PURPOSE We undertook a study to determine whether test-ordering strategy and other consultation-related factors infl uence satisfaction with and anxiety after a consultation among patients seeking care for unexplained complaints.METHODS A cluster-randomized clinical trial was conducted in family medicine practices in the Netherlands. Participants were 498 patients with unexplained complaints seen by 63 primary care physicians. Physicians either immediately ordered a blood test for patients or followed a 4-week watchful waiting approach. Physicians and patients completed questionnaires asking about their characteristics, satisfaction with care, and anxiety, and aspects of the consultation. The main outcomes were patient satisfaction and anxiety. Data were analyzed by multilevel logistic regression analysis.
RESULTSPatients were generally satisfi ed with their consultation and had moderately low anxiety afterward (mean scores on 11-point scales, 7.3 and 3.1, respectively), with no difference between the immediate testing and watchful waiting groups (χ 2 = 2.4 and 0.3, respectively). The factors associated with higher odds of satisfaction were mainly related to physician-patient communication: patients' satisfaction with their physician generally, feeling taken seriously, and knowing the seriousness of complaints afterward; physicians' discussing testing and not considering complaints bearable; and older physician age. The same was true for factors associated with higher odds of anxiety: patients expecting testing or referral, patients not knowing the seriousness of their complaints afterward, and physicians not seeing a cause for alarm.CONCLUSIONS Test-ordering strategy does not infl uence patients' satisfaction with and anxiety after a consultation. Instead, specifi c aspects of physicianpatient communication are important. Apparently, primary care physicians underestimate how much they can contribute to the well-being of their patients by discussing their worries.
INTRODUCTIONU nexplained complaints in primary care can be defi ned as those complaints for which a primary care physician, after clarifying the reason for the encounter, taking the patient's history, and performing a physical examination, is unable to establish a diagnosis.1 Unexplained complaints are rather prevalent, especially in family medicine; on average, 3% to 39% of consultations involve complaints considered to be unexplained by the primary care physician. [2][3][4][5] In many cases, blood tests are ordered for these patients. Since testing in such situations is often superfl uous from a diagnostic point of view, several strategies have been promoted to reduce the ordering of tests. [6][7][8] One of these strategies is to use a watchful waiting approach.
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WATCHFUL WA I T ING F OR UNE X PL A INED CO MPL A IN T SSo far, in the medical literature, this strategy has been used more in the treatment setting than in the diagnostic setting. [9][10][11] In the context of unexplained complaints, which are usually self-limiting, this appr...