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Health Care Delivery

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Physician understanding of patient expectations is critical to patient satisfaction

Meeting patients' expectations for care produces greater care satisfaction, which in turn is related to greater adherence to medical advice, less "doctor shopping," and a lower tendency to sue for malpractice. Doctors can meet these expectations only if they first find out and understand what the patient expects of them and, in some cases, redirect misguided expectations, such as demands for inappropriate care.

One obstacle to progress in this area has been disagreement over the most appropriate methods for identifying, monitoring, and classifying patient expectations and requests. In a study supported in part by the Agency for Healthcare Research and Quality (HS09812), Richard L. Kravitz, M.D., M.S.P.H., of the University of California, Davis, reviews the conceptual relationships linking patients' expectations, requests, and satisfaction with care, as well as approaches to measuring these expectations and requests.

Dr. Kravitz points out that the clinical encounter is a negotiation between patient and physician. The negotiation will be easier if physicians remember that many patients are concerned that their symptoms represent a serious illness, and patients often have their own explanations for the symptoms. Various studies have found that some expectations are so prevalent (for example, expectations of physical examination and discussion of prognosis) that physicians should incorporate these elements into most symptom-focused office visits. Also, since patients' expectations are varied and can be specific, physicians should simply ask, "Is there anything in particular you were hoping I would do today?" Since many patients have residual unmet expectations, doctors should reserve time toward the end of the visit to ask, for example, "Is there anything we didn't get to or anything else you were hoping I would cover?" To facilitate research on patients' verbal requests to doctors, Dr. Kravitz developed a Taxonomy of Requests by Patients (TORP). An initial use of TORP suggests that it can be a useful tool for identifying the most common forms of patient requests and clarifying which communication strategies lead to the most successful doctor-patient negotiations.

See "Measuring patients' expectations and requests," by Dr. Kravitz, in the May 2001 Annals of Internal Medicine 134, pp. 881-888.

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