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Concerns and Expectations in Patients Presenting With Physical Complaints:  Frequency, Physician Perceptions and Actions, and 2-Week Outcome

Richard L. Marple, MD, MPH; Kurt Kroenke, MD; Catherine R. Lucey, MD; Jay Wilder, MD; Christine A. Lucas, MPH
Arch Intern Med. 1997;157(13):1482-1488. doi:10.1001/archinte.1997.00440340122012.
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Background:  Specific concerns and expectations may be a key reason that people with common physical complaints seek health care for their symptoms.

Objectives:  To determine the frequency of symptomrelated patient concerns and expectations, physician perceptions and actions, and the relationship of these factors to patient satisfaction and symptom outcome.

Methods:  This was a prospective cohort study of 328 adult outpatients presenting for evaluation of a physical complaint. The setting was a general medicine clinic in a teaching hospital. Measures included previsit patient questionnaire to identify symptom-related concerns and expectations; a postvisit physician questionnaire to determine physician perceptions and actions; and a 2-week follow-up patient questionnaire to assess symptom outcome and satisfaction with care.

Results:  Pain of some type accounted for 55% of common symptoms, upper respiratory tract illnesses for 22%, and other physical complaints for 23%. Two thirds of patients were worried their symptom might represent a serious illness, 62% reported impairment in their usual activities, and 78%, 46%, and 41% hoped the physician would prescribe a medication, order a test, or provide a referral. Physicians often perceived symptoms as less serious or disabling and frequently did not order anticipated tests or referrals. While symptoms improved 78% of the time at 2-week follow-up, only 56% of patients were fully satisfied. Residual concerns and expectations were the strongest correlates of patient satisfaction.

Conclusions:  Improved recognition of symptom-related concerns and expectations might improve satisfaction with care in patients presenting with common physical complaints.Arch Intern Med. 1997;157:1482-1488

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