Patient Expectations

Patient expectations reflect the hopes, wishes, or desires of patients concerning health care needs and services. They include expectations about the structure, process, and outcomes of health care. Structural expectations focus on both the physical facilities (location, ambience, amenities, and equipment) and personnel (numbers, types, and appearance). Expectations centering on processes of care include technical (information gathering, physical examination, testing, prescriptions and referrals) and interpersonal (physician–patient communication including information exchange and active listening) aspects of care. Outcome expectations include aspects of somatic and psychosocial results of care, both in the short and the long term.

Expectations vary widely from person to person and from society to society. These differences are based on sociodemographic and biopsychosocial features and on prior experiences with the health care system. For example, Americans have higher expectations for timeliness, involvement in health care decisions, and full recovery than do citizens of most other countries. Some of these expectations, especially those related to outcomes that are less under the control of health care providers, may be unrealistic.

The role of patient expectations in the health care system has increased dramatically in the past several years as patient autonomy and consumerism have supplanted paternalism as the main feature of the patient–provider interaction. Understanding patient expectations is important for several reasons. First, meeting patient expectations for care may be considered an intrinsic goal of medical care.

Expectations are also directly related to patient satisfaction; satisfaction may be viewed as the difference between what is expected and what is actually perceived. Patient satisfaction with care, in turn, is an important element in health care marketing as well as in assessing and determining quality of care. For example, high levels of satisfaction relate to greater levels of adherence with therapeutic plans, improved continuity of care, and fewer malpractice suits. Patient satisfaction also has a high correlation with quality of care as assessed by professionals, and studies have shown that patients can distinguish between the quality of the technical and interpersonal aspects of care.

Knowing an individual's personal expectations for care and for the outcome of care are critical in making clinical decisions in which personal preferences and values are important. This information can only come from the patients themselves. Including expectations and preferences in care planning is an intrinsic component of participatory decision making, a process in which the patient plays a major role, along with the clinician, in determining what course of treatment to pursue.

Patient expectations also provide guidance as to what health care services should be optimized to meet the patient's own desired outcomes. This includes decisions as to allocation of funds, designing delivery systems, and measuring quality of care.

Knowing and achieving patient expectations are also clearly important in a competitive health care market. Levels of satisfaction with providers, based on expectations, are a major determinant of staying or leaving providers and health care plans.