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July 14, 1997

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

Author Affiliations

From the Departments of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Md (Drs Marple and Kroenke and Ms Lucas), and Walter Reed Army Medical Center, Washington, DC (Drs Lucey and Wilder).

Arch Intern Med. 1997;157(13):1482-1488. doi:10.1001/archinte.1997.00440340122012

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