Unmet expectations in primary care and the agreement between doctor and patient: a questionnaire study

Background Questionnaires completed respectively by doctor and patient may give conflicting views of what actions the doctor took during a consultation in primary care. This disagreement will affect an assessment of whether patient expectations of care were met, and may itself be influenced by fulfilment of expectations. Objective To investigate how patient expectations, and patient and doctor reports of doctor's actions in a primary care setting are associated. Design Questionnaire survey. Setting Fifty Royal Navy, Army and Royal Air Force medical centres. Participants A total of 117 members of the British Armed Forces with a health problem identified by a screening questionnaire, and their medical officers. Main outcome measures Patient and doctor reports following a consultation indicating whether the doctor gave a prescription, made a referral or did tests, and patient expectations of these outcomes. Results Agreement between patient and doctor (kappa) was 0.81 for prescribing, 0.69 for referral and 0.54 for tests. The prevalence of unmet expectations was higher when estimated from doctors' reports than from patients' reports (prescription P = 0.016; referral P = 0.065; tests P = 0.092; difference of 6% in each case). Patient and doctor were more likely to disagree on what happened if the action reported by the doctor did not match the patient's expectations (all P < 0.01, except for when doctor reported doing tests P = 0.058). Conclusion Whether or not a doctor's actions appear to fulfil patient expectations in a primary care consultation depends on whether those actions are reported by the doctor or the patient.