Are patients more satisfied when they receive a prescription? The effect of patient expectations in general practice

Objective - To test the hypotheses that patient expectations are a driving force in drug prescribing and that fulfilment of expectations is followed by higher satisfaction. Design - Pre- and post-consultation survey of patients; parallel doctor survey (matched pairs). Setting - Primary health care in Gottingen, a town of about 130 000 inhabitants in Germany. Subjects - Ten general practitioners and 185 randomly addressed patients. Main outcome measures - Patient expectations with respect to the result of the consultation; doctor's perception of patient expectations; agreement between patient and doctor; patient satisfaction. Results - Nearly half of the patients (86/185) expected a drug prescription from their doctor; 68% (125/185) received a prescription, The doctors recognized the expectation of a prescription in only 40.7% of the patients. A high percentage (82.6%) of patients expecting a drug were issued a prescription. Nearly all the patients (45/48) who expected a drug according to their doctor's judgement left the surgery with a prescription, and 58.4% of the remaining patients were prescribed a drug. There was no difference in satisfaction scores between patients whose expectations were or were not fulfilled. Conclusion - These results are in some contrast to the main hypotheses. As fulfilment of expectations was not associated with higher satisfaction, physicians need not necessarily worry that patients will change their doctor if he or she refuses a pharmacologically dubious prescription.