Met or Matched Expectations
What accounts for a successful back
pain consultation in Primary Care?
Ehab Georgy
PG Researcher
Bournemouth University
United Kingdom
Prof. Eloise Carr
Deputy Dean, School of
Health & Social Care
Bournemouth University
Prof. Alan Breen
Professor, Musculoskeletal
Health Care, Anglo-European
College of Chiropractic
A presentation for the 3rd bi-annual conference of the
European Forum for Primary Care - Pisa, Italy 2010
Back Pain (BP)
 Affecting up to 2 in 3 of the adult population each year.
 One of the most common reasons for consulting a doctor.
 Main reason for hospitalisation and other care service utilisation.
 Bio-psychosocial management has been problematic; many doctors see
it as a difficult and unrewarding condition to deal with in Primary Care.
Medical Consultation
 The essence of BP care in Primary Care is the consultation.
 A process of negotiation between the patient and doctor.
 Geared towards information, advice or specific care.
 It serves three main functions: build a relationship, collect data and
agree on a management plan.
Expectations
 Prediction about specific events likely to happen during the
consultation.
 Patients & doctors seem to each have their own agenda of consultation.
(Malmivaara et al., 1995; Skelton et al., 1995; Maniadakis and Gray, 2000; Walker, 2000; Gask and Usherwood,
2002; Breen et al., 2007; Savigny et al., 2009).
Expectations:
why complex??
 Defined and conceptualised in various ways.
 No ideal method for measuring expectations.
 Expectations are influenced by:
• Culture and Background.
• Past experiences.
• Acquired knowledge.
• Perceived vulnerability to illness.
(Thompson and Sunol, 1995; Kravitz, 2001)
Patients and doctors appear to
have a specific agenda during
the consultation;
These agendas seem to have
different content and focus
and
there seems to be a mismatch
between patients and doctors
beliefs in regards to different
aspects of the consultation
(Ogden et al., 1997; Georgy et al., 2009)
Patients’ expectations
GP showing
interest and
listening
Information
Physical
examination
Education
and
stress
counselling
Sharing
problems and
doubts
Reassurance
and
advice
Doctors’ expectations
Accurate
diagnosis
Adequate
explanation
of the problem
Information
Prescribing
effective
treatment
Education
Avoid
unnecessary
referrals
or tests
(Kravitz et al., 1994; Sanchez-Menegay and Stalder, 1994; Turner et al., 1998; Tomlin et al., 1999; Verbeek et al., 2004;
Parsons et al., 2007; Ruiz-Moral et al., 2007).
Matched patient-doctor expectations: why important?
Patient-doctor agreement is of paramount importance and has
the potential to affect the consultation outcome in various ways:
higher
concordance
positive
perception of
improvement
greater adherence
better
to treatment communication
better general
health
outcomes
higher
satisfaction
(Starfield et al., 1981; Williams et al., 1995; Cedraschi et al., 1996; Liaw, Young and Farish, 1996; Fagerberg et
al., 1999; Maly et al., 2002; Kerse et al., 2004; Krupat et al., 2004; Azoulay et al., 2005; Staiger et al., 2005)
Research aim and Objectives
Main aim

to investigate the matching of patients’ and doctors’ expectations
related to BP consultation in Primary Care.
objectives

To explore patients’ and doctors’ BP specific expectations using a
structured questionnaire that was designed for the study.

To discern the matching of patients’ and doctors’ expectations
related to BP consultation in Primary Care.

To explore the perceived importance of matched expectations for
patients & doctors regarding specific aspects of consultation.
METHODS



A mixed methods sequential nested design.
11 Doctors and 57 Back Pain Patients.
Two parts:
1. Quantitative
part:
A
cross-sectional correlation approach.
 comparing each patient and his/her corresponding doctor.
 Patients & doctors completed the expectations questionnaire;
(a 21-item tool consisting of two matched parts: one for
patients and another -similar but adapted- for doctors.
 Main outcome measure was patients-doctor agreement.
2. Qualitative
part:
 Sub-sample
of the same group (nested)- 6 patients & 6 doctors.
 Recorded semi-structured telephone interviews.
 to explore their perceptions of the significance of matched
expectations for a successful BP consultation.
Findings- Questionnaire analysis
Highly expected
Less expected
Findings- Questionnaire analysis
*Low agreement
*Disagreement
*Moderate
agreement
*High
agreement
Findings- Telephone interviews
Perceived Importance of Matched Expectations
Better communication and interaction:
Mrs A (BP patient): “… obviously, if I feel I have agreed with my
doctor about most aspects during the consultation, for
example, explanation of the problem, the need for tests or
referral and about the treatment plan that can fit my life style,
then I feel I have had a positive experience and that I was able
to share my doubts and concerns with my doctor much better”.
Dr B (GP): “... if the doctor is hopefully on the same wavelength
of anticipation as the patient, the patient feels as if the doctor
has been listening and the consultation would be much more
valuable”.
Findings- Telephone interviews
Perceived Importance of Matched Expectations
Better compliance and adherence to treatment:
Mr C (patient): “Patient-doctor agreement is very important,
because if you feel that the doctor has been listening to you
and isn’t just treating you as a number and does know your
needs, then you are more likely to listen to what the doctor
says and take his advice”.
Dr D (GP): “… if the patient’s agenda is not revealed and if
the doctor is directing the consultation in a way that
patient's expectations are not explored, most probably, this
consultation will go wrong and the outcome will be
compromised, and this obviously will affect the compliance
and adherence to treatment and consequently the
satisfaction and possibly the symptom improvement”.
Met or Matched Expectations?
Met or Matched Model. Georgy EE, Carr ECJ and Breen AC (2010). In review; Health Expectations Journal
Key message
It is proposed that, for more successful
back pain consultation, it is important to:
o Elicit patients’ expectations during the
encounter.
o Address unmet expectations with
alternatives.
o Manage and negotiate inappropriate
expectations.
o Educate patients for well-formulated future
expectations.
o Match rather than just meet patients’
and doctors’ expectations.
Have a very enjoyable
and fruitful time in Pisa
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