NEW YORK (Reuters) -- Nearly 20% of people surveyed claim their doctor does not fully meet their expectations regarding medical care, a new study shows.
The report published in the November 1 issue of the Annals of Internal Medicine specifies seven areas where expectations are most often unmet and recommends that doctors be more sensitive to what their patients may expect from them, even when that is not always made clear.
According to Dr. Richard Kravitz and his University of California co-authors, 125 of 688 HMO and private group practice patients reported "one or more omissions of care" by their internist.
These unmet expectations include the following categories and examples beginning with the percentage of patients who cited them:
23% -- physician preparation for the visit (failing to review chart before patient's arrival)
26% -- history taking (not asking about specific medical or lifestyle factors)
30% -- physical examination (not listening to the heart with a stethoscope)
28% -- diagnostic testing (omitting cholesterol level measurement)
19% -- prescription of medication (not prescribing pain killers)
26% -- referral to specialists (not recommending a consultation with a neurosurgeon)
15% -- information and counseling (not answering questions about prognosis).
The study also points out for the first time that patient expectations for health care are shaped by a variety of factors -- how ill a person thinks he or she is at the time; intensity of symptoms, including pain and disability; the perception of vulnerability to illness because of lifestyle or family history; and knowledge acquired from friends, family, other doctors and the media.
"By stripping away some of the mystique surrounding patients' expectations, we hope our study will enable physicians to refine their history-taking skills and priorities, to be sensitive to patient expectations even when these are not made explicit, and to reduce needless (doctor:patient) conflict," the authors stated.
They said their data also suggest that doctors are "one of the most powerful influences" on patients' expectations.
"Physicians can promote inappropriate expectations by prescribing marginally beneficial tests and therapies, couching clinical beliefs as medical dicta, and giving into inappropriate patient requests without discussion."
The authors recommended that doctors "share with patients some of medicine's inherent uncertainties" and engage them as partners in negotiating treatment.
SOURCE: Annals of Internal Medicine (1996;125 (9) 730-736)
