Although there has been an increased emphasis on patient-centered care, the proper use of health care resources may pose a particular challenge for physicians trying to meet patient expectations. Patients may request tests or medications of minimal benefit, and a patient-centered approach requires an understanding of the patient’s expectations for the physician visit and a negotiation regarding his or her requests. Peck and colleagues conducted a prospective study of the nature and prevalence of specific patient expectations for tests, referrals, and new medications at primary care visits; whether these expectations are met or unmet; and whether there is a correlation between met or unmet expectations and patient satisfaction.

Male patients were recruited at a primary care clinic over a six-month period. Patients were asked to indicate how necessary it was for the physician to provide or schedule items on a list of 12 services at that day’s appointment. If service was designated as “absolutely necessary” or “somewhat necessary” for the physician to provide, the patient questionnaire was coded to reflect an expectation for that service. Patients were then asked to specify what test, medication, or referral they expected to be provided by the physician at that visit. Investigators later determined whether the expected service was provided at the visit, and patient satisfaction was measured using the American Board of Internal Medicine Patient Satisfaction Questionnaire and a modified version of the Visit-specific Questionnaire.

Of the 401 patients approached for inclusion in the study, 253 completed the previsit and postvisit interviews. More than one half (56 percent) of the patients had at least one expectation for a test, referral, or new medication resulting from their visit. Thirty-one percent had only one expectation, whereas 25 percent had two or more expectations. Expectations were similar among patients with at least one expectation for a test (33 percent), a referral (28 percent), or a new medication (31 percent).

Requests for tests and referrals often were vague, relating to the patient’s presenting symptoms rather than for a specific test or subspecialist. Sixty percent of expectations for tests were met; 46 percent of expectations for referral were met. Patients identified 27 categories of new medications, with 18 percent of these expectations being for pain medication. Of these expectations, 56 percent were met.

Patient satisfaction was very high and was not related to expectation, even though one half of all patients who expected a test, referral, or new medication did not receive the service they expected. Patient satisfaction was related only to unmet expectations for new medications; high satisfaction was reported by 65 percent of patients who wanted and received a new medication, but by only 29 percent of patients who wanted a new medication and did not receive it.

The authors conclude that nonmedical services, such as counseling and patient education, may influence patient satisfaction more than tests or referrals do. In addition, the white, male demographic of this study typically has higher satisfaction rates. The authors noted that patient expectations were vague and heterogeneous.