title: Unmet expectations in primary care and the agreement between doctor and patient: a questionnaire study.
abstract: BACKGROUND
  Questionnaires completed respectively by doctor and patient may give conflicting views of what actions the doctor took during a consultation in primary care. This disagreement will affect an assessment of whether patient expectations of care were met, and may itself be influenced by fulfillment of expectations.
  
  
  OBJECTIVE
  To investigate how patient expectations, and patient and doctor reports of doctor's actions in a primary care setting are associated.
  
  
  METHODS
  Questionnaire survey.
  
  
  METHODS
  Fifty Royal Navy, Army and Royal Air Force medical centres.
  
  
  METHODS
  A total of 117 members of the British Armed Forces with a health problem identified by a screening questionnaire, and their medical officers.
  
  
  METHODS
  Patient and doctor reports following a consultation indicating whether the doctor gave a prescription, made a referral or did tests, and patient expectations of these outcomes.
  
  
  RESULTS
  Agreement between patient and doctor (kappa) was 0.81 for prescribing, 0.69 for referral and 0.54 for tests. The prevalence of unmet expectations was higher when estimated from doctors' reports than from patients' reports (prescription P=0.016; referral P=0.065; tests P=0.092; difference of 6% in each case). Patient and doctor were more likely to disagree on what happened if the action reported by the doctor did not match the patient's expectations (all P<0.01, except for when doctor reported doing tests P=0.058).
  
  
  CONCLUSIONS
  Whether or not a doctor's actions appear to fulfil patient expectations in a primary care consultation depends on whether those actions are reported by the doctor or the patient.
authors.affiliation: Department of Public Health Sciences, Guy's, King's & St Thomas' School of Medicine, London, UK. richard.hooper@kcl.ac.uk
authors.forename: Richard
authors.initials: R
authors.lastname: Hooper
authors.forename: Roberto J
authors.initials: RJ
authors.lastname: Rona
authors.forename: Claire
authors.initials: C
authors.lastname: French
authors.forename: Margaret
authors.initials: M
authors.lastname: Jones
authors.forename: Simon
authors.initials: S
authors.lastname: Wessely
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D010817:Physician-Patient Relations; D011320:Primary Health Care / Q000458:organization & administration*; D012017:Referral and Consultation; D011795:Surveys and Questionnaires; D006113:United Kingdom