title: Concerns and expectations in patients presenting with physical complaints. Frequency, physician perceptions and actions, and 2-week outcome.
abstract: BACKGROUND
  Specific concerns and expectations may be a key reason that people with common physical complaints seek health care for their symptoms.
  
  
  OBJECTIVE
  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.
authors.affiliation: Department of Medicine, Uniformed Services, University of the Health Sciences, Bethesda, Md, USA.
authors.forename: R L
authors.initials: RL
authors.lastname: Marple
authors.forename: K
authors.initials: K
authors.lastname: Kroenke
authors.forename: C R
authors.initials: CR
authors.lastname: Lucey
authors.forename: J
authors.initials: J
authors.lastname: Wilder
authors.forename: C A
authors.initials: CA
authors.lastname: Lucas
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D003955:Diagnostic Tests, Routine; D011307:Drug Prescriptions; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009819:Office Visits; D017060:Patient Satisfaction; D011446:Prospective Studies; D012017:Referral and Consultation; D011795:Surveys and Questionnaires; D016896:Treatment Outcome