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.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Lazare A, Eisenthal S, Sasserman L. The customer approach to patienthood. Arch Gen Psychiatry. 1975;32:553–8.
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.
Greenfield S, Kaplan S, Ware J Jr. Expanding patient involvement in care. Ann Intern Med. 1985;102:520–8.
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.
Weiss BD, Sent JH. Patient satisfaction survey instrument for use in health maintenance organizations. Med Care. 1990;28:434–45.
Eisenberg JM. Physician utilization: the state of research about physicians’ practice patterns. Med Care. 1985;23:461–83.
Woolf SH, Kamerow DB. Testing for uncommon conditions: the heroic search for positive test results. Arch Intern Med. 1990;150:2451–8.
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.
Uhlmann RF, Inui TS, Carter WB. Patient requests and expectations: definitions and clinical applications. Med Care. 1984;22:681–5.
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.
Brown JB, Adams ME. Patients as reliable reporters of medical care process. Recall of ambulatory encounter events. Med Care. 1992;30:400–11.
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.
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.
Ware JE Jr, Hays RD. Methods for measuring patient satisfaction with specific medical encounters. Med Care. 1988;26:393–402.
Hosner DW, Lemeshow S. Applied Logistic Regression. New York: John Wiley and Sons, 1989.
Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33:159–74.
Spiro HM. Delayed diagnosis of disease. JAMA. 1985;253:2258.
Uhlmann RF, Carter WB, Inui TS. Fulfillment of patient requests in a general medicine clinic. Am J Public Health. 1984;74:257–8.
Deyo RA, Diehl AK, Rosenthal M. Reducing roentgenography use: can patient expectations be altered? Arch Intern Med. 1987;147:141–5.
Fitzgerald FT. Physical diagnosis versus modern technology. A review. West J Med. 1990;152:377–82.
Parker SC, Kroboth FJ. Practical problems of conducting patient satisfaction surveys. J Gen Intern Med. 1991;6:430–5.
Author information
Authors and Affiliations
Additional information
Supported by grants from the UCLA Academic Senate and the UCLA Center for Educational Development and Research.
About this article
Cite this article
Kravitz, R.L., Cope, D.W., Bhrany, V. et al. Internal medicine patients’ expectations for care during office visits. J Gen Intern Med 9, 75–81 (1994). https://doi.org/10.1007/BF02600205
Issue Date:
DOI: https://doi.org/10.1007/BF02600205