The influence of patient-practitioner agreement on outcome of care.

Abstract

A previous study suggested that patientpractitioner agreement and follow-up in ambulatory care facilitates problem resolution as judged by patients. In this study in another medical practice, practitioner-patient agreement on what problems required follow-up was associated with greater problem resolution as judged by the practitioners regardless of the severity of the problems. In this study, patients did not judge problems mentioned only by themselves to be less improved than problems mentioned by both them and their practitioners. However, in this study more of the problems mentioned only by patients were mentioned in the note of the visit contained in the medicalThe initial process of care, recognition of patients' problems by practitioners, has received little attention in research although it is clear that all other processes (diagnosis, management, reassessment) depend upon adequate and accurate perception of the underlying reason for the visit. A growing literature, much of it from Great Britain,'-3 addresses this issue by analyzing the verbal interactions between doctors and patients and demonstrating patterns of communication that are intuitively considered dysfunctional. There also has been more systematic study of the gaps in recognition of patients' problems and of their impact on patient care. Accurate recognition of patients' problems is associated with better understanding on the part of patients,4'5 more compliance,6'7 and better outcomes.8'9 Practitioners do better at recognizing patients' problems when there is continuity of care.'0 Medical records specifically designed to improve information recognition also facilitate problem-recognition by practitioners. "-'3Roter showed that professional dominance of the practitioner-patient interaction could be reduced by encouraging patients to express their problems niore forcefully.'4 In a

Hospitalized Patients' Understanding of Their Plan of Care

“…[1][2][3][4] Experts have advocated for a shift in patient-physician relationships from a directive style to a more collaborative interaction. [19][20][21] This shared decision-making model elicits patient preferences and emphasizes the patient's understanding of the risks and benefits of diagnostic and therapeutic decisions, alternatives, and uncertainties.…”

“…Studies in ambulatory settings document that agreement between patients and physicians regarding the diagnosis and treatment plan is associated with improved medication adherence and better outcomes. [1][2][3][4] Hospital settings pre sent unique challenges to the patient-physician relationship, including the lack of a prior relationship, rapid pace of clinical care, and dynamic nature of inpatient medical teams. Prior studies revealed important findings about the relationship between hospitalized patients and health care professionals.…”

The doctor-patient relationship

“…Close the interview less critical than the perception by patients that they are the focus of the time and that they are accurately heard. Other aspects important to the relationship include eliciting patients' own explanations of their illness, 23,24 giving patients information, 25,26 and involving patients in developing a treatment plan. 27 (For an overview of this area of research, see Putnam and Lipkin, 1995.…”

Agreement between self-report and medical records on signs and symptoms of respiratory illness

“…6,7 Agreement between clinicians and patients regarding the assessment of presenting clinical symptoms is important for patient satisfaction [8][9][10][11][12] and symptom resolution. [13][14][15] In research, differences in estimations of the prevalence or incidence of symptoms that are dependent on data source can lead to substantial differences in estimated disease parameters. 16 An understanding of the relative agreement and disagreement between the occurrence of symptoms by self-report compared with medical records can be useful in the interpretation of the clinical and research literature.…”