title: Symptoms as the main problem: a cross- sectional study of patient experience in primary care.
abstract: BACKGROUND
  Symptoms are common in primary care. Besides providing thorough assessment of possible severe disease, the general practitioner (GP) must ensure good health care to all patients, irrespective of diagnoses. We aimed to explore patient satisfaction with the provided care and how well expectations in patients were met when no diagnosis was made during the consultation.
  
  
  METHODS
  Cross-sectional study based on a questionnaire survey conducted in 2008-2009 among 377 GPs and their patients in the Central Denmark Region. A total of 2286 patients completed a questionnaire after the consultation (response rate: 54 %). The questionnaire included four satisfaction items from the EUROPEP instrument and a question about unmet expectations. For each patient, the GP answered a one-page registration form including information about the main problem in the consultation, chronic disorders and assessment of prognosis. Statistical analyses were adjusted for patient characteristics and GP clustering.
  
  
  RESULTS
  A higher proportion of patients reported illness worry (20 vs. 17 %, p-value: 0.005), unmet expectations (17 vs. 13 %, p-value: 0.019) and dissatisfaction with their GP after the consultation when no diagnosis was made. Dissatisfaction was primarily related to the medical examination (adjusted OR 1.30; 95 % CI: 1.06-1.60) and GP explanations (adjusted OR 1.40; 95 % CI: 1.14-1.71). Exploratory analyses revealed an association between dissatisfaction with examination and the GP assessment that symptoms were unrelated to biomedical disease. This association was found both in patients with 'symptoms only' and patients given a specific diagnosis.
  
  
  CONCLUSIONS
  GPs are challenged by patients presenting symptoms that do not fit the patterns of biomedical diagnoses. The current study demonstrates more illness worry, unmet expectations and dissatisfaction with the consultation in these patients compared to patients receiving a diagnosis. This trend is true for all patients assessed as having 'symptoms only' at the end of a consultation and not only for the minority group with 'medically unexplained symptoms'. As primary care is the frontline of the health-care system, symptoms are managed as the main problem in almost one in three consultations. It is about time that we take the same professional approach to symptoms as we have done for years to biomedical disease.
authors.affiliation: Department of Public Health, Research Unit for General Practice, Aarhus University, Bartholins Alle 2, DK-8000, Aarhus C, Denmark. mrosendal@health.sdu.dk.
authors.forename: Marianne
authors.initials: M
authors.lastname: Rosendal
authors.affiliation: Department of Public Health, Research Unit for General Practice, Aarhus University, Bartholins Alle 2, DK-8000, Aarhus C, Denmark.
authors.forename: Anders Helles
authors.initials: AH
authors.lastname: Carlsen
authors.affiliation: Department of Public Health, Research Unit for General Practice, Aarhus University, Bartholins Alle 2, DK-8000, Aarhus C, Denmark.
authors.forename: Mette Troellund
authors.initials: MT
authors.lastname: Rask
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D003718:Denmark; D005260:Female; D058006:General Practice / Q000379:methods / Q000592:standards*; D019538:Health Care Surveys; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D010808:Physical Examination / Q000592:standards; D010817:Physician-Patient Relations; D011320:Primary Health Care / Q000379:methods / Q000592:standards*; D063189:Symptom Assessment / Q000592:standards*; D055815:Young Adult
keywords: MESH: signs and symptoms, primary health care, general practice, cross-sectional, patient satisfaction, treatment outcome; NON-MESH: medically unexplained symptoms