Communication About Symptoms in Primary Care: Impact on Patient Outcomes

BACKGROUND AND PURPOSE: Good communication is an integral part of a healing relationship. Our study's purpose was to explore the relationship between patient-doctor communication about physical symptoms and patient outcomes METHODS: Five hundred (500) consecutive adults presenting with physical symptoms were surveyed. Previsit surveys assessed for patient symptom characteristics, illness worry, stress, expectations, functional status (MOS SF-6), and mental disorders (PRIME-MD). Immediately postvisit, patients were asked about their satisfaction (Rand-9), the presence of unmet expectations, and what the clinicians did for them; clinicians were asked what they did for the patients and also completed a 10-item measure of how difficult the encounter was from their perspective (DDPRQ). At 2 weeks, patient surveys assessed symptom outcome, functional status (MOS SF6), and satisfaction. RESULTS: There was a high degree of agreement between clinician and patient reports about concrete actions during the encounter, such as prescription writing, diagnostic test ordering, or providing referrals. However, there was little agreement about whether clinicians discussed the symptom's diagnosis (k = 0.18) or prognosis (k = 0.27). Encounters in which patients' reported receiving such information were associated with greater satisfaction ( DIAGNOSIS: 2.1, 95% CI: 1.5-3.1; PROGNOSIS: 2.0, 95% CI: 1.4-2.9), fewer unmet expectations ( DIAGNOSIS: 0.41, 95% CI: 0.24-0.71; PROGNOSIS: 0.75, 95% CI: 0.52-0.98), less postvisit worry that their symptom( s) could be serious ( DIAGNOSIS: 0.41, 95% CI: 0.29-0.64; PROGNOSIS: 0.53, 95% CI: 0.36-0.79), and better 2-week symptom outcomes ( DIAGNOSIS: 1.7, 95% CI: 1.1-2.5; PROGNOSIS: 1.9, 95% CI: 1.3-3.0). CONCLUSIONS: Patients and clinicians disagreed about whether or not communication about symptom diagnosis and prognosis occurred during their encounter. Patient reports of receiving such information were associated with greater satisfaction, less worry, fewer unmet expectations, and better 2-week symptom outcomes.