Effects of physician awareness of symptom-related expectations and mental disorders. A controlled trial.
OBJECTIVE
To study whether physician awareness of symptom-related expectations and mental disorders reduces unmet expectations or improves patient satisfaction.


METHODS
Prospective, before-after trial, with control (n = 250) and intervention (n = 250) groups. Outcomes were assessed immediately after the index office visit, at 2 weeks, and at 3 months.


METHODS
Ambulatory walk-in clinic.


METHODS
Five hundred adults with physical complaints. Exclusion criteria included upper respiratory tract infection and dementia. Follow-up was accomplished in 100% immediately after the visit, 92.6% at 2 weeks, and 82.6% at 3 months.


METHODS
Two-hour physician workshop followed by information provided before each visit on patient expectations, illness worry, and Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) disorders.


METHODS
Symptom-related expectations, satisfaction with care, symptom improvement, functional status, physician-perceived difficulty of the encounter, visit costs, and use of health care services.


RESULTS
Serious illness worry (64%), 1 or more specific expectations (98%), or a DSM-IV disorder (29%) were commonly present in study patients. Intervention patients were less likely to report unmet expectations (odds ratio, 0.52; 95% confidence interval [CI], 0.43-0.97) immediately after the visit and at 2 weeks, less likely to be perceived as difficult by their physician (odds ratio, 0.49; 95% CI, 0.24-0.98), and more likely to be fully satisfied at 2 weeks (odds ratio, 1.63; 95% CI, 1.14-2.00). By 3 months, groups were similar in terms of satisfaction and residual expectations. Symptom improvement occurred in most patients by 2 weeks (70.5%) and 3 months (81.2%), regardless of study group. There was also no difference in patients' serious illness worry during the follow-up. The intervention did not increase visit costs or use of health care services.


CONCLUSIONS
Identifying symptom-related expectations and mental disorders in patients presenting with physical complaints may improve satisfaction with care at 2-week follow-up and physician-perceived difficulty of the encounter.
Jackson
J L
JL
Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Md., USA. jejackson@usuhs.mil
Kroenke
K
K
Chamberlin
J
J
D000553:Ambulatory Care; D001294:Attitude to Health; D001364:Awareness; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000523:psychology* / Q000628:therapy; D008875:Middle Aged; D016017:Odds Ratio; D017060:Patient Satisfaction; D010820:Physicians / Q000523:psychology*; D011446:Prospective Studies; D016896:Treatment Outcome