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


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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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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