patient interaction: what do elders want? J Am Osteopath Assoc. 2002;102:73–8.PubMedGoogle Scholar
  22. 22.
    Ferguson WJ, Candib LM. Culture, language, and the doctorpatient relationship. Fam Med. 2002;34:353–61.PubMedGoogle Scholar
  23. 23.
    Marple RL, Kroenke K, Lucey CR, Wilder J, Lucas CA. Concerns and expectations in patients presenting with physical complaints: frequency, physician perceptions and actions, and 2-week outcome. Arch Intern Med. 1997;157:1482–8.PubMedCrossRefGoogle Scholar
  24. 24.
    Kravitz RL, Bell RA, Azari R, Krupat E, Kelly-Reif S, Thom D. Request fulfillment in office practice: antecedents and relationship to outcomes. Med Care. 2002;40:38–51.PubMedCrossRefGoogle Scholar
  25. 25.
    Eisenberg JM. Physician utilization: the state of research about physicians’ practice patterns. Med Care. 1985;23:461–83.PubMedCrossRefGoogle Scholar
  26. 26.
    Woolf SH, Kamerow DB. Testing for uncommon conditions: the heroic search for positive test results. Arch Intern Med. 1990;150:2451–8.CrossRefGoogle Scholar
  27. 27.
    Marton KI, Sox HC Jr, Wasson J, Duisenberg CE. The clinical value of the upper gastrointestinal tract roentgenogram series. Arch Intern Med. 1980;140:191–5.PubMedCrossRefGoogle Scholar
  28. 28.
    Woo B, Woo B, Cook EF, Weisberg M, Goldman L. Screening procedures in the asymptomatic adult: comparison of physicians’ recommendations, patients’ desires, published guidelines, and actual practice. JAMA. 1985;254:1480–4.PubMedCrossRefGoogle Scholar
  29. 29.
    Davis T, Long S, Jackson R, et al. Rapid estimate of adult literacy in medicine: a shortened screening instrument. Fam Med. 1993;25:391–5.PubMedGoogle Scholar
  30. 30.
    Peck BM, Asch DA, Goold SD, et al. Measuring patient expectations: does the instrument affect satisfaction or expectations? Med Care. 2001;39:100–8.PubMedCrossRefGoogle Scholar
  31. 31.
    Kravitz RL. Measuring patients’ expectations and requests. Ann Intern Med. 2001;134:881–8.PubMedGoogle Scholar
  32. 32.
    PSQ Project Co-Investigators. Final Report on the Patient Satisfaction Questionnaire Project. Washington, DC: American Board of Internal Medicine; 1989.Google 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.
    Like R, Zyzanski SJ. Patient satisfaction with the clinical encounter: social psychological determinants. Soc Sci Med. 1987;24:351–7.PubMedCrossRefGoogle Scholar
  35. 35.
    Hopton JL, Howie JG, Porter AM. The need for another look at the patient in general practice satisfaction surveys. Fam Pract. 1993;10:82–7.PubMedCrossRefGoogle Scholar
  36. 36.
    Williams B. Patient satisfaction: a valid concept? Soc Sci Med. 1994;38:509–16.PubMedCrossRefGoogle Scholar
  37. 37.
    Sitzia J, Wood N. Patient satisfaction: a review of issues and concepts. Soc Sci Med. 1997;45:1829–43.PubMedCrossRefGoogle Scholar
  38. 38.
    Hall JA, Dornan MC. Patient sociodemographic characteristics as predictors of satisfaction with medical care: a meta-analysis. Soc Sci Med. 1990;30:811–8.CrossRefGoogle Scholar
  39. 39.
    Rahmqvist M. Patient satisfaction in relation to age, health status and other background factors: a model for comparisons of care units. Int J Qual Health Care. 2001;13:385–90.PubMedCrossRefGoogle Scholar
  40. 40.
    Anderson LA, Zimmerman MA. Patient and physician perceptions of their relationship and patient satisfaction: a study of chronic disease management. Patient Educ Couns. 1993;20:27–36.PubMedCrossRefGoogle Scholar
  41. 41.
    Khayat K, Salter B. Patient satisfaction surveys as a market research tool for general practices. Br J Gen Pract. 1994;44:215–9.PubMedGoogle Scholar
  42. 42.
    McKinley RK, Middleton JF. What do patients want from doctors? Content analysis of written patient agendas for the consultation. Br J Gen Pract. 1999;49:796–800.PubMedGoogle Scholar
  43. 43.
    Bell RA, Kravitz RL, Thom D, Krupat E, Azari R. Unmet expectations for care and the patient-physician relationship. J Gen Intern Med. 2002;17:817–24.PubMedCrossRefGoogle Scholar
  44. 44.
    Kaplan S, Greenfield S, Gandek B, Rogers W. Characteristics of physicians with participatory decision-making styles. Ann Intern Med. 1996;124:497–504.PubMedGoogle Scholar
  45. 45.
    Goold SD, Lipkin M Jr. The doctor-patient relationship: challenges, opportunities, and strategies. J Gen Intern Med. 1999;14:26–33.CrossRefGoogle Scholar
  46. 46.
    Braddock CH III, Edwards KA, Hasenberg NM, Laidley TL, Levinson W. Informed decision making in outpatient practice: time to get back to basics. JAMA. 1999;282:2313–20.PubMedCrossRefGoogle Scholar
  47. 47.
    Eisenthal S, Lazare A. Expression of patients’ requests in the initial interview. Psychol Rep. 1977;40:131–8.PubMedGoogle Scholar
  48. 48.
    Balint J, Shelton W. Regaining the initiative. Forging a new model of the patient-physician relationship. JAMA. 1996;275:887–91.PubMedCrossRefGoogle Scholar
  49. 49.
    Mann S, Sripathy K, Siegler EL, Davidow A, Lipkin M, Roter DL. The medical interview: differences between adult and geriatric outpatients. J Am Geriatr Soc. 2001;49:65–71.PubMedCrossRefGoogle Scholar
  50. 50.
    Roter DL. The outpatient medical encounter and elderly patients. Clin Geriatr Med. 2000;16:95–107.PubMedCrossRefGoogle Scholar

Copyright information

© Society of General Internal Medicine 2004

Authors and Affiliations

  • B. Mitchell Peck
    • 4
  • Peter A. Ubel
    • 7
    • 8
  • Debra L. Roter
    • 9
  • Susan Dorr Goold
    • 8
  • David A. Asch
    • 5
    • 6
  • Amy S. Jeffreys
    • 1
  • Steven C. Grambow
    • 1
    • 2
  • James A. Tulsky
    • 1
    • 3
  1. 1.the Center for Health Services Research in Primary CareDurham VA Medical CenterDurham
  2. 2.Department of Biostatistics and BioinformaticsDuke University Medical CenterDurham
  3. 3.Department of MedicineDuke University Medical CenterDurham
  4. 4.College of Public HealthUniversity of Oklahoma Health Sciences CenterOklahoma City
  5. 5.Center for Health Equity Research and PromotionPhiladelphia VA Medical CenterPhiladelphia
  6. 6.Leonard Davis Institute of Health EconomicsUniversity of PennsylvaniaPhiladelphia
  7. 7.Ann Arbor VA Medical CenterAnn Arbor
  8. 8.University of Michigan Medical CenterAnn Arbor
  9. 9.Johns Hopkins School of Public HealthBaltimore

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