Skip to main content

Advertisement

Log in

The Effect of Patients’ Met Expectations on Consultation Outcomes. A Study with Family Medicine Residents

  • Original Article
  • Published:
Journal of General Internal Medicine Aims and scope Submit manuscript

Abstract

Objectives

To know the patients’ expectations and the fulfillment of these at family medicine consultations by resident doctors and to assess their effect on some consultation outcomes.

Design

A prospective cohort study.

Participants

Patients attending family medicine consultations held by 38 resident doctors: 1,301 eligible patients, 702 filled in all questionnaires.

Measurements

Before each visit, the patients’ expectations about that particular consultation were registered. Right after the visit was over, their perception of several aspects of the communicative interaction with the doctor was measured. Later, patients were interviewed on the phone to know how their expectations had been fulfilled, how satisfied they were about the consultation, how they had followed the doctor’s suggestions, if they were going to seek further care for the same cause later, and the evolution of their clinical problem. Logistic regression was the main analysis used.

Results

The most common expectations were the doctor showing interest and listening (30.5%), getting some information about the diagnosis (16.3%), and sharing problems and doubts (11.1%). The rate of main expectations that were met was 76.5%. Satisfaction with the encounter was associated with the clinical evolution [odds ratio (OR) 2.23; confidence interval (CI): 1.32–3.75], and the fulfilling of the patients’ main or two main expectations was significantly related to all the measured outcomes (satisfaction OR 3.51, CI: 1.73–7.8; adherence OR 1.80, CI: 1.11–2.92; clinical evolution OR 1.54, CI: 1.01–2.35; and seeking further care later OR 0.54, CI:0.36–0.81)

Conclusions

Patients prioritize expectations of a more general sort when they attend primary care consultations and residents fulfill these acceptably. The fulfillment of expectations seems to affect the studied outcomes more than other factors.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Kravitz R. Measuring patients’ expectations and requests. Ann Intern Med. 2001;134:881–8.

    PubMed  CAS  Google Scholar 

  2. Williams S, Weinman J, Dale J, Newman S. Patient expectations: What do primary care patients want from the GP and how far does meeting expectations affect patient satisfaction? Fam Pract. 1995;12:193–201.

    Article  PubMed  CAS  Google Scholar 

  3. Kravitz R, Callahan E, Paterniti D, Antonius D, Dunham M, Lewis C. Prevalence and sources of patients’ unmet expectations for care. Ann Intern Med. 1996;125:730–7.

    PubMed  CAS  Google Scholar 

  4. Hamm R, Hicks R, Bemben D. Antibiotics and respiratory infections: are patients more satisfied when expectations are met? J Fam Pract. 1996;43:56–62.

    PubMed  CAS  Google Scholar 

  5. Marple R, Kroenke K, CR L, Wilder J, Lucas C. Concerns and expectations in patients presenting physical complaints. Arch Intern Med. 1997;157:1482–8.

    Article  PubMed  CAS  Google Scholar 

  6. Peck B, Ubel P, Roter D, et al. Do unmet expectations for specific tests, referrals and new medications reduce patients’ satisfaction? J Gen Intern Med. 2004;19:1080–7.

    Article  PubMed  Google Scholar 

  7. Kravitz R, Cope D, Bhrany V, Leake B. Internal medicine patients’ expectations for care during office visit. J Gen Intern Med. 1994;9:75–81

    Article  PubMed  CAS  Google Scholar 

  8. Kravitz R, Callahan E, Azari R, Antonius D, Lewis C. Assessing patients’ expectations in ambulatory medical practice. Does measurement approach make a difference? J Gen Intern Med. 1997;12:67–72.

    Article  PubMed  CAS  Google Scholar 

  9. Bell R, Kravitz R, Thom D, Krupat E, Azari R. Unsaid but not forgotten. Arch Intern Med. 2001;161:1977–84.

    Article  PubMed  CAS  Google Scholar 

  10. Jackson J, Kroenke K. The effect of unmet expectations among adults presenting physical symptoms. Ann Intern Med. 2001;134:889–97.

    PubMed  CAS  Google Scholar 

  11. Thom D, Kravitz R, Bell R, Krupat E, Azari R. Patients trust in the physician relationship to patient requests. Fam Pract. 2002;19:476–83.

    Article  PubMed  Google Scholar 

  12. Rao J, Weinberger M, Kroenke K. Visit-specific expectations and patient-centered outcomes. A literature review. Arch Fam Med. 2000;9:1148–55.

    Article  PubMed  CAS  Google Scholar 

  13. Peltenburg M, Fischer J, Bahrs O, van Dulmen S, van den Brink-Muinen A. The unexpected in primary care: A multicentered study on the emergence of unvoiced patient agenda. Ann Fam Med. 2004;2:534–40.

    Article  PubMed  Google Scholar 

  14. Peck B, Asch D, Goold S, et al. Measuring patient expectations. Does the instrument affect satisfaction or expectations? Med Care. 2001;39:100–8.

    Article  PubMed  CAS  Google Scholar 

  15. Zebiene E, Razgauskas E, Basys V, et al. Meeting patient’s expectations in primary care consultation in Lithuania. Int J Qual Health Care. 2004;16:83–9.

    Article  PubMed  CAS  Google Scholar 

  16. Froehlich G, Weich G. Meeting walk-in patients’ expectations for testing. J Gen Intern Med. 1996;11:470–4.

    Article  PubMed  CAS  Google Scholar 

  17. Himmel W, Lippert-Urbanke E, Kochen M. Are patients more satisfied when they receive a prescription? The effect of expectations in general practice. Scand J Prim Health Care. 1997;15:118–22.

    Article  PubMed  CAS  Google Scholar 

  18. Uhlmann R, Inui T, Pecorato R, Carter W. Relationship to patient request fulfillment to compliance, glycemic control, and other health care outcomes in insulin-dependence diabetes. J Gen Intern Med. 1988;3:458–63.

    Article  PubMed  CAS  Google Scholar 

  19. Bell R, Kravitz R, Thom D, Krupat E, Azari R. Unmet expectations for care and the patient–physician relationship. J Gen Intern Med. 2002;17:817–24.

    Article  PubMed  Google Scholar 

  20. Macfarlane J, Holmes W, Macfarlane R, Britten N. Influence of patients’ expectations on antibiotic management of acute lower respiratory tract illness in general practice: questionnaire study. BMJ. 1997;315:1211–4.

    PubMed  CAS  Google Scholar 

  21. Jackson J, Kroenke K, Chamberlin J. Effects of physician awareness of symptom-related expectations and mental disorders. Arch Fam Med. 1999;8:135–42.

    Article  PubMed  CAS  Google Scholar 

  22. Kravitz R, Bell R, Azari R, Krupat E, Kelly-Reif S, Thom D. Request fulfillment in office practice: antecedents and relationship to outcomes. J Gen Intern Med. 2002;40:38–51.

    Google Scholar 

  23. Kaplan S, Greenfield S, Ware J. Assessing the effects of physician–patient interactions on the outcomes of chronic disease. Med Care. 1989;27:S111–127.

    Google Scholar 

  24. Kinmonth A, Woodcock A, Griffin S, Spiegal N, Campbell M, on behalf of the Diabetes Care from Diagnosis Research Team. Randomised controlled trial of patient centred care of diabetes in general practice: impact on current well-being and future disease risk. BMJ. 1998;317:1202–8.

    PubMed  CAS  Google Scholar 

  25. Sanchez-Menegay C, Hudes E, Cummings S. Patient expectations and satisfaction with medical care for upper respiratory infections. J Gen Intern Med. 1992;7:432–4.

    Article  PubMed  CAS  Google Scholar 

  26. Junod Perron N, Secretan F, Vannotti M, Pecoud A, Favrat B. Patient expectations at a multicultural out-patient clinic in Switzerland. Fam Pract. 2003;20:428–33.

    Article  Google Scholar 

  27. Sánchez-Menegay C, Stalder H. Do physicians take into account patients’ expectations? J Gen Intern Med. 1994;9:404–6.

    Article  PubMed  Google Scholar 

  28. Cabré Vila J, Ortega Vila Y, Vila Córcoles A, Guillén López A, Checa Webber E, Farré Guasch J. ¿Qué espera el paciente de su médico de familia cuando acude habitualmente a su consulta? (What do patients expect from their family doctors when they go to their consultation on a regular basis?) Aten Primaria 1999;24:403–4.

    Google Scholar 

  29. Palacio Lapuente F, Marquet Palomer R, Oliver Esteve A, Castro Guardiola P, Bel Reverter M, Piñol Moreso J. Las expectativas de los pacientes: ¿qué aspectos valoran en un centro de salud? Un estudio cualicuantitativo. (Patients’ expectations: what aspects do they value in a health centre? A quali-quantitative study). Aten Primaria 2003;31:307–14.

    Article  PubMed  CAS  Google Scholar 

  30. Deveugele M, Derese A, van der Brink-Muinen A, Bensing J, De Maeseneer J. Consultation length in general practice: cross-sectional study in six European countries. BMJ. 2002;325:472–7.

    Article  PubMed  Google Scholar 

  31. Seguí Díaz M, Linares Pou L, Blanco López W, Ramos Aleixades J, Torrent Quetglás M. Tiempos durante la visita médica en atención primaria.(Length of medical visits in primary care) Aten Primaria 2004;33:496–502.

    Article  PubMed  Google Scholar 

  32. Ruiz Moral R, Rodríguez Salvador J, Pérula de Torres L, Prados Castillejo J. Evolución del perfil comunicacional de los médicos residentes de medicina de familia. (Evolution of the communicative profile of family medicine trainees) Aten Primaria 2002;29:132–44.

    PubMed  CAS  Google Scholar 

  33. Ruiz Moral R, Parras Rejano J, Alcalá Partera J, Castro Marín E, Pérula de Torres L. ¿Bienvenido y hasta luego u hola y adiós?: conductas comunicativas de los médicos residentes en los momentos iniciales y finales de las consultas. (Welcome and so long or hello and goodbye? Communicative behaviours of resident doctors at the beginning and end of consultations). Aten Primaria 2005;36:537–44.

    Article  PubMed  CAS  Google Scholar 

  34. Ruiz-Moral R, Perez Rodriguez E, Perula de Torres L, Torre de la Torre J. Physician–patient communication: a study on the observed behaviours of specialty physicians and the ways their patients perceive them. Patient Educ Couns 2006 doi:10.1016/j.pec.2006.02.010 (in press).

  35. Ruiz Moral R, Rodríguez Salvador J, Pérula de Torres L, Prados Castillejo J. Effectiveness of a clinical interviewing training program for family practice residents: a randomized controlled trial. Fam Med. 2003;35:489–95.

    Google Scholar 

  36. Levy-Storms L, Schnelle J, Simmons S. A comparison of methods to assess nursing home residents’ unmet needs. Gerontologist. 2002;42:454–61.

    PubMed  Google Scholar 

  37. Levy-Storms L, Simmons S, Gutierrez V, Miller-Martínez D, Hickey K, Schnelle J. A refined protocol for coding nursing home residents’ comments during satisfaction interviews. J Gerontol B Psychol Sci Soc Sci. 2005;60:S326–330.

    PubMed  Google Scholar 

  38. Webb S, Lloyd M. Prescribing and referral in general practice: a study of patients’ expectations and doctors’ actions. Br J Gen Pract. 1994;44:165–9.

    PubMed  CAS  Google Scholar 

  39. Cockburn J, Pit S. Prescribing behaviour in clinical practice: patients’ expectations and doctors’ perceptions of patients’ expectations—a questionnaire study. BMJ. 1997;315:520–3.

    PubMed  CAS  Google Scholar 

  40. Stewart M, Brown J, Donner A, et al. The impact of patient-centered care on outcomes. J Fam Pract. 2000;49(9):796–804.

    PubMed  CAS  Google Scholar 

  41. Little P, Everitt H, Williamson I, et al. Observational study on the effect of patient centeredness and positive approach on outcomes of general practice consultations. BMJ. 2001;323:908–11.

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgements

We thank Ronald Epstein (University of Rochester) for his helpful suggestions about the manuscript and Purificación Jiménez for her assistance with the English version. A part of this study (“Patient expectations with general practice visit and their relationship with visit outcomes”) was presented at the European Association of Communication & Health conference in Brugge (Belgium) in September, 2004.

Potential Financial Conflicts of Interest

None disclosed.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Roger Ruiz-Moral.

Additional information

This work has been funded by a grant from the Andalusian Health Service (Health Council of the Andalusian Autonomous Government) (exp 187/00) and Andalusian Society of Family and Community Medicine (SAMFYC).

Appendices

Appendix

SPPIC (scale on the patient’s perception of the interaction at the consultation)

figure a

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ruiz-Moral, R., Pérula de Torres, L. & Jaramillo-Martin, I. The Effect of Patients’ Met Expectations on Consultation Outcomes. A Study with Family Medicine Residents. J GEN INTERN MED 22, 86–91 (2007). https://doi.org/10.1007/s11606-007-0113-8

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11606-007-0113-8

Key words

Navigation