Concerns and expectations in patients presenting with physical complaints. Frequency, physician perceptions and actions, and 2-week outcome

Arch Intern Med. 1997 Jul 14;157(13):1482-8.


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 symptom-related 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.

MeSH terms

  • Activities of Daily Living
  • Adult
  • Aged
  • Diagnostic Tests, Routine
  • Drug Prescriptions
  • Female
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Office Visits*
  • Patient Satisfaction*
  • Prospective Studies
  • Referral and Consultation
  • Surveys and Questionnaires
  • Treatment Outcome