title: Communication about symptoms in primary care: impact on patient outcomes.
abstract: OBJECTIVE
  Good communication is an integral part of a healing relationship. Our study's purpose was to explore the relationship between patient-doctor communication about physical symptoms and patient outcomes
  
  
  METHODS
  Five hundred (500) consecutive adults presenting with physical symptoms were surveyed. Previsit surveys assessed for patient symptom characteristics, illness worry, stress, expectations, functional status (MOS SF-6), and mental disorders (PRIME-MD). Immediately postvisit, patients were asked about their satisfaction (Rand-9), the presence of unmet expectations, and what the clinicians did for them; clinicians were asked what they did for the patients and also completed a 10-item measure of how difficult the encounter was from their perspective (DDPRQ). At 2 weeks, patient surveys assessed symptom outcome, functional status (MOS SF6), and satisfaction.
  
  
  RESULTS
  There was a high degree of agreement between clinician and patient reports about concrete actions during the encounter, such as prescription writing, diagnostic test ordering, or providing referrals. However, there was little agreement about whether clinicians discussed the symptom's diagnosis (k = 0.18) or prognosis (k = 0.27). Encounters in which patients' reported receiving such information were associated with greater satisfaction (
  
  
  METHODS
  2.1, 95% CI: 1.5-3.1;
  
  
  CONCLUSIONS
  2.0, 95% CI: 1.4-2.9), fewer unmet expectations (
  
  
  METHODS
  0.41, 95% CI: 0.24-0.71;
  
  
  CONCLUSIONS
  0.75, 95% CI: 0.52-0.98), less postvisit worry that their symptom( s) could be serious (
  
  
  METHODS
  0.41, 95% CI: 0.29-0.64;
  
  
  CONCLUSIONS
  0.53, 95% CI: 0.36-0.79), and better 2-week symptom outcomes (
  
  
  METHODS
  1.7, 95% CI: 1.1-2.5;
  
  
  CONCLUSIONS
  1.9, 95% CI: 1.3-3.0).
  
  
  CONCLUSIONS
  Patients and clinicians disagreed about whether or not communication about symptom diagnosis and prognosis occurred during their encounter. Patient reports of receiving such information were associated with greater satisfaction, less worry, fewer unmet expectations, and better 2-week symptom outcomes.
authors.affiliation: Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA. jejackson@usuhs.mil
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Jackson
mesh_terms: D000328:Adult; D001007:Anxiety; D016001:Confidence Intervals; D005260:Female; D005639:Frustration; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D009819:Office Visits / Q000706:statistics & numerical data*; D017063:Outcome Assessment, Health Care; D010358:Patient Participation / Q000706:statistics & numerical data*; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D010817:Physician-Patient Relations; D011320:Primary Health Care / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires