INTERNAL-MEDICINE PATIENTS EXPECTATIONS FOR CARE DURING OFFICE VISITS

Objective: To describe internal medicine patients' expectations for ca re during office visits and to examine the relationship between fulfil lment of expectations for care and visit satisfaction. Design: Survey of patients and their physicians. Setting: The internal medicine pract ice of faculty and housestaff at a large academic center in Southern C alifornia. 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 t hey thought necessary for their physicians to provide; the patients' a nd physicians' postvisit reports of the elements of care actually prov ided; and the patients' satisfaction with care. Results: Among 28 spec ific elements of care, seven were considered necessary by a majority o f the patients (examination of the eyes/ears/ nose/throat, lungs, hear t, and abdomen; blood testing; prognostic counseling; and discussion o f patients' own ideas about management). A higher number of elements o f care were thought necessary by patients who were nonwhite and had no t completed college; Up to 38% of the patients reported not receiving elements of care they had considered necessary; specific agreement bet ween physicians and patients about care not received ranged from 63% t o 100%. Not receiving certain ''necessary'' elements of care was assoc iated with lower visit satisfaction. Conclusion: Internal medicine pat ients at the center studied had specific expectations for the content of their physician visits. However, they routinely failed to receive s ome of the items they thought necessary. Unless patients' expectations are carefully elicited and dealt with, the physician-patient relation ship may be adversely affected.