Unsaid but not forgotten - Patients' unvoiced desires in office visits

Objectives: To examine patient, physician, and health care system character istics associated with unvoiced desires for action, as well as the conseque nces of these unspoken requests. Patients and Methods: Patient surveys were administered before, immediately after, and 2 weeks after outpatient visits in the practices of 45 family p ractice, internal medicine, and cardiology physicians working in a multispe cialty group practice or group model health maintenance organization. Data were collected at the index visit from 909 patients, of whom 97.6% were sur veyed 2 weeks after the outpatient visit. Before the visit, patients rated their trust in the physician, health concerns, and health status. After the visit, patients reported on various types of unexpressed desires and rated their visit satisfaction. At follow-up, patients rated their satisfaction, health concerns, and health status, and also described their postvisit hea lth care use. Evaluations of the visit were also obtained from physicians. Results: Approximately 9% of the patients had I or more unvoiced desire(s). Desires for referrals (16.5% of desiring patients) and physical therapy (8 .2%) were least likely to be communicated. Patients with unexpressed desire s tended to be young, undereducated, and unmarried and were less likely to trust their physician. Patients with unvoiced desires evaluated the physici an and visit less positively;, these encounters were evaluated by physician s as requiring more effort. Holding an unvoiced desire was associated with less symptom improvement, but did not affect postvisit health care use. Conclusions: Patients' unvoiced needs affect patients' and physicians' visi t evaluations and patients' subjective perceptions of improvement. Implicat ions of these findings for clinical practice are examined.