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The Physician-Patient Relationship |

The Effect of Unmet Expectations among Adults Presenting with Physical Symptoms

Jeffrey L. Jackson, MD, MPH; and Kurt Kroenke, MD
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From the Uniformed Services University of the Health Sciences, Bethesda, Maryland; and the Regenstrief Institute for Health Care and Indiana University School of Medicine, Indianapolis, Indiana. Note: This article is one of a series of articles comprising an Annals of Internal Medicine supplement entitled “ Investigating Symptoms: Frontiers in Primary Care Research—Perspectives from The Seventh Regenstrief Conference ” To see a complete list of the articles included in this supplement, please view its Table of Contents.

Copyright ©2004 by the American College of Physicians

Grant Support: In part by an intramural grant from the Uniformed Services University of the Health Sciences.

Requests for Single Reprints: Jeffrey L. Jackson, MD, MPH, Department of Medicine-EDP, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814; e-mail, jejackson@usuhs.mil.

Current Author Addresses: Dr. Jackson: Department of Medicine-EDP, Uniformed Services University, 4301 Jones Bridge Road, Bethesda, MD 20814.

Dr. Kroenke: Regenstrief Institute for Health Care, 1001 West 10th Street, Indianapolis, IN 46202.

Ann Intern Med. 2001;134(9_Part_2):889-897. doi:10.7326/0003-4819-134-9_Part_2-200105011-00013
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Background: Unmet patient expectations are common and have been associated with decreased patient satisfaction.

Objective: To assess the prevalence and effect of unmet expectations in patients presenting with physical symptoms.

Design: Prospective cohort study.

Setting: Primary care walk-in clinic. Most patients were seeing a particular provider for the first time.

Patients: 750 adults whose principal reason for the clinic visit was a physical symptom.

Measurements: Patients completed previsit questionnaires that assessed symptom characteristics, the patient's expectations of the visit, functional status (Medical Outcomes Study Short Form-6), and mental disorders (Primary Care Evaluation of Mental Disorders [PRIME-MD]). Patient questionnaires given immediately after the visit and 2 weeks after the visit assessed patient satisfaction with the visit and unmet expectations; the 2-week questionnaire also assessed symptom outcome and functional status. Postvisit physician questionnaires measured encounter difficulty (Difficult Doctor Patient Relationship Questionnaire) and what the physician did in response to the patient's symptom.

Results: Nearly all patients (98%) had at least one previsit expectation, including a diagnosis (81%), an estimate of how long the symptom was likely to last (63%), a prescription (60%), a diagnostic test (54%), and a subspecialty referral (45%). Immediately after the visit, the most common unmet expectations were for prognostic information (51%) or diagnostic information (33%). Only 11% of patients had an unmet expectation of a diagnostic test, subspecialty referral, prescription, or sick slip. Unmet patient expectations were more common after encounters experienced as difficult by the clinician and in patients with underlying mental disorders. Patients with no unmet expectations had less worry about serious illness (54% vs. 27%; P < 0.001) and greater satisfaction (59% vs. 19%; P < 0.001), and patients who reported receiving diagnostic or prognostic information were more likely to have symptom alleviation (relative risk, 1.2 [95% CI, 1.02 to 1.3]) and functional improvement (functional status score, 25 vs. 23; P = 0.01) at 2 weeks.

Conclusions: Patients who seek care for physical symptoms and do not leave the encounter with an unmet expectation are more likely to be satisfied with their care and to have less worry about serious illness. Diagnostic and prognostic information are particularly valued by patients and may be associated with greater improvement in symptoms and functional status 2 weeks after the visit.


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Figure 1.
Distribution of previsit expectations among patients presenting with physical symptoms.
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