title: Do unmet expectations for specific tests, referrals, and new medications reduce patients' satisfaction?
abstract: BACKGROUND
  Patient-centered care requires clinicians to recognize and act on patients' expectations. However, relatively little is known about the specific expectations patients bring to the primary care visit.
  
  
  OBJECTIVE
  To describe the nature and prevalence of patients' specific expectations for tests, referrals, and new medications, and to examine the relationship between fulfillment of these expectations and patient satisfaction.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  VA general medicine clinic.
  
  
  METHODS
  Two hundred fifty-three adult male outpatients seeing their primary care provider for a scheduled visit.
  
  
  RESULTS
  Fifty-six percent of patients reported at least 1 expectation for a test, referral, or new medication. Thirty-one percent had 1 expectation, while 25% had 2 or more expectations. Expectations were evenly distributed among tests, referrals, and new medications (37%, 30%, and 33%, respectively). Half of the patients who expressed an expectation did not receive one or more of the desired tests, referrals, or new medications. Nevertheless, satisfaction was very high (median of 1.5 for visit-specific satisfaction on a 1 to 5 scale, with 1 representing "excellent"). Satisfaction was not related to whether expectations were met or unmet, except that patients who did not receive desired medications reported lower satisfaction.
  
  
  CONCLUSIONS
  Patients' expectations are varied and often vague. Clinicians trying to implement the values of patient-centered care must be prepared to elicit, identify, and address many expectations.
authors.affiliation: College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA. bmitchellpeck@tamu.edu
authors.forename: B Mitchell
authors.initials: BM
authors.lastname: Peck
authors.forename: Peter A
authors.initials: PA
authors.lastname: Ubel
authors.forename: Debra L
authors.initials: DL
authors.lastname: Roter
authors.forename: Susan Dorr
authors.initials: SD
authors.lastname: Goold
authors.forename: David A
authors.initials: DA
authors.lastname: Asch
authors.forename: Amy S
authors.initials: AS
authors.lastname: Jeffreys
authors.forename: Steven C
authors.initials: SC
authors.lastname: Grambow
authors.forename: James A
authors.initials: JA
authors.lastname: Tulsky
mesh_terms: D000368:Aged; D000554:Ambulatory Care Facilities; D003142:Communication; D011307:Drug Prescriptions; D006801:Humans; D007388:Internal Medicine; D008297:Male; D008875:Middle Aged; D009657:North Carolina; D010358:Patient Participation; D017060:Patient Satisfaction; D010817:Physician-Patient Relations; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care / Q000379:methods*; D011446:Prospective Studies; D012017:Referral and Consultation / Q000706:statistics & numerical data; D014728:Veterans / Q000523:psychology