title: Pain, Functional Scores, and Radiographic Severity of Illness Influence the Perception of Time Spent With the Physician by Patients Presenting for Initial Evaluation of Knee Osteoarthritis.
abstract: BACKGROUND
  Patient satisfaction has become a significant factor in reimbursement schedules for physicians. A matter of debate is whether the patient's perception of time spent with the physician improves patient satisfaction. We sought to determine whether patient-physican time correlates with patient satisfaction and which factors are associated with patient perception of time.
  
  
  METHODS
  A total of 73 patients who presented for an initial evaluation of knee osteoarthritis were evaluated by the same orthopedic surgeon at an outpatient clinic in New Orleans, LA. Each encounter was timed with a stopwatch. After the physician encounter, patients were asked to fill out a questionnaire assessing their perception of time spent with the physician, subjective pain, satisfaction with the visit, and understanding of the diagnosis and treatment plan. Patients were also asked to complete 4 functionality surveys. Radiographs of the patients' knees were taken and quantified using Kellgren-Lawrence and Ahlbäck grading scales.
  
  
  RESULTS
  We noted no relationship between patient satisfaction and patients' perception of time spent with the physician. Patients perceived their time with the physician to be an average of 6.5 minutes more than the actual time. However, patients who reported higher subjective pain scores (>7 on a 10-point scale) misestimated their time with the physician by nearly 96%, while patients with lower subjective pain scores (<7 on a 10-point scale) misestimated their time with the physician by only 54% (P<0.007). We discovered similar findings in patients with worse Kellgren-Lawrence radiographic scores as well as worse Oxford Knee Scores and Knee injury and Osteoarthritis Outcome Scores. The actual time spent was not different among patients.
  
  
  CONCLUSIONS
  Patients with greater subjective pain and worse functional status and patients with worse radiographic severity of knee osteoarthritis perceived greater time spent with the physician. However, no relationship between these variables and patient satisfaction scores was seen.
authors.affiliation: Department of Surgery, University of Illinois at Chicago, Chicago, IL.
authors.forename: Ronak
authors.initials: R
authors.lastname: Kedia
authors.affiliation: Department of Pediatrics, Palmetto Health Children's Hospital, Columbia, SC.
authors.forename: Chandni
authors.initials: C
authors.lastname: Dargan
authors.affiliation: Chicago Medical School, Rosalind Franklin University of Medicine and Science, Chicago, IL.
authors.forename: Omar
authors.initials: O
authors.lastname: Hassan
authors.affiliation: Department of Orthopedic Surgery, Louisiana State University Health Sciences Center, New Orleans, LA.
authors.forename: Vinod
authors.initials: V
authors.lastname: Dasa
keywords: Communication; Patient Protection and Affordable Care Act; insurance–health; insurance–health–reimbursement; osteoarthritis–knee; patient satisfaction