BACKGROUND: Patient-centered care requires clinicians to recognize and act on patients’ expectations. However, relatively little is known
about the specific expectations patients bring to the primary care visit.
OBJECTIVE: To describe the nature and prevalence of patients’ specific expectations for tests, referrals, and new medications, and to
examine the relationship between fulfillment of these expectations and patient satisfaction.
DESIGN: Prospective cohort study.
SETTING: VA general medicine clinic.
PATIENTS/PARTICIPANTS: Two hundred fifty-three adult male outpatients seeing their primary care provider for a scheduled visit.
MEASUREMENTS AND MAIN RESULTS: Fifty-six percent of patients reported at least 1 expectation for a test, referral, or new medication. Thirty-one percent
had 1 expectation, while 25% had 2 or more expectations. Expectations were evenly distributed among tests, referrals, and
new medications (37%, 30%, and 33%, respectively). Half of the patients who expressed an expectation did not receive one or
more of the desired tests, referrals, or new medications. Nevertheless, satisfaction was very high (median of 1.5 for visit-specific
satisfaction on a 1 to 5 scale, with 1 representing “excellent”). Satisfaction was not related to whether expectations were
met or unmet, except that patients who did not receive desired medications reported lower satisfaction.
CONCLUSIONS: Patients’ expectations are varied and often vague. Clinicians trying to implement the values of patient-centered care must
be prepared to elicit, identify, and address many expectations.
Key words patient expectations - patient satisfaction - veterans
This material was based on work supported by the Office of Research and Development, Health Services Research and Development
Service, Department of Veterans Affairs (MPC 97-011). The views expressed in this article are those of the authors and do
not necessarily represent the views of the Department of Veterans Affairs.
We also ran analyses using a more narrow definition of expectations than the one described above. Only patients who responded
that it was “absolutely” necessary for the doctor to order a test, refer to a specialist, or prescribe a new medication were
defined as having these expectations for the visit. We used this narrower definition of expectations to determine whether
patients who expressed the highest desire for the service were less satisfied if they did not receive what they wanted. Results
were similar when we used a more inclusive definition of expectation. Therefore, we present only the results of expectations
defined by patients who responded “absolutely” or “somewhat necessary” for a service.