Patient’s Expectation from a Doctor - Best, Fast, and at Low Cost

The expectations of patients in health care continue to increase, and managing these expectations effectively is essential to enhance satisfaction, improve outcomes and decrease liability.[1] Understanding the expectations of the patients and their families helps healthcare providers to align care with patient values, and this becomes even more challenging in an environment where there are many people seeking treatment, with cost and time being a major factor. Every patient who seeks medical consultation has expectations based on his understanding of the illness, its causation, cultural background, health beliefs, attitudes, and intelligence. Demographic and cultural factors also play a role. A fine balance should, therefore, be achieved between patient expectations, physicians’ perceptions, needs, and priorities of health care. How far the physician reaches an understanding with the patient will also have an impact on the successful outcome of the consultation.[2] The price healthcare providers and hospitals have to pay for dissatisfied patients and customers is high; hence, investment of time and energy to understand these issues makes a huge difference which is certainly worthwhile.[1] Some of the general expectations of patients include: To be listened to attentively To receive a clear explanation and instructions about their condition, prognosis, and treatment To be treated by staff who show care/concern/compassion To get a professional service. Some examples of unrealistic expectations of patients would include:[1] Expecting to discuss several major problems, all in one standard consultation, sometimes of family members too Wanting guaranteed treatment and quick results Prescription to be given without a consultation Expecting priority consultation and unwilling to wait for their turn Seeking access to the physician 24 h a day for any problem whatsoever Assuming that the physician will always know the exact diagnosis at the first consultation and initiate immediate treatment Expecting treatment without side effects of drugs or complications Discounts and free treatment. A study by Dormohammadi et al. collected data from 199 hospitalized and 201 ambulatory patients (response rates 88% and 93%, respectively). In both groups, the most important domain of expectations from doctors was “competency and quality of care,” followed by “availability” in hospitalized patients and “giving information and patient autonomy” among ambulatory patients.[3] The approach to patient-centered care can be divided into three broad areas:[1] Respect for patient values, preferences, and expressed needs: Many patients and their family members feel once under medical care decisions are taken by the treating team and their journey will be in unchartered territory. Coordination and integration of care: Patients feel vulnerable when ill, and they feel the need for competent and caring healthcare personnel. There is a need to make the “connection” and be comfortable with all aspects of the care – from acute care to support teams Information, communications, and education: All information must be shared with patients frankly and openly, including clinical, management plan, costs involved and even prognostic information. Problems arise when there could be changes midway in the course or during unexpected scenarios. Common expectations, such as wanting the best doctor, fast service, and at the lowest cost, can create hurdles in effective patient management. While taking prescription medications, patients expect medicines should be prescribed for the 1) shortest time possible 2) with the lowest strength 3) smallest size of the tablets 4) should taste good and 5) with no side effects. However, fulfilling all these expectations simultaneously is rarely possible. Healthcare delivery is a shared responsibility, and health services need to balance all the stakeholders. Coordination is the multiplier that transforms limited resources into effective health outcomes. Patients and physicians must have a relationship based on trust and connected by open communication, full access to information, and support. Emergency physicians in Hong Kong have come up with a list of 10 Cs, helpful and applicable for quality emergency care and risk management: competence, confidence, comfortable, careful attitude, compliance with protocols, checklists, courtesy, being calm and controlled, compassionate, and considerate, as well as timely and appropriate communication. These are the same values everyone strives for as healthcare professionals.[4] Especially, time is a major limiting factor in the effective implementation of these, which needs to be balanced with manpower and resources in the developing world. It has also been rightly pointed out in the patients satisfaction-related literatures, as well as the WHO responsiveness framework and other health service encounter frameworks that limited attention is paid to the various social, cultural, historical, and economic background which shape people's expectations of health care.[2] There is a need to have a better understanding and acknowledgement of patients’ expectations, which is the key to improving health professionals’ consultation skills, which will, in turn, lead to a satisfied client.