 | Failure
to receive a back X-ray or other imaging procedure |
Incorrect
Most
individuals in the general population who experience common symptoms
do not seek care but rather use self-treatment and "tincture
of time" instead of visiting a physician. Probably 20% or
less of symptomatic individuals do seek care (Green
et al., 2001), and, surprisingly, this relates just as much
to symptom-specific expectations as it does to severity or duration
of the symptom itself (Jackson
and Kroenke, 2001).
Common expectations
are a desire for the physician to explain the symptom's likely
cause and expected prognosis as well as the belief that certain
physician actions may be necessary, such as prescribing a medication,
ordering a diagnostic test, or providing a referral to a medical
or surgical subspecialist.
Physicians
actually do better in eliciting, negotiating, and providing the
specific actions outlined above than they do in eliciting patient-specific
worries about the symptom and communicating diagnostic and prognostic
information. Failure in this patient-physician communication is
associated not only with lower satisfaction with care but also
reduced symptom alleviation at follow-up.
Two recommended
questions a clinician might ask to elicit unexpressed expectations
before ending the index visit with a symptomatic patient are:
"Was
there anything else you were . . .
- worried
about with respect to your symptom(s)?"
- thinking
might be helpful in terms of what I might do?"
Measuring
previsit expectations and postvisit residual expectations may
be useful in certain kinds of symptoms research since it has been
shown that unmet expectations are associated with a variety of
patient outcomes (Rao
et al., 2000).
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