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Effects of Physician Awareness of Symptom-Related Expectations and Mental Disorders
A Controlled Trial
Jeffrey L. Jackson, MD, MPH;
Kurt Kroenke, MD;
Judith Chamberlin, MPH
Arch Fam Med. 1999;8:135-142.
Objective To study whether physician awareness of symptom-related expectations and mental disorders reduces unmet expectations or improves patient satisfaction.
Design Prospective, before-after trial, with control (n=250) and intervention (n=250) groups. Outcomes were assessed immediately after the index office visit, at 2 weeks, and at 3 months.
Setting Ambulatory walk-in clinic.
Participants Five hundred adults with physical complaints. Exclusion criteria included upper respiratory tract infection and dementia. Follow-up was accomplished in 100% immediately after the visit, 92.6% at 2 weeks, and 82.6% at 3 months.
Interventions Two-hour physician workshop followed by information provided before each visit on patient expectations, illness worry, and Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) disorders.
Measurements Symptom-related expectations, satisfaction with care, symptom improvement, functional status, physician-perceived difficulty of the encounter, visit costs, and use of health care services.
Results Serious illness worry (64%), 1 or more specific expectations (98%), or a DSM-IV disorder (29%) were commonly present in study patients. Intervention patients were less likely to report unmet expectations (odds ratio, 0.52; 95% confidence interval [CI], 0.43-0.97) immediately after the visit and at 2 weeks, less likely to be perceived as difficult by their physician (odds ratio, 0.49; 95% CI, 0.24-0.98), and more likely to be fully satisfied at 2 weeks (odds ratio, 1.63; 95% CI, 1.14-2.00). By 3 months, groups were similar in terms of satisfaction and residual expectations. Symptom improvement occurred in most patients by 2 weeks (70.5%) and 3 months (81.2%), regardless of study group. There was also no difference in patients' serious illness worry during the follow-up. The intervention did not increase visit costs or use of health care services.
Conclusion Identifying symptom-related expectations and mental disorders in patients presenting with physical complaints may improve satisfaction with care at 2-week follow-up and physician-perceived difficulty of the encounter.
From the Departments of Medicine (Drs Jackson and Kroenke) and Preventive Medicine and Biometrics (Dr Chamberlin), Uniformed Services University of the Health Sciences, Bethesda, Md, and the Department of Medicine, Walter Reed Army Medical Center, Washington, DC (Dr Jackson). Dr Kroenke is now with the Regenstrief Institute for Health Care and Indiana University School of Medicine, Indianapolis.
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